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Provendier A, Migliorelli F, Loussert L, Boileau BG, Vayssiere C, Hamdi SM, Hanaire H, Dupuis N, Guerby P. The sFLT-1/PlGF Ratio for the Prediction of Preeclampsia-Related Adverse Fetal and Maternal Outcomes in Women with Preexisting Diabetes. Reprod Sci 2024:10.1007/s43032-024-01540-9. [PMID: 38605263 DOI: 10.1007/s43032-024-01540-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
To evaluate the predictive value of the sFlt-1/PlGF ratio for the prediction of preeclampsia in women with preexisting diabetes mellitus. This is a monocentric retrospective observational study conducted between January 2018 and December 2020. All singleton pregnancies with preexisting diabetes mellitus, who had a dosage of the sFlt-1/PlGF ratio between 30 and 34 + 6 weeks of gestation were included. The principal outcome was preeclampsia. The secondary outcomes were preterm preeclampsia, gestational hypertension, placental abruption, intrauterine fetal death, IUGR, small for gestational age and a composite outcome named "hypertensive disorder of pregnancy" including gestational hypertension, preeclampsia and HELLP syndrome (hemolysis, elevated liver enzymes and low platelet count). Of 63 patients, 22% presented preeclampsia. The area under the curve of sFlt-1/PlGF ratio was 0.90 (95% CI: 0.79-0.96) for the prediction of preeclampsia. The receiver operator characteristic analysis suggested that the optimal sFlt-1/PlGF cutoff to predict preeclampsia was 29, with a sensitivity of 86% (95% CI: 60.1-96.0) and a specificity of 92% (95% CI: 80.8-96.8). A cut-off of 38 provided a sensitivity of 71% (95% CI: 45.4-88.3), a specificity of 92% (95% CI: 80.8-96.8). Further analysis using multivariable methods revealed nephropathy was significantly associated with PE (p = 0.014). The use of the sFlt-1/PlGF ratio during the third trimester of pregnancy seems to be of interest as a prognostic tool to improve multidisciplinary management of patients with preexisting diabetes mellitus.
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Affiliation(s)
- Anais Provendier
- Department of Obstetrics and Gynecology, Paule de Viguier maternity, CHU Toulouse, 330 avenue de Grande-Bretagne, 70034 31059, Toulouse, TSA, France
| | - Federico Migliorelli
- Department of Obstetrics and Gynecology, Paule de Viguier maternity, CHU Toulouse, 330 avenue de Grande-Bretagne, 70034 31059, Toulouse, TSA, France
| | - Lola Loussert
- Department of Obstetrics and Gynecology, Paule de Viguier maternity, CHU Toulouse, 330 avenue de Grande-Bretagne, 70034 31059, Toulouse, TSA, France
| | - Béatrice Guyard Boileau
- Department of Obstetrics and Gynecology, Paule de Viguier maternity, CHU Toulouse, 330 avenue de Grande-Bretagne, 70034 31059, Toulouse, TSA, France
| | - Christophe Vayssiere
- Department of Obstetrics and Gynecology, Paule de Viguier maternity, CHU Toulouse, 330 avenue de Grande-Bretagne, 70034 31059, Toulouse, TSA, France
| | - Safouane M Hamdi
- Department of Biochemistry and Hormonology, University Paul Sabatier, Toulouse, France
| | - Hélène Hanaire
- Department of Endocrinology and Diabetology, University Paul Sabatier, Toulouse, France
| | - Ninon Dupuis
- Department of Obstetrics and Gynecology, Paule de Viguier maternity, CHU Toulouse, 330 avenue de Grande-Bretagne, 70034 31059, Toulouse, TSA, France
| | - Paul Guerby
- Department of Obstetrics and Gynecology, Paule de Viguier maternity, CHU Toulouse, 330 avenue de Grande-Bretagne, 70034 31059, Toulouse, TSA, France.
- Toulouse Institute for Infectious and Inflammatory Diseases, Inserm UMR 1291 - CNRS UMR 5051- University Toulouse III, Toulouse, France.
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Patabendige M, Chan F, Vayssiere C, Ehlinger V, Van Gemund N, le Cessie S, Prager M, Marions L, Rozenberg P, Chevret S, Young DC, Le Roux PA, Gregson S, Waterstone M, Rolnik DL, Mol BW, Li W. Vaginal misoprostol versus vaginal dinoprostone for cervical ripening and induction of labour: An individual participant data meta-analysis of randomised controlled trials. BJOG 2024. [PMID: 38425020 DOI: 10.1111/1471-0528.17794] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Induction of labour (IOL) is common practice and different methods carry different effectiveness and safety profiles. OBJECTIVES To compare the effectiveness, and maternal and perinatal safety outcomes of IOL with vaginal misoprostol versus vaginal dinoprostone using individual participant data from randomised clinical trials. SEARCH STRATEGY The following databases were searched from inception to March 2023: CINAHL Plus, ClinicalTrials.gov, Cochrane Pregnancy and Childbirth Group Trial Register, Ovid Embase, Ovid Emcare, Ovid MEDLINE, Scopus and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). SELECTION CRITERIA Randomised controlled trials (RCTs), with viable singleton gestation, no language restrictions, and all published and unpublished data. DATA COLLECTION AND ANALYSIS An individual participant data meta-analysis was carried out. MAIN RESULTS Ten of 52 eligible trials provided individual participant data, of which two were excluded after checking data integrity. The remaining eight trials compared low-dose vaginal misoprostol versus dinoprostone, including 4180 women undergoing IOL, which represents 32.8% of all participants in the published RCTs. Of these, 2077 were assigned to low-dose vaginal misoprostol and 2103 were assigned to vaginal dinoprostone. Compared with vaginal dinoprostone, low-dose vaginal misoprostol had a comparable rate of vaginal birth. Composite adverse perinatal outcomes did not differ between the groups. Compared with vaginal dinoprostone, composite adverse maternal outcomes were significantly lower with low-dose vaginal misoprostol (aOR 0.80, 95% CI 0.65-0.98, P = 0.03, I2 = 0%). CONCLUSIONS Low-dose vaginal misoprostol and vaginal dinoprostone for IOL are comparable in terms of effectiveness and perinatal safety. However, low-dose vaginal misoprostol is likely to lead to a lower rate of composite adverse maternal outcomes than vaginal dinoprostone.
