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Bouvet L, Fabre J, Roussin C, Nadal C, Dezavelle S, Vial F, Le Gouez A, Soued M, Keita H, Zein W, Desgranges FP, Thuet V, Boucekine M, Duclos G, Leone M, Zieleskiewicz L. Prevalence and factors associated with high-risk gastric contents in women admitted to the maternity unit for childbirth: a prospective multicentre cohort study. Br J Anaesth 2024; 132:553-561. [PMID: 38177007 DOI: 10.1016/j.bja.2023.11.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND This multicentre prospective observational study sought to determine the prevalence and the factors associated with high-risk gastric contents in women admitted to the maternity unit for childbirth, and to identify the clinical situations in which ultrasound assessment of gastric contents would be most helpful (i.e. when the prevalence of high-risk gastric contents is close to 50%). METHODS Ultrasound assessments of gastric contents were performed within the first hour after admission to the maternity unit. The prevalence of high-risk gastric contents was calculated and variables associated with high-risk gastric contents were identified using logistic regression analyses. RESULTS A total of 1003 parturients were analysed. The prevalence of high-risk gastric contents was 70% (379/544; 95% confidence interval: 66-74%) in women admitted in spontaneous labour and 65% (646/1003; 95% confidence interval: 61-67%) in the whole cohort. Lower gestational age, increased fasting duration for solids, and elective Caesarean delivery were independently associated with reduced likelihood of high-risk gastric contents. In women admitted in spontaneous labour and in the whole cohort, the prevalence of high-risk gastric contents ranged from 85% to 86% for fasting duration for solids <6 h, 63%-68% for fasting 6-8 h, 54%-55% for fasting 8-12 h, and 47%-51% for fasting ≥12 h. CONCLUSIONS Around two-thirds of parturients had high-risk gastric contents within the first hour after admission to the maternity unit. Our results suggest that gastric emptying for solids continues in labouring women, and that gastric ultrasound would be most helpful when fasting duration is ≥8 h.
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Affiliation(s)
- Lionel Bouvet
- Department of Anaesthesiology and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, Bron, France; Research Unit APCSe VetAgro Sup UP 2021.A101 - University of Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France.
| | - Juliette Fabre
- Department of Anaesthesiology and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, Bron, France
| | - Charlotte Roussin
- Department of Anaesthesiology and Intensive Care, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Camille Nadal
- Department of Anaesthesiology and Intensive Care, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Sylvain Dezavelle
- Department of Anaesthesiology and Intensive Care, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Florence Vial
- Department of Anaesthesiology and Intensive Care, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Agnès Le Gouez
- Department of Anaesthesiology and Intensive Care, Hôpital Antoine Béclère, Assistance Publique - Hôpitaux de Paris, Clamart, France
| | - Mickael Soued
- Department of Anaesthesiology and Intensive Care, Hôpital Antoine Béclère, Assistance Publique - Hôpitaux de Paris, Clamart, France
| | - Hawa Keita
- Department of Anaesthesiology and Intensive Care, Hôpital Necker Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Waed Zein
- Department of Anaesthesiology and Intensive Care, Hôpital Necker Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - François-Pierrick Desgranges
- Research Unit APCSe VetAgro Sup UP 2021.A101 - University of Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France; Department of Anaesthesiology and Intensive Care, L'Hôpital Nord-Ouest, Villefranche-sur-Saône, France
| | - Vincent Thuet
- Department of Anaesthesiology and Intensive Care, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Mohamed Boucekine
- Department of Biostatistics, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Gary Duclos
- Department of Anaesthesiology and Intensive Care, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Marc Leone
- Department of Anaesthesiology and Intensive Care, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Laurent Zieleskiewicz
- Department of Anaesthesiology and Intensive Care, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France
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Bagou G, Sentilhes L, Mercier FJ, Berveiller P, Blanc J, Cesareo E, Dewandre PY, Douai B, Gloaguen A, Gonzalez M, Le Conte P, Le Gouez A, Madar H, Maisonneuve E, Morau E, Rackelboom T, Rossignol M, Sibiude J, Vaux J, Vivanti A, Goddet S, Rozenberg P, Garnier M, Chauvin A. Guidelines for the management of urgent obstetric situations in emergency medicine, 2022. Anaesth Crit Care Pain Med 2022; 41:101127. [PMID: 35940033 DOI: 10.1016/j.accpm.2022.101127] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To provide recommendations on the management of urgent obstetrical emergencies outside the maternity ward. DESIGN A group of 24 experts from the French Society of Emergency Medicine (SFMU), the French Society of Anaesthesia and Intensive Care Medicine (SFAR) and the French College of Gynaecologists and Obstetricians (CNGOF) was convened. Potential conflicts of interest were formally declared at the outset of the guideline development process, which was conducted independently of industry funding. The authors followed the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method to assess the level of evidence in the literature. The potential drawbacks of strong recommendations in the presence of low-level evidence were highlighted. Some recommendations with an insufficient level of evidence were not graded. METHODS Eight areas were defined: imminent delivery, postpartum haemorrhage (prevention and management), threat of premature delivery, hypertensive disorders in pregnancy, trauma, imaging, cardiopulmonary arrest, and emergency obstetric training. For each field, the expert panel formulated questions according to the PICO model (population, intervention, comparison, outcomes) and an extensive literature search was conducted. Analysis of the literature and formulation of recommendations were conducted according to the GRADE method. RESULTS Fifteen recommendations on the management of obstetrical emergencies were issued by the SFMU/SFAR/CNGOF panel of experts, and 4 recommendations from formalised expert recommendations (RFE) established by the same societies were taken up to answer 4 PICO questions dealing with the pre-hospital context. After two rounds of voting and several amendments, strong agreement was reached for all the recommendations. For two questions (cardiopulmonary arrest and inter-hospital transfer), no recommendation could be made. CONCLUSIONS There was significant agreement among the experts on strong recommendations to improve practice in the management of urgent obstetric complications in emergency medicine.