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Affiliation(s)
- Malitha Patabendige
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
- Ministry of Health, Colombo, Sri Lanka
- Monash Health - Casey Hospital, Berwick, Victoria, Australia
| | - Fei Chan
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
| | - Christophe Vayssiere
- Centre for Epidemiology and Research in Population Health (CERPOP), UMR1295, Toulouse University, Inserm, Paul Sabatier University, Toulouse, France
- Department of Obstetrics and Gynaecology, Paule de Viguier Hospital, Toulouse University Hospital, Toulouse, France
| | - Virginie Ehlinger
- Centre for Epidemiology and Research in Population Health (CERPOP), UMR1295, Toulouse University, Inserm, Paul Sabatier University, Toulouse, France
| | - Nicolette Van Gemund
- Department of Obstetrics and Gynaecology, Franciscus Gasthuis, Rotterdam, the Netherlands
| | - Saskia le Cessie
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
| | - Martina Prager
- Division of Obstetrics and Gynaecology, Department of Women's and Children's Health, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Lena Marions
- Division of Obstetrics and Gynaecology, Department of Women's and Children's Health, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Patrick Rozenberg
- Department of Gynaecology and Obstetrics, Poissy Hospital, University Paris V, Paris, France
| | - Sylvie Chevret
- Department of Biostatistics, Hopital Saint-Louis, University Paris VII, INSERM, Paris, France
| | - David C Young
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Paul A Le Roux
- Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa
| | - Sarah Gregson
- Maternity Unit, Queen Mary's Sidcup NHS Trust, Kent, UK
| | | | - Daniel L Rolnik
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
| | - Wentao Li
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
- National Perinatal Epidemiology and Statistics Unit (NPESU), Centre for Big Data Research in Health, and School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia
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Pasquier C, Raymond S, Duchanois D, Sauné K, Oliveira-Mendes K, Vayssiere C, Izopet J. Human papillomavirus testing using HPV APTIMA® assay and an external cellularity control in self-collected samples. J Med Virol 2023; 95:e29283. [PMID: 38088528 DOI: 10.1002/jmv.29283] [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: 07/19/2023] [Revised: 10/06/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023]
Abstract
In cervical cancer screening programs, the detection of high-risk human papillomavirus (HR-HPV) is now widely implemented on physician-collected samples and has expanded to include self-collected samples. The use of a cellularity control (CC) is needed to reduce false-negative HPV results. An external mRNA CC for the HPV APTIMA® assay was assessed for its analytical performance and the results were compared with both cervix cytobrush samples taken by physicians and self-collected vaginal samples from 148 women. The performance of the CC was adjusted to control for the presence of cellular mRNA in the ThinPrep® and Multitest® transport media. This CC is user-friendly but implies to perform two independent assays on PANTHER® automate. Self-collected vaginal sampling gives a lower median CC results (13.2 vs. 16.9 min) but a higher risk of negative CC results (3.3 vs. 0%). The usefulness of the CC for the HR-HPV assay may be optimized by the definition of a threshold for a minimum cell number to be tested to increase confidence in HPV-negative results. The systematic use of an RNA CC increases confidence for HPV RNA assays on self-collected vaginal samples.