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Affiliation(s)
- Gilles Bagou
- SAMU-SMUR of Lyon, University Hospital Edouard Herriot, Lyon, France.
| | - Loïc Sentilhes
- Gynaecology and Obstetrics Department, University Hospital Pellegrin, Bordeaux, France
| | - Frédéric J Mercier
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Antoine Béclère, Clamart, France
| | - Paul Berveiller
- Gynaecology and Obstetrics Department, CHI Poissy Saint-Germain, Poissy, France
| | - Julie Blanc
- Gynaecology and Obstetrics Department, University Hospital Hôpital Nord, Marseille, France
| | - Eric Cesareo
- SAMU-SMUR 69, University Hospital Hospices Civils de Lyon, Lyon, France
| | - Pierre-Yves Dewandre
- Department of Anaesthesiology and Critical Care Medicine, University hospital of Liège, Liège, Belgium
| | | | - Aurélie Gloaguen
- Emergency Department, Hospital William Morey, Chalon-sur-Saone, France
| | - Max Gonzalez
- Department of Anaesthesiology and Critical Care Medicine in Gynaecology and Obstetrics, University Hospital Jeanne de Flandre, Lille, France
| | | | - Agnès Le Gouez
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Antoine Béclère, Clamart, France
| | - Hugo Madar
- Gynaecology and Obstetrics Department, University Hospital Pellegrin, Bordeaux, France
| | | | - Estelle Morau
- Department of Anaesthesiology, Critical Care, Pain and Emergency, University hospital Carémeau, Nîmes, France
| | - Thibaut Rackelboom
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Pellegrin, Bordeaux, France
| | - Mathias Rossignol
- University Paris Cité - APHP Nord, Department of Anaesthesiology and Critical Care Medicine, University Hospital Lariboisière, Paris, France
| | - Jeanne Sibiude
- Gynaecology and Obstetrics Department, University Hospital Louis Mourier, Colombes, France
| | - Julien Vaux
- SMUR 94, University Hospital Henri Mondor, Créteil, France
| | - Alexandre Vivanti
- Gynaecology and Obstetrics Department, Antoine Béclère University Hospital, Clamart, France
| | - Sybille Goddet
- SAMU-SMUR 21 and Emergency Department, University Hospital of Dijon, Dijon, France
| | - Patrick Rozenberg
- Gynaecology and Obstetrics Department, CHI Poissy Saint-Germain, Poissy, France
| | - Marc Garnier
- Sorbonne University, GRC29, DMU DREAM, Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, Paris, France
| | - Anthony Chauvin
- SAMU-SMUR 75 and Emergency Department, Lariboisière University Hospital, Paris, France; Université de Paris, INSERM U942 MASCOT, Paris, France
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Morau E, Bouvet L, Dewandre PY, Vial F, Bonnin M, Chassard D, Julliac B, Bouthors AS, Bonnet MP, Fisher C, Gonzalez M, Keita H, Le Gouez A, Rackelboom T, Benhamou D, Mercier FJ. Covid-19, grossesse et anesthésie réanimation obstétricale : bilan et perspectives. Le Praticien en Anesthésie Réanimation 2022; 26:63-66. [PMID: 35125903 PMCID: PMC8808696 DOI: 10.1016/j.pratan.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Bonnet MP, Garnier M, Keita H, Compère V, Arthuis C, Raia-Barjat T, Berveiller P, Burey J, Bouvet L, Bruyère M, Castel A, Clouqueur E, Gonzalez Estevez M, Faitot V, Fischer C, Fuchs F, Lecarpentier E, Le Gouez A, Rigouzzo A, Rossignol M, Simon E, Vial F, Vivanti AJ, Zieleskiewicz L, Sénat MV, Schmitz T, Sentilhes L. [Reprint of: Severe pre-eclampsia: guidelines for clinical practice from the French Society of Anesthesiology and Intensive Care (SFAR) and the French College of Gynaecologists and Obstetricians (CNGOF)]. Gynecol Obstet Fertil Senol 2021:S2468-7189(21)00246-4. [PMID: 34772654 DOI: 10.1016/j.gofs.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Marie-Pierre Bonnet
- Sorbonne Université, GRC 29, DMU DREAM, Department of Anaesthesiology and Intensive Care, Armand Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Centre de Recherche épidémiologie et Statistiques Sorbonne Paris Cité (CRESS) U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France.