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Affiliation(s)
| | - Stéphanie Raymond
- Department of Virology, Toulouse University Hospital, Toulouse, France
| | - Delphine Duchanois
- Research Unit in Obstetrics and Gynaecology (UROG), Toulouse University Hospital, Toulouse, France
| | - Karine Sauné
- Department of Virology, Toulouse University Hospital, Toulouse, France
| | | | - Christophe Vayssiere
- Research Unit in Obstetrics and Gynaecology (UROG), Toulouse University Hospital, Toulouse, France
| | - Jacques Izopet
- Department of Virology, Toulouse University Hospital, Toulouse, France
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Rozenberg P, Sentilhes L, Goffinet F, Vayssiere C, Senat MV, Haddad B, Morel O, Garabedian C, Vivanti A, Perrotin F, Kayem G, Azria E, Raynal P, Verspyck E, Sananes N, Gallot D, Bretelle F, Seco A, Winer N, Deneux-Tharaux C. Efficacy of early intrauterine balloon tamponade for immediate postpartum hemorrhage after vaginal delivery: a randomized clinical trial. Am J Obstet Gynecol 2023; 229:542.e1-542.e14. [PMID: 37209893 DOI: 10.1016/j.ajog.2023.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/29/2023] [Revised: 05/08/2023] [Accepted: 05/14/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Many questions remain about the appropriate use of intrauterine balloon devices in postpartum hemorrhage after vaginal delivery refractory to first-line uterotonics. Available data suggest that early use of intrauterine balloon tamponade might be beneficial. OBJECTIVE This study aimed to compare the effect of intrauterine balloon tamponade used in combination with second-line uterotonics vs intrauterine balloon tamponade used after the failure of second-line uterotonic treatment on the rate of severe postpartum hemorrhage in women with postpartum hemorrhage after vaginal delivery refractory to first-line uterotonics. STUDY DESIGN This multicenter, randomized, controlled, parallel-group, nonblinded trial was conducted at 18 hospitals and enrolled 403 women who had just given birth vaginally at 35 to 42 weeks of gestation. The inclusion criteria were a postpartum hemorrhage refractory to first-line uterotonics (oxytocin) and requiring a second-line uterotonic treatment with sulprostone (E1 prostaglandin). In the study group, the sulprostone infusion was combined with intrauterine tamponade by an ebb balloon performed within 15 minutes of randomization. In the control group, the sulprostone infusion was started alone within 15 minutes of randomization, and if bleeding persisted 30 minutes after the start of sulprostone infusion, intrauterine tamponade using the ebb balloon was performed. In both groups, if the bleeding persisted 30 minutes after the insertion of the balloon, an emergency radiological or surgical invasive procedure was performed. The primary outcome was the proportion of women who either received ≥3 units of packed red blood cells or had a calculated peripartum blood loss of >1000 mL. The prespecified secondary outcomes were the proportions of women who had a calculated blood loss of ≥1500 mL, any transfusion, an invasive procedure and women who were transferred to the intensive care unit. The analysis of the primary outcome with the triangular test was performed sequentially throughout the trial period. RESULTS At the eighth interim analysis, the independent data monitoring committee concluded that the incidence of the primary outcome did not differ between the 2 groups and stopped inclusions. After 11 women were excluded because they met an exclusion criterion or withdrew their consent, 199 and 193 women remained in the study and control groups, respectively, for the intention-to-treat analysis. The women's baseline characteristics were similar in both groups. Peripartum hematocrit level change, which was needed for the calculation of the primary outcome, was missing for 4 women in the study group and 2 women in the control group. The primary outcome occurred in 131 of 195 women (67.2%) in the study group and 142 of 191 women (74.3%) in the control group (risk ratio, 0.90; 95% confidence interval, 0.79-1.03). The groups did not differ substantially for rates of calculated peripartum blood loss pf ≥1500 mL, any transfusion, invasive procedure, and admission to an intensive care unit. Endometritis occurred in 5 women (2.7%) in the study group and none in the control group (P=.06). CONCLUSION The early use of intrauterine balloon tamponade did not reduce the incidence of severe postpartum hemorrhage compared with its use after the failure of second-line uterotonic treatment and before recourse to invasive procedures.
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Affiliation(s)
- Patrick Rozenberg
- Department of Obstetrics and Gynecology, American Hospital of Paris, Neuilly-sur-Seine, France; Université Paris-Saclay, UVSQ, Inserm, Equipe U1018, Epidémiologie clinique, CESP, Montigny-le-Bretonneux, France.
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - François Goffinet
- Department of Obstetrics and Gynecology, Hôpital Cochin-Port Royal, AP-HP, Paris, France
| | - Christophe Vayssiere
- Department of Obstetrics and Gynecology, Hôpital Paule de Viguier, CHU, Toulouse, France
| | - Marie-Victoire Senat
- Department of Obstetrics and Gynecology, Hôpital Bicêtre AP-HP, Le Kremlin-Bicêtre, France
| | - Bassam Haddad
- Department of Obstetrics and Gynecology, Hôpital Intercommunal de Créteil, Créteil, France
| | - Olivier Morel
- Department of Obstetrics and Gynecology, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Charles Garabedian
- Department of Obstetrics and Gynecology, Hôpital Jeanne de Flandre, Lille, France
| | - Alexandre Vivanti
- Department of Obstetrics and Gynecology, Hôpital Antoine-Béclère AP-HP, Clamart, France
| | - Franck Perrotin
- Department of Obstetrics and Gynecology, Hôpital Bretonneau, Tours, France
| | - Gilles Kayem
- Department of Obstetrics and Gynecology, Hôpital Armand Trousseau AP-HP, Paris, France
| | - Elie Azria
- Department of Obstetrics and Gynecology, Hôpital Saint Joseph, Paris, France
| | - Pierre Raynal
- Department of Obstetrics and Gynecology, Hôpital André Mignot, Le Chesnay-Rocquencourt, France
| | - Eric Verspyck
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Nicolas Sananes
- Department of Obstetrics and Gynecology, Centre Médico-Chirurgical et Obstétrical, Schiltigheim, France
| | - Denis Gallot
- Department of Obstetrics and Gynecology, CHU Clermont-Ferrand Site Estaing, Clermont Ferrand, France
| | - Florence Bretelle
- Department of Obstetrics and Gynecology, Hôpital Nord, Marseille, France
| | - Aurélien Seco
- Clinical Research Unit Necker Cochin, APHP, Paris, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, Hôpital Mère-Enfant, Nantes, France; NUN INRAE UMR 1280, PhAN Nantes University, Nantes, France
| | - Catherine Deneux-Tharaux
- Obstetrical Perinatal and Paediatric Epidemiology Research Team, Université de Paris Cité, CRESS, INSERM, INRA, Paris, France
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Thom EA, Saade GR, Askie LM, Ugwu LG, Mol BW, Vayssiere C, Norman JE, Pajkrt E, Clifton RG, Biggio JR, Arnaud C, Berghella V, Canino MG, Carreras E, Dugoff L, Hoffman MK, Pacagnella RC, Reddy UM, Saccone G, van ‘t Hooft J, Dang VQ. PROMPT: Prospective Meta-analysis for Pessary Trials Study Protocol. Am J Perinatol 2023:10.1055/s-0043-1771018. [PMID: 37429323 PMCID: PMC10776795 DOI: 10.1055/s-0043-1771018] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
OBJECTIVE Preterm birth, defined as birth before 37 weeks of gestation, is a leading cause of perinatal and infant mortality throughout the world. Preterm birth is also associated with long-term neurological disabilities and other significant health issues in children. A short cervix in the second trimester has been noted to be one of the strongest predictors of subsequent spontaneous preterm birth in both singleton and multiple pregnancies. Some studies have shown that cervical support in the form of an Arabin pessary lowers the risk of preterm birth in women with a singleton gestation and short cervical length; however, other studies have conflicting results. Our objective was to form an international collaborative of planned or ongoing randomized trials of pessary in singleton and twin gestations with a short cervix. STUDY DESIGN In November 2014, an international group of investigators, who had initiated or were planning randomized trials of pessary for pregnant people with a short cervix and singleton or twin gestation to prevent preterm birth, formed a collaboration to plan a prospective individual patient data (IPD) meta-analysis of randomized trials (PROspective Meta-analysis of Pessary Trials [PROMPT]). The PROMPT investigators agreed on meta-analysis IPD hypotheses for singletons and twins, eligibility criteria, and a set of core baseline and outcome measures. The primary outcome is a composite of fetal death or preterm delivery before 32 weeks' gestation. Secondary outcomes include maternal and neonatal morbidities. The PROMPT protocol may be viewed as a written agreement among the study investigators who make up the PROMPT consortium (PROSPERO ID# CRD42018067740). RESULTS Results will be published in phases as the individual participating studies are concluded and published. Results of the first phase of singleton and twin pessary trials are expected to be available in late 2022. Updates are planned as participating trials are completed and published. KEY POINTS · Short cervical length predicts preterm birth.. · Results of prior cervical pessary trials are mixed.. · Meta-analysis of pessary trials protocol..
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Affiliation(s)
- Elizabeth A. Thom
- The George Washington University Biostatistics Center, Washington, District of Columbia
| | - George R. Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Lisa M. Askie
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Lynda G. Ugwu
- The George Washington University Biostatistics Center, Washington, District of Columbia
| | - Ben W.J. Mol
- Department of Obstetrics and Gynecology, Monash University, Monash, Australia
| | - Christophe Vayssiere
- Department of Obstetrics and Gynecology, Toulouse III University, Toulouse, France
| | | | - Eva Pajkrt
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - Rebecca G. Clifton
- The George Washington University Biostatistics Center, Washington, District of Columbia
| | - Joseph R. Biggio
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Catherine Arnaud
- Department of Obstetrics and Gynecology, Toulouse III University, Toulouse, France
| | - Vincenzo Berghella
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania Am J Perinatol
| | - Maria G. Canino
- Department of Obstetrics and Gynaecology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Elena Carreras
- Department of Obstetrics and Gynaecology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Lorraine Dugoff
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew K. Hoffman
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Rodolfo C. Pacagnella
- Department of Obstetrics and Gynecology, State University of Campinas—UNICAMP, São Paulo, Brazil
| | - Uma M. Reddy
- Division of Extramural Research Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Gabriele Saccone
- Department of Obstetrics and Gynecology, University of Naples Federico II, Naples, Italy
| | - Janneke van ‘t Hooft
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - Vinh Q. Dang
- Department of Obstetrics and Gynecology, My Duc Hospital, Ho Chi Minh City, Viet Nam