| | - Marc Garnier
- Sorbonne Université, APHP, GRC 29, DMU DREAM, Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, Paris, France
| | - Hawa Keita
- Université de Paris, Department of Anaesthesiology and Intensive Care, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Vincent Compère
- Department of Anaesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Chloé Arthuis
- Department of Obstetrics and Gynaecology, Nantes University Hospital, Mother and Child Hospital, Nantes, France
| | - Tiphaine Raia-Barjat
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, Saint Etienne University Hospital, Université de Saint Etienne Jean Monnet, INSERM, U 1059 SainBioSE, F-42023 Saint Etienne, France
| | - Paul Berveiller
- Department of Obstetrics and Gynaecology - Poissy Saint-Germain Hospital, Poissy, France; Université Paris-Saclay, UVSQ, INRAE, BREED, Jouy-en-Josas, France; Ecole Nationale Vétérinaire d'Alfort, BREED, Maison-Alfort, France
| | - Julien Burey
- Sorbonne Université, APHP, GRC 29, DMU DREAM, Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, Paris, France
| | - Lionel Bouvet
- Department of Anaesthesiology and Intensive Care, Mother and Child Hospital, Hospices Civils de Lyon, Bron, France; Université de Lyon, Claude Bernard Lyon 1, Villeurbanne, France
| | - Marie Bruyère
- Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, Le Kremlin- Bicêtre, France
| | - Adeline Castel
- Department of Anaesthesiology and Intensive Care, Paule de Viguier University Hospital, Toulouse, France
| | - Elodie Clouqueur
- Department of Obstetrics and Gynaecology, Tourcoing Hospital, France
| | - Max Gonzalez Estevez
- Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Jeanne de Flandre Maternity Hospital, Lille University Hospital, Lille, France
| | - Valentina Faitot
- Department of Anaesthesiology and Intensive Care, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - Catherine Fischer
- Department of Anaesthesiology and Intensive Care, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Florent Fuchs
- Department of Obstetrics and Gynaecology, Montpellier University Hospital, Arnaud de Villeneuve Hospital, Montpellier, France; Institut Desbrest d'Epidémiologie et de Santé Publique (IDESP), UMR INSERM - Université de Montpellier, Campus Santé, IURC, Montpellier, France
| | - Edouard Lecarpentier
- Department of Gynaecology, Obstetrics and Reproductive Medicine, Université de Paris Est Créteil, CHIC of Créteil, Créteil, France; INSERM U955 Institut Biomédical Henri Mondor, Créteil, France
| | - Agnès Le Gouez
- Department of Anaesthesiology and Intensive Care, Antoine Béclère Hospital, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Agnès Rigouzzo
- Sorbonne Université, GRC 29, DMU DREAM, Department of Anaesthesiology and Intensive Care, Armand Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mathias Rossignol
- Department of Anaesthesiology and Intensive Care and SMUR, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Emmanuel Simon
- Department of Gynaecology, Obstetrics and Reproductive Biology, Dijon Bourgogne University Hospital, France; UFR Sciences de santé Dijon, Université de Bourgogne, France
| | - Florence Vial
- Department of Anaesthesiology and Intensive Care, Nancy University Hospital, Nancy, France
| | - Alexandre J Vivanti
- Division of Obstetrics and Gynaecology, Antoine Béclère University Hospital, Université de Paris Saclay, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurent Zieleskiewicz
- Department of Anaesthesiology and Intensive Care, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Université de Aix Marseille, France; Centre for Cardiovascular and Nutrition Research (C2VN), INSERM, INRA, Université de Aix Marseille, Marseille, France
| | - Marie-Victoire Sénat
- Department of Gynaecology and Obstetrics, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University de Paris-Saclay, UVSQ, CESP, INSERM, Villejuif, France
| | - Thomas Schmitz
- Centre de Recherche épidémiologie et Statistiques Sorbonne Paris Cité (CRESS) U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France; Department of Gynaecology and Obstetrics, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Aliénor d'Aquitaine Maternity Hospital, Bordeaux University Hospital, Bordeaux, France