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di Donato E, Guerby P, Guyard Boileau B, Vayssiere C, Allouche M. A nomogram to optimize the timing of antenatal corticosteroids in threatened preterm delivery. Am J Obstet Gynecol MFM 2023; 5:100955. [PMID: 37178718 DOI: 10.1016/j.ajogmf.2023.100955] [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: 03/16/2023] [Accepted: 03/30/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Recent observational studies reported a high rate of suboptimal use of antenatal corticosteroids (too anticipated or retrospectively not indicated) for women at risk of preterm delivery despite a recommended use within 7 days before delivery. OBJECTIVE This study aimed to elaborate a nomogram aiming at optimizing the timing of administration of antenatal corticosteroids in case of threatened preterm labor, asymptomatic short cervix, or uterine contractions. STUDY DESIGN This was an observational retrospective study conducted in a tertiary hospital. All women between 24 and 34 weeks of gestation who received corticosteroids during hospitalization for threatened preterm delivery, asymptomatic short cervix, or uterine contractions requiring tocolysis between 2015 and 2019 were included. Clinical, biological, and sonographic data of women were used to construct logistic regression models for predicting delivery within 7 days. The model was validated on an independent series of women hospitalized in 2020. RESULTS Among the 1343 women included in this study, the risk factors independently associated with a delivery within 7 days in multivariate analysis were vaginal bleeding (odds ratio, 14.47; 95% confidence interval, 7.81-26.81; P<.001); need for a second-line tocolysis, such as atosiban (odds ratio, 5.66; 95% confidence interval, 3.39-9.45; P<.001); C-reactive protein level (per 1 mg/L increase; odds ratio, 1.03; 95% confidence interval, 1.02-1.04; P<.001); cervical length (per 1 mm increase; odds ratio, 0.84; 95% confidence interval, 0.82-0.87; P<.001); uterine scar (odds ratio, 2.98; 95% confidence interval, 1.33-6.65; P=.008), and gestational age at admission (per week of amenorrhea increase; odds ratio, 1.10; 95% confidence interval, 1.00-1.20; P=.041). Based on these results, a nomogram was developed that, in retrospect, would have allowed physicians to avoid or delay antenatal corticosteroids in 57% of cases in our population. The discrimination of the predictive model was good when applied to the validation set of 232 women hospitalized in 2020. It would have enabled physicians to avoid or delay antenatal corticosteroids in 52% of cases. CONCLUSION This study developed a simple use, accurate prognostic score to identify women at risk of delivery within 7 days in cases of threatened preterm delivery, asymptomatic short cervix, or uterine contractions and thereby optimized the use of antenatal corticosteroids.
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Affiliation(s)
- Emmeline di Donato
- Department of Gynecology and Obstetrics, Paule De Viguier Hospital, Toulouse University Hospital, Toulouse, Toulouse, France.
| | - Paul Guerby
- Department of Gynecology and Obstetrics, Paule De Viguier Hospital, Toulouse University Hospital, Toulouse, Toulouse, France
| | - Béatrice Guyard Boileau
- Department of Gynecology and Obstetrics, Paule De Viguier Hospital, Toulouse University Hospital, Toulouse, Toulouse, France
| | - Christophe Vayssiere
- Department of Gynecology and Obstetrics, Paule De Viguier Hospital, Toulouse University Hospital, Toulouse, Toulouse, France
| | - Mickaël Allouche
- Department of Gynecology and Obstetrics, Paule De Viguier Hospital, Toulouse University Hospital, Toulouse, Toulouse, France
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7
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Loussert L, Berveiller P, Magadoux A, Allouche M, Vayssiere C, Garabedian C, Guerby P. Association between marked fetal heart rate variability and neonatal acidosis: A prospective cohort study. BJOG 2023; 130:407-414. [PMID: 36398385 PMCID: PMC10108100 DOI: 10.1111/1471-0528.17345] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 07/03/2022] [Revised: 10/08/2022] [Accepted: 10/17/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the association between marked variability in fetal heart rate (FHR) and neonatal acidosis. DESIGN Bicentric prospective cohort study. SETTING From January 2019 to December 2019, in two French tertiary care maternity units. POPULATION Women in labour at ≥37 weeks of gestation, with continuous FHR monitoring until delivery and with the availability of umbilical arterial pH. Women with intrauterine fetal death or medical termination, multiple pregnancies, non-cephalic presentation or planned caesarean delivery were excluded. METHODS The exposure was marked variability in FHR in the 60 minutes before delivery, defined as a variability greater than 25 beats per minute, with a minimum duration of 1 minute. To assess the association between marked variability and neonatal acidosis, we used multivariable modified Poisson regression modelling. We then conducted subgroup analyses according to the US National Institute of Child Health and Human Development (NICHD) category of the associated fetal heart rate. MAIN OUTCOME MEASURES Neonatal acidosis, defined as an umbilical artery pH of ≤7.10. RESULTS Among the 4394 women included, 177 (4%) had marked variability in fetal heart rate in the 60 minutes before delivery. Acidosis occurred in 6.0% (265/4394) of the neonates. In the multivariable analysis, marked variability was significantly associated with neonatal acidosis (aRR 2.30, 95% CI 1.53-3.44). In subgroup analyses, the association between marked variability and neonatal acidosis remained significant in NICHD category-I and category-II groups. CONCLUSIONS Marked variability was associated with a twofold increased risk of neonatal acidosis.
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Affiliation(s)
- Lola Loussert
- Department of Obstetrics and Gynecology, CHU Toulouse, Toulouse, France
| | - Paul Berveiller
- Department of Obstetrics and Gynecology, CHI Poissy, Paris, France
| | - Alexia Magadoux
- Department of Obstetrics and Gynecology, CHI Poissy, Paris, France
| | - Michael Allouche
- Department of Obstetrics and Gynecology, CHU Toulouse, Toulouse, France
| | - Christophe Vayssiere
- Department of Obstetrics and Gynecology, CHU Toulouse, Toulouse, France.,CERPOP, UMR 1295, Team SPHERE (Study of Perinatal, Pediatric and Adolescent Health: Epidemiological Research and Evaluation) Toulouse III University, Toulouse, France
| | | | - Paul Guerby
- Department of Obstetrics and Gynecology, CHU Toulouse, Toulouse, France.,Toulouse Institute for Infectious and Inflammatory Diseases, Inserm UMR 1291 - CNRS UMR 5051, University Toulouse III, Toulouse, France
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8
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Ego A, Monier I, Vilotitch A, Kayem G, Vayssiere C, Verspyck E, Zeitlin J. Serial plotting of symphysis-fundal height and estimated fetal weight to improve the antenatal detection of infants small for gestational age: A cluster randomised trial. BJOG 2023; 130:729-739. [PMID: 36655486 DOI: 10.1111/1471-0528.17399] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/09/2022] [Accepted: 11/21/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To assess whether standardised longitudinal reporting of growth monitoring information improves antenatal detection of infants who are small for gestational age (SGA), compared with usual care. DESIGN Cluster-randomised controlled trial. SETTING Sixteen French level-3 units in 2018-2019. POPULATION Singleton pregnancies. METHODS The intervention consisted of the serial plotting of symphysis-fundal height (SFH) and estimated fetal weight (EFW) measurements on customised growth charts using a software program, compared with standard antenatal care. We estimated relative risks (RR) adjusted for known risk factors for fetal growth restriction (FGR). MAIN OUTCOME MEASURES The primary outcome was antenatal detection of FGR among SGA births (with birthweights below the tenth centile of French customised curves), defined as the mention of suspected FGR in medical records and either referral ultrasounds for growth monitoring or indicated delivery for FGR. Secondary outcomes were false-positive rates, mode of delivery, perinatal morbidity and mortality, and number of antenatal visits and ultrasounds. RESULTS In total, seven intervention clusters (n = 4349) and eight control clusters (n = 4943) were analysed, after the exclusion of one intervention centre for a major deviation in protocol. SGA births represented 613 (14.1%) and 626 (12.7%) of all births, respectively. The rates of antenatal detection of FGR among SGA births were 40.0% in the intervention arm versus 37.1% in the control arm (crude RR 1.08, 95% CI 0.87-1.34; adj RR 1.09, 95% CI 0.88-1.35). No benefits of the intervention were detected in the analyses of secondary outcomes. CONCLUSIONS Serial plotting of SFH and EFW measurements on customised growth charts did not improve the antenatal detection of FGR among SGA births.
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Affiliation(s)
- Anne Ego
- CNRS, TIMC UMR5525, MESP, Univ. Grenoble Alpes, Department of Public Health, CHU Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, Inserm CIC1406, CHU Grenoble Alpes, Grenoble, France
| | - Isabelle Monier
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Institut national de la santé et de la recherche médicale (INSERM), Institut national de la recherche agronomique (INRA), Paris, France.,Department of Obstetrics and Gynecology, Antoine Béclère Hospital, AP-HP, Paris Saclay University, Clamart, France
| | - Antoine Vilotitch
- Univ. Grenoble Alpes, Inserm CIC1406, CHU Grenoble Alpes, Grenoble, France
| | - Gilles Kayem
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Institut national de la santé et de la recherche médicale (INSERM), Institut national de la recherche agronomique (INRA), Paris, France.,Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP, FHU PREMA, Sorbonne University, Paris, France
| | - Christophe Vayssiere
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France.,UMR1295 CERPOP (Centre for Epidemiology and Population Health Research), Team SPHERE (Study of Perinatal, Paediatric and Adolescent Health: Epidemiological Research and Evaluation), Toulouse III University, Toulouse, France
| | - Eric Verspyck
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France
| | - Jennifer Zeitlin
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Institut national de la santé et de la recherche médicale (INSERM), Institut national de la recherche agronomique (INRA), Paris, France
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9
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Loussert L, Mol BW, Vayssiere C. Letter to the editor in response to “Therapeutic role of enoxaparin in intra-uterine growth restriction: A randomized clinical trial”. J Gynecol Obstet Hum Reprod 2022; 51:102448. [DOI: 10.1016/j.jogoh.2022.102448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022]
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10
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Diguisto C, Le Gouge A, Marchand MS, Megier P, Ville Y, Haddad G, Winer N, Arthuis C, Doret M, Debarge VH, Flandrin A, Delmas HL, Gallot D, Mares P, Vayssiere C, Sentilhes L, Cheve MT, Paumier A, Durin L, Schaub B, Equy V, Giraudeau B, Perrotin F. Low-dose aspirin to prevent preeclampsia and growth restriction in nulliparous women identified by uterine artery Doppler as at high risk of preeclampsia: A double blinded randomized placebo-controlled trial. PLoS One 2022; 17:e0275129. [PMID: 36260615 PMCID: PMC9581352 DOI: 10.1371/journal.pone.0275129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/08/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION This trial evaluates whether daily low-dose aspirin initiated before 16 weeks of gestation can reduce preeclampsia and fetal growth restriction in nulliparous women identified by first-trimester uterine artery Dopplers as at high risk of preeclampsia. METHODS This randomized, blinded, placebo-controlled, parallel-group trial took place in 17 French obstetric departments providing antenatal care. Pregnant nulliparous women aged ≥ 18 years with a singleton pregnancy at a gestational age < 16 weeks of gestation with a lowest pulsatility index ≥ 1.7 or a bilateral protodiastolic notching for both uterine arteries on an ultrasound performed between 11+0 and 13+6 weeks by a certified sonographer were randomized at a 1:1 ratio to 160 mg of low-dose aspirin or to placebo to be taken daily from inclusion to their 34th week of gestation. The main outcome was preeclampsia or a birthweight ≤ 5th percentile. Other outcomes included preeclampsia, severe preeclampsia, preterm preeclampsia, preterm delivery before 34 weeks, mode of delivery, type of anesthesia, birthweight ≤ 5th percentile and perinatal death. RESULTS The trial was interrupted due to recruiting difficulties. Between June 2012 and June 2016, 1104 women were randomized, two withdrew consent, and two had terminations of pregnancies. Preeclampsia or a birthweight ≤ 5th percentile occurred in 88 (16.0%) women in the low-dose aspirin group and in 79 (14.4%) in the placebo group (proportion difference 1.6 [-2.6; 5.9] p = 0.45). The two groups did not differ significantly for the secondary outcomes. CONCLUSION Low-dose aspirin was not associated with a lower rate of either preeclampsia or birthweight ≤ 5th percentile in women identified by their first-trimester uterine artery Doppler as at high risk of preeclampsia. TRIAL REGISTRATION (NCT0172946).