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Bonnet MP, Garnier M, Keita H, Compère V, Arthuis C, Raia-Barjat T, Berveiller P, Burey J, Bouvet L, Bruyère M, Castel A, Clouqueur E, Gonzalez Estevez M, Faitot V, Fischer C, Fuchs F, Lecarpentier E, Le Gouez A, Rigouzzo A, Rossignol M, Simon E, Vial F, Vivanti AJ, Zieleskiewicz L, Camilleri C, Sénat MV, Schmitz T, Sentilhes L. Guidelines for the management of women with severe pre-eclampsia. Anaesth Crit Care Pain Med 2021; 40:100901. [PMID: 34602381 DOI: 10.1016/j.accpm.2021.100901] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To provide national guidelines for the management of women with severe pre-eclampsia. DESIGN A consensus committee of 26 experts was formed. A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. METHODS The last SFAR and CNGOF guidelines on the management of women with severe pre-eclampsia were published in 2009. The literature is now sufficient for an update. The aim of this expert panel guidelines is to evaluate the impact of different aspects of the management of women with severe preeclampsia on maternal and neonatal morbidities separately. The experts studied questions within 7 domains. Each question was formulated according to the PICO (Patients Intervention Comparison Outcome) model and the evidence profiles were produced. An extensive literature review and recommendations were carried out and analysed according to the GRADE® methodology. RESULTS The SFAR/CNGOF experts panel provided 25 recommendations: 8 have a high level of evidence (GRADE 1+/-), 9 have a moderate level of evidence (GRADE 2+/-), and for 7 recommendations, the GRADE method could not be applied, resulting in expert opinions. No recommendation was provided for 3 questions. After one scoring round, strong agreement was reached between the experts for all the recommendations. CONCLUSIONS There was strong agreement among experts who made 25 recommendations to improve practices for the management of women with severe pre-eclampsia.
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Affiliation(s)
- Marie-Pierre Bonnet
- Sorbonne Université, GRC 29, DMU DREAM, Department of Anaesthesiology and Intensive Care, Armand Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Centre de Recherche Épidémiologie et Statistiques Sorbonne Paris Cité (CRESS) U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France.
| | - Marc Garnier
- Sorbonne Université, APHP, GRC 29, DMU DREAM, Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, Paris, France
| | - Hawa Keita
- Université de Paris, Department of Anaesthesiology and Intensive Care, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Vincent Compère
- Department of Anaesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Chloé Arthuis
- Department of Obstetrics and Gynaecology, Nantes University Hospital, Mother and Child Hospital, Nantes, France
| | - Tiphaine Raia-Barjat
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, Saint Etienne University Hospital, Université de Saint Etienne Jean Monnet, INSERM, U 1059 SainBioSE, F-42023 Saint Etienne, France
| | - Paul Berveiller
- Department of Obstetrics and Gynaecology - Poissy Saint-Germain Hospital, Poissy, France; Université Paris-Saclay, UVSQ, INRAE, BREED, Jouy-en-Josas, France; Ecole Nationale Vétérinaire d'Alfort, BREED, Maison-Alfort, France
| | - Julien Burey
- Sorbonne Université, APHP, GRC 29, DMU DREAM, Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, Paris, France
| | - Lionel Bouvet
- Department of Anaesthesiology and Intensive Care, Mother and Child Hospital, Hospices Civils de Lyon, Bron, France; Université de Lyon, Claude Bernard Lyon 1, Villeurbanne, France
| | - Marie Bruyère
- Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, Le Kremlin- Bicêtre, France
| | - Adeline Castel
- Department of Anaesthesiology and Intensive Care, Paule de Viguier University Hospital, Toulouse, France
| | - Elodie Clouqueur
- Department of Obstetrics and Gynaecology, Tourcoing Hospital, France
| | - Max Gonzalez Estevez
- Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Jeanne de Flandre Maternity Hospital, Lille University Hospital, Lille, France
| | - Valentina Faitot
- Department of Anaesthesiology and Intensive Care, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - Catherine Fischer
- Department of Anaesthesiology and Intensive Care, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Florent Fuchs
- Department of Obstetrics and Gynaecology, Montpellier University Hospital, Arnaud de Villeneuve Hospital, Montpellier, France; Institut Desbrest d'Epidémiologie et de Santé Publique (IDESP), UMR INSERM - Université de Montpellier, Campus Santé, IURC, Montpellier, France
| | - Edouard Lecarpentier
- Department of Gynaecology, Obstetrics and Reproductive Medicine, Université de Paris Est Créteil, CHIC of Créteil, Créteil, France; INSERM U955 Institut Biomédical Henri Mondor, Créteil, France
| | - Agnès Le Gouez
- Department of Anaesthesiology and Intensive Care, Antoine Béclère Hospital, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Agnès Rigouzzo
- Sorbonne Université, GRC 29, DMU DREAM, Department of Anaesthesiology and Intensive Care, Armand Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mathias Rossignol
- Department of Anaesthesiology and Intensive Care and SMUR, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Emmanuel Simon
- Department of Gynaecology, Obstetrics and Reproductive Biology, Dijon Bourgogne University Hospital, France; UFR Sciences de santé Dijon, Université de Bourgogne, France
| | - Florence Vial
- Department of Anaesthesiology and Intensive Care, Nancy University Hospital, Nancy, France
| | - Alexandre J Vivanti
- Division of Obstetrics and Gynaecology, Antoine Béclère University Hospital, Université de Paris Saclay, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurent Zieleskiewicz
- Department of Anaesthesiology and Intensive Care, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Université de Aix Marseille, France; Centre for Cardiovascular and Nutrition Research (C2VN), INSERM, INRA, Université de Aix Marseille, Marseille, France
| | - Céline Camilleri
- "Grossesse et Santé, Contre la Prééclampsie" Association, Paris, France
| | - Marie-Victoire Sénat
- Department of Gynaecology and Obstetrics, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University de Paris-Saclay, UVSQ, CESP, INSERM, Villejuif, France
| | - Thomas Schmitz
- Centre de Recherche Épidémiologie et Statistiques Sorbonne Paris Cité (CRESS) U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France; Department of Gynaecology and Obstetrics, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Aliénor d'Aquitaine Maternity Hospital, Bordeaux University Hospital, Bordeaux, France
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Keita H, James A, Bouvet L, Herrmann E, Le Gouez A, Mazoit JX, Mercier FJ, Benhamou D. Clinical, obstetrical and anaesthesia outcomes in pregnant women during the first COVID-19 surge in France: A prospective multicentre observational cohort study. Anaesth Crit Care Pain Med 2021; 40:100937. [PMID: 34391984 PMCID: PMC8359490 DOI: 10.1016/j.accpm.2021.100937] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/27/2021] [Accepted: 07/06/2021] [Indexed: 12/24/2022]
Abstract
Introduction Clinical outcomes and critical care utilisation associated with Coronavirus Disease 2019 (COVID-19) in obstetric patients remain limited particularly in relation to severe cases. Methods A retrospective multicentre cohort study was conducted during the first wave of COVID-19 in France in 18 tertiary referral maternity units. Consecutive women with confirmed or suspected COVID-19 during pregnancy or the delivery hospitalisation were included between March and July 2020 (17-week period). We report clinical, obstetrical and anaesthetic outcomes of pregnant women with COVID-19 and report the prevalence of severe forms and risk factors for respiratory support in this cohort. Results There were 126 included cases; RT-PCR testing occurred in 82 cases, of which 64 (78%) had a positive test. The caesarean section rate was 52%, and preterm delivery (< 37 weeks) rate was 40%. Neuraxial anaesthesia was performed in 108 (86%) cases with an increasing proportion compared to general anaesthesia over time (p < 0.0002). Twenty-eight cases received oxygen supplementation (nasal oxygen therapy or mechanical ventilation); the SOFAresp score was associated with gestational age at the time of COVID-19 presentation (p = 0.0036) and at delivery (p < 0.0001). Postpartum intensive care unit (ICU) admission occurred in 21 cases (17%) with 17 (13%) receiving invasive or non-invasive ventilation. Pre-delivery factors associated with postpartum ventilation were oxygen support, oxygen saturation and haemoglobin levels. Conclusion In our cohort, COVID-19 was associated with significant maternal morbidity resulting in high ICU admission rates (17%) and invasive or non-invasive ventilation utilisation (10%).