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Affiliation(s)
- Caroline Diguisto
- Pôle de Gynécologie Obstétrique, Médecine Fœtale, Médecine et Biologie de la Reproduction, Centre Olympe de Gouges, CHRU de Tours, Tours, France
- Université de Tours, Tours, France
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE,F, Paris, France
- * E-mail:
| | | | | | - Pascal Megier
- Department of Gynaecology and Obstetrics, Centre Hospitalier Régional d’Orléans, Orleans, France
| | - Yves Ville
- Centre de Dépistage PRIMA FACIE Université de Paris, Paris, France
- Maternité, AP-HP, Hôpital Necker, Paris, France
| | - Georges Haddad
- Cabinet Mosaïque Santé, La Chaussée Saint Victor, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, University Hospital of Nantes, Nantes, NUN, INRAE, UMR 1280, PhAN, Université de Nantes, Nantes, France
| | - Chloé Arthuis
- Department of Obstetrics and Gynecology, University Hospital of Nantes, Nantes, NUN, INRAE, UMR 1280, PhAN, Université de Nantes, Nantes, France
| | - Muriel Doret
- Service de Gynécologie-Obstétrique, HFME, Hospices Civils de Lyon, Lyon, France
| | - Veronique Houfflin Debarge
- Department of Obstetrics, CHU Lille, Univ. Lille, ULR 2694—METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Anaig Flandrin
- Service de Gynécologie-Obstétrique, Hôpital Arnaud de Villeneuve, CHRU de Montpellier, Montpellier, France
| | - Hélène Laurichesse Delmas
- Service de Gynécologie-Obstétrique, Hôpital d’Estaing, CHU de Clermont-Ferrand, Maternité Clermont Ferrand, Clermont-Ferrand, France
| | - Denis Gallot
- Service de Gynécologie-Obstétrique, Hôpital d’Estaing, CHU de Clermont-Ferrand, Maternité Clermont Ferrand, Clermont-Ferrand, France
| | - Pierre Mares
- Département de Gynécologie Obstétrique, Centre Hospitalo-Universitaire Caremeau, Nîmes, France
- École de Maïeutique, Université de Montpellier, Site de Nîmes, Nîmes, France
| | - Christophe Vayssiere
- Department of Obstetrics and Gynaecology, Paule de Viguier Hospital, Toulouse University Hospital Center, Toulouse, France
- Centre for Epidemiology and Population Health Research, Team SPHERE, Toulouse III University, Toulouse, France
| | - Loïc Sentilhes
- Service de Gynécologie-Obstétrique, Groupe Hospitalier Pellegrin, CHRU de Bordeaux, Talence, France
| | | | - Anne Paumier
- Service de Gynécologie-Obstétrique, Polyclinique de l’Atlantique, Saint-Herblain, France
| | - Luc Durin
- Service de Gynécologie-Obstétrique, Polyclinique du Parc, Caen, France
| | - Bruno Schaub
- Service de Gynécologie-Obstétrique, Maison de la Femme, de la Mère et de l’Enfant, CHU Martinique, Fort-de-France, Martinique, France
| | - Veronique Equy
- Service de Gynécologie-Obstétrique, Hôpital Couple Enfant, CHRU de Grenoble, La Tronche, France
| | - Bruno Giraudeau
- Université de Tours, Tours, France
- INSERM CIC1415, CHRU de Tours, Tours, France
| | - Franck Perrotin
- Pôle de Gynécologie Obstétrique, Médecine Fœtale, Médecine et Biologie de la Reproduction, Centre Olympe de Gouges, CHRU de Tours, Tours, France
- Université de Tours, Tours, France
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11
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Verspyck E, Gascoin G, Senat MV, Ego A, Simon L, Guellec I, Monier I, Zeitlin J, Subtil D, Vayssiere C. [Ante- and postnatal growth charts in France - guidelines for clinical practice from the Collège national des gynécologues et obstétriciens français (CNGOF) and from the Société française de néonatologie (SFN)]. Gynecol Obstet Fertil Senol 2022; 50:570-584. [PMID: 35781088 DOI: 10.1016/j.gofs.2022.06.008] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To recommend the most appropriate biometric charts for the detection of antenatal growth abnormalities and postnatal growth surveillance. METHODS Elaboration of specific questions and selection of experts by the organizing committee to answer these questions; analysis of the literature by experts and drafting conclusions by assigning a recommendation (strong or weak) and a quality of evidence (high, moderate, low, very low) and for each question; all these recommendations have been subject to multidisciplinary external review (obstetrician gynecologists, pediatricians). The objective for the reviewers was to verify the completeness of the literature review, to verify the levels of evidence established and the consistency and applicability of the resulting recommendations. The overall review of the literature, quality of evidence and recommendations were revised to take into consideration comments from external reviewers. RESULTS Antenatally, it is recommended to use all WHO fetal growth charts for EFW and common ultrasound biometric measurements (strong recommendation; low quality of evidence). Indeed, in comparison with other