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Affiliation(s)
- Hawa Keita
- Assistance Publique des Hôpitaux Paris, Hôpital Necker-Enfants-Malades, Service d'Anesthésie-Réanimation, AP-HP, Centre - Université de Paris, Paris, France; Unité de Recherche EA 7323 Pharmacologie et Évaluation des Thérapeutiques Chez l'Enfant et la Femme Enceinte, Université de Paris, Paris, France.
| | - Arthur James
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière, Paris, France
| | - Lionel Bouvet
- Service d'Anesthésie-Réanimation, Hospices Civils de Lyon, Groupement Hospitalier Est, Hôpital Femme-Mère-Enfant, 59, Boulevard Pinel, 69500 Bron, France
| | - Emilie Herrmann
- Service d'Anesthésie Réanimation, Hôpital de Hautepierre, 1 Avenue Molière, 67200 Strasbourg, France
| | - Agnès Le Gouez
- Département d'Anesthésie-Réanimation, Hôpital Antoine-Béclère - APHP, Université Paris-Saclay, 157, rue de la Porte de Trivaux, 92140 Clamart, France
| | - Jean-Xavier Mazoit
- Département d'Anesthésie-Réanimation, Hôpital Bicêtre, Université Paris-Saclay, 48 rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France
| | - Frédéric-Jean Mercier
- Département d'Anesthésie-Réanimation, Hôpital Antoine-Béclère - APHP, Université Paris-Saclay, 157, rue de la Porte de Trivaux, 92140 Clamart, France
| | - Dan Benhamou
- Département d'Anesthésie-Réanimation, Hôpital Bicêtre, Université Paris-Saclay, 48 rue du Général Leclerc, 94275, Le Kremlin-Bicêtre, France
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Bonnet MP, Ayoub N, Le Gouez A, Mercier FJ. Vitamin C in severe preeclampsia: a promising therapeutic option against peripartum pulmonary oedema? Anaesth Crit Care Pain Med 2021; 40:100814. [PMID: 33582303 DOI: 10.1016/j.accpm.2021.100814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Marie-Pierre Bonnet
- Sorbonne Université, GRC 29, DMU DREAM, Service d'Anesthésie-Réanimation Hôpital Armand Trousseau, AP-HP Paris, France; Université de Paris, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004 Paris, France
| | - Nouhad Ayoub
- Département d'Anesthésie, Hôpital Antoine Béclère, APHP, Université Paris-Saclay, 157, rue de la Porte de Trivaux, 92140 Clamart, France
| | - Agnès Le Gouez
- Département d'Anesthésie, Hôpital Antoine Béclère, APHP, Université Paris-Saclay, 157, rue de la Porte de Trivaux, 92140 Clamart, France
| | - Frédéric J Mercier
- Département d'Anesthésie, Hôpital Antoine Béclère, APHP, Université Paris-Saclay, 157, rue de la Porte de Trivaux, 92140 Clamart, France.
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Soued M, Vivanti AJ, Smiljkovski D, Deffieux X, Benachi A, Le Gouez A, Mercier FJ. Efficacy of Intra-Uterine Tamponade Balloon in Post-Partum Hemorrhage after Cesarean Delivery: An Impact Study. J Clin Med 2020; 10:jcm10010081. [PMID: 33379355 PMCID: PMC7795364 DOI: 10.3390/jcm10010081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/20/2020] [Accepted: 12/23/2020] [Indexed: 11/16/2022] Open
Abstract
Invasive therapies (surgery or radiological embolization) are used to control severe post-partum hemorrhage. The intra-uterine tamponade balloon is a potential alternative, well documented after vaginal delivery. However, available data on its use after cesarean delivery remain scarce. This study assessed the efficacy of the intra-uterine tamponade balloon during post-partum hemorrhage in a cesarean delivery setting. Using a retrospective impact design, post-partum hemorrhage-related outcomes before (“pre-balloon” period) versus after implementation of intra-uterine tamponade balloon (“post-balloon” period) were compared. All women with post-partum hemorrhage requiring potent uterotonic treatment with prostaglandins after cesarean delivery over a 9-year period were eligible. The primary outcome was the rate of invasive procedure (conservative surgery, radiological embolization and/or hysterectomy). p < 0.05 was considered statistically significant. A total of 279 patients were included (140 vs. 139). Most baseline characteristics were comparable between the two studied periods. The success rate of the intra-uterine tamponade balloon was 82%, and no related complications occurred. Rates of invasive procedures and transfusion were significantly reduced (28.6% vs. 11.5%, p < 0.001 and 44.3% vs. 28.1%, p = 0.006 respectively) during the “post-balloon” period, and length of hospital stay was shorter (p < 0.001). Implementation of intra-uterine tamponade balloon during post-partum hemorrhage after cesarean delivery appears to be safe and effective, with a decrease in both invasive procedures and transfusion rates.
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Affiliation(s)
- Mickaël Soued
- Department of Anesthesia, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (D.S.); (A.L.G.); (F.J.M.)
- Correspondence:
| | - Alexandre J. Vivanti
- Department of Gynecology and Obstetrics, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (A.J.V.); (X.D.); (A.B.)
| | - Daniel Smiljkovski
- Department of Anesthesia, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (D.S.); (A.L.G.); (F.J.M.)
| | - Xavier Deffieux
- Department of Gynecology and Obstetrics, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (A.J.V.); (X.D.); (A.B.)
| | - Alexandra Benachi
- Department of Gynecology and Obstetrics, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (A.J.V.); (X.D.); (A.B.)
| | - Agnès Le Gouez
- Department of Anesthesia, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (D.S.); (A.L.G.); (F.J.M.)
| | - Frédéric J. Mercier
- Department of Anesthesia, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (D.S.); (A.L.G.); (F.J.M.)
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Vivanti AJ, Mattern J, Vauloup-Fellous C, Jani J, Rigonnot L, El Hachem L, Le Gouez A, Desconclois C, Ben M'Barek I, Sibiude J, Benachi A, Picone O, Cordier AG. Retrospective Description of Pregnant Women Infected with Severe Acute Respiratory Syndrome Coronavirus 2, France. Emerg Infect Dis 2020; 26:2069-2076. [PMID: 32633712 PMCID: PMC7454086 DOI: 10.3201/eid2609.202144] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Fix data are available on the management of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We conducted a retrospective study of 100 pregnant women with SARS-CoV-2 infection in 4 obstetric units in the Paris metropolitan area of France during March 12-April 13, 2020. Among patients, 52 (52%) were hospitalized, 10 (10%) in intensive care units (ICUs). Women with higher body mass indexes (BMIs; median 30.7 kg/m2) were more likely to be hospitalized in ICUs than other women (median BMI 26.2 kg/m2). Women hospitalized in ICUs had lower lymphocyte count at diagnosis (median 0.77 × 109 cells/L) than women not hospitalized in ICUs (median lymphocyte count 1.15 × 109 cells/L). All women requiring oxygen >5 L/min were intubated. Clinical and laboratory evaluation of SARS-CoV-2-positive pregnant women at the time of diagnosis can identify patients at risk for ICU hospitalization.
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Morau E, Bouvet L, Keita H, Vial F, Bonnet MP, Bonnin M, Le Gouez A, Chassard D, Mercier FJ, Benhamou D. Anaesthesia and intensive care in obstetrics during the COVID-19 pandemic. Anaesth Crit Care Pain Med 2020; 39:345-349. [PMID: 32405520 PMCID: PMC7219381 DOI: 10.1016/j.accpm.2020.05.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
MESH Headings
- Analgesia, Obstetrical/methods
- Anesthesia, Obstetrical/adverse effects
- Anesthesia, Obstetrical/methods
- Betacoronavirus
- COVID-19
- Cesarean Section
- Coronavirus Infections/prevention & control
- Coronavirus Infections/therapy
- Coronavirus Infections/transmission
- Critical Care/methods
- Cross Infection/prevention & control
- Cross Infection/transmission
- Delivery, Obstetric/methods
- Diagnostic Tests, Routine
- Disease Transmission, Infectious/prevention & control
- Doulas
- Female
- Fetal Monitoring
- Health Personnel/education
- Humans
- Infant, Newborn
- Infection Control/methods
- Infectious Disease Transmission, Patient-to-Professional/prevention & control
- Infectious Disease Transmission, Vertical/prevention & control
- Labor, Induced
- Occupational Diseases/prevention & control
- Pandemics/prevention & control
- Patient Care Team
- Personal Protective Equipment
- Pneumonia, Viral/prevention & control
- Pneumonia, Viral/therapy
- Pneumonia, Viral/transmission
- Pregnancy
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/therapy
- Pregnancy, High-Risk
- Prenatal Care/methods
- Respiratory Distress Syndrome/epidemiology
- Respiratory Distress Syndrome/therapy
- SARS-CoV-2
- Telemedicine
- Thrombophilia/drug therapy
- Thrombophilia/etiology
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Affiliation(s)
- Estelle Morau
- Department of Anaesthesia Intensive Care and Perioperative Medicine, CHU Nîmes, 4, rue du Professeur Rober-Debré, 30029 Nîmes, France.