prescriptive curves and descriptive curves, the WHO prescriptive charts show better performance for the screening of SGA (Small for Gestational Age) and LGA (Large for Gestational Age) with adequate proportions of fetuses screened at extreme percentiles in the French population. It also has the advantages of having EFW charts by sex and biometric parameters obtained from the same perspective cohort of women screened by qualified sonographers who measured the biometric parameters according to international standards. Postnatally, it is recommended to use the updated Fenton charts for the assessment of birth measurements and for growth monitoring in preterm infants (strong recommendation; moderate quality of evidence) and for the assessment of birth measurements in term newborn (expert opinion). CONCLUSION It is recommended to use WHO fetal growth charts for antenatal growth monitoring and Fenton charts for the newborn.
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Affiliation(s)
- E Verspyck
- Service de gynécologie-obstétrique, CHU de Rouen, université de Rouen, Rouen, France.
| | - G Gascoin
- Service de néonatologie, CHU de Toulouse, université de Toulouse, hôpital des enfants, Toulouse, France
| | - M-V Senat
- Service de gynécologie-obstétrique, CHU du Kremlin-Bicêtre, université du Kremlin-Bicêtre, Le Kremlin-Bicêtre, France
| | - A Ego
- Pôle santé publique, CHU de Grenoble-Alpes, Grenoble, France
| | - L Simon
- Service de néonatologie, CHU de Nantes, université de Nantes, Nantes, France
| | - I Guellec
- Service de néonatologie, CHU de Nice, université de Nice, Nice, France
| | - I Monier
- Inserm UMR1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), CRESS, Sorbonne Paris-Cité, Paris, France; Service de gynécologie-obstétrique, université Paris Saclay, hôpital Antoine-Béclère, AP-HP, Clamart, France
| | - J Zeitlin
- Inserm UMR1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), CRESS, Sorbonne Paris-Cité, Paris, France
| | - D Subtil
- Service de gynécologie-obstétrique, CHU de Lille, université de Lille, Lille, France
| | - C Vayssiere
- Service de gynécologie-obstétrique, CHU de Toulouse, hôpital Paule-de-Viguier, Toulouse, France; Team SPHERE (Study of Perinatal, pediatric and adolescent Health: Epidemiological Research and Evaluation), CERPOP, UMR 1295, Toulouse III University, Toulouse, France
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12
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Offringa Y, Paret L, Vayssiere C, Parant O, Loussert L, Guerby P. Second stage cesarean section and the risk of preterm birth in subsequent pregnancies. Int J Gynaecol Obstet 2022; 159:783-789. [PMID: 35307823 DOI: 10.1002/ijgo.14186] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 01/07/2022] [Revised: 02/17/2022] [Accepted: 03/17/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate the risk of spontaneous preterm birth on subsequent pregnancies after second stage cesarean section. METHODS This is a retrospective cohort study. Women were included if they had their two consecutive births in Toulouse University Hospital in the study period. The first birth was a singleton livebirth at term (≥37 weeks of gestation), divided in three categories according to the mode of delivery: vaginal delivery (group A), cesarean section before the second stage of labor (group B), cesarean section during the second stage of labor (group C). The subsequent pregnancy was the first subsequent pregnancy, conducted after 16 weeks of gestation. The primary outcome was spontaneous preterm birth in the subsequent pregnancy, defined as delivery before 37 weeks of gestation. Secondary endpoints included preterm rupture of membranes in the subsequent pregnancy. RESULTS Between 2003 and 2018, 7776 women (84.7%) in group A, 1263 (13.8%) in group B and 143 (1.5%) in group C were included. The adjusted odds ratio of spontaneous preterm birth before 37 weeks of gestation after second stage cesarean section was 2.4 (group C vs group A + B, 95% confidence interval: 1.2-4.8), P = 0.01). The rate of preterm rupture of membranes was also significantly higher in group C (6% vs 2% in group A, P = 0.009, 6% vs 3% in group B, P= 0.05) with OR = 3.0 (group C vs group A + B, 95% CI: 1.55-6.16, P < 0.001). CONCLUSION History of term second stage of labor cesarean section is an independent risk factor for spontaneous preterm birth and for preterm rupture of membrane in the subsequent pregnancy.
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Affiliation(s)
- Yvonne Offringa
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France
| | - Louise Paret
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France
| | - Christophe Vayssiere
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France.,Inserm UMR1295 CERPOP (