| | - Lionel Bouvet
- Service d'Anesthésie Réanimation, Groupement Hospitalier Est, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Lyon, France
| | - Hawa Keita
- Assistance publique des Hôpitaux Paris, hôpital Necker-Enfants-Malades, service d'anesthésie-réanimation, AP-HP, Centre - Université de Paris, Paris, France; Unité de Recherche EA 7323 Pharmacologie et Evaluation des Thérapeutiques Chez l'Enfant et la Femme Enceinte, Université de Paris, Paris, France
| | - Florence Vial
- Department of Anaesthesia and Critical Care Medicine CHRU Nancy, Nancy, France
| | - Marie Pierre Bonnet
- Department of Anaesthesiology and Critical Care, Armand Trousseau Hospital, DMU DREAM, Assistance publique des Hôpitaux de Paris, Paris, France; Université de Paris, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France; Obstetrical Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Martine Bonnin
- Department of Anaesthesia and Critical Care Medicine, Pôle Anesthésie-Réanimation-Estaing, Clermont-Ferrand, France
| | - Agnès Le Gouez
- Department of Anaesthesia and Critical Care Medicine, Antoine Béclère Hospital, AP-HP, Université Paris-Saclay, Clamart, France
| | - Dominique Chassard
- Service d'Anesthésie Réanimation, Groupement Hospitalier Est, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Lyon, France
| | - Frédéric J Mercier
- Department of Anaesthesia and Critical Care Medicine, Antoine Béclère Hospital, AP-HP, Université Paris-Saclay, Clamart, France
| | - Dan Benhamou
- Service d'Anesthésie Réanimation Médecine Péri Opératoire, AP-HP, Université Paris Saclay, Hôpital Bicêtre, 78, rue du Général Leclerc, 94275 Le Kremlin Bicêtre Cedex, France
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Le Gouez A, Bonnet MP, Leclerc T, Mazoit JX, Benhamou D, Mercier FJ. Effective concentration of levobupivacaine and ropivacaine in 80% of patients receiving epidural analgesia (EC80) in the first stage of labour: A study using the Continual Reassessment Method. Anaesth Crit Care Pain Med 2017; 37:429-434. [PMID: 29294357 DOI: 10.1016/j.accpm.2017.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 12/05/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND A comparison of the effective dose in 50% of patients (ED50) has suggested that the potency of levobupivacaine lies between that of bupivacaine and ropivacaine. However, for clinical purposes, knowledge and use of doses close to the ED95 are more relevant. This study was designed to determine the EC80 (effective concentration) for both epidural levobupivacaine and ropivacaine using the Continual Reassessment Method (CRM) during obstetric analgesia. METHODS In this double-blind randomised study, term parturients were included by cohorts of 6 if cervical dilatation was≤5cm and visual analogue pain score (VAPS)>30mm. Efficacy was defined by a decrease of VAPS to a value≤10, thirty minutes after epidural injection of 20mL of levobupivacaine or ropivacaine. The first cohort received the lowest dose. Every next cohort received a dose according to the response's probability calculated using a Bayesian method, incorporating data from all consecutive previous patients. In addition, a logistic equation was fitted a posteriori to the whole data set to determine the whole dose-probability curve. RESULTS Fifty-four patients were enrolled. Levobupivacaine 0.17% and ropivacaine 0.2% gave probabilities of success of 82% and 72% respectively. By fitting the logistic model to the data, the concentration leading to a probability of 0.8 (EC80) was 0.14% for levobupivacaine and 0.24% for ropivacaine while the EC50 were 0.09% for levobupivacaine and 0.17% for ropivacaine, respectively. CONCLUSION This study suggests that epidural levobupivacaine used as the sole drug for labour analgesia has an EC80 lower than that of ropivacaine.
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Affiliation(s)
- Agnès Le Gouez
- Anaesthesia and critical care department, hôpital Antoine-Béclère, Assistance publique-Hôpitaux de Paris, 157, rue de la Porte-de-Trivaux, BP 405, 92141 Clamart, France.
| | - Marie-Pierre Bonnet
- Anaesthesia and critical care department, Cochin teaching hospital, groupement hospitalier universitaire Ouest, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France; Paris 05 René-Descartes University, 75006 Paris, France; Inserm, UMR S953, epidemiological research unit on perinatal health and women's and children's health, maternité Port Royal, Cochin teaching hospital, 75014 Paris, France; UMR S953, UPMC Paris 06 university, 75005 Paris, France
| | - Thomas Leclerc
- Anaesthesia and critical care department, Percy military teaching hospital, 92141 Clamart, France
| | - Jean-Xavier Mazoit
- Anaesthesia and critical care department, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, 94275 Le Kremlin-Bicêtre, France
| | - Dan Benhamou
- Anaesthesia and critical care department, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, 94275 Le Kremlin-Bicêtre, France
| | - Frédéric J Mercier
- Anaesthesia and critical care department, hôpital Antoine-Béclère, Assistance publique-Hôpitaux de Paris, 157, rue de la Porte-de-Trivaux, BP 405, 92141 Clamart, France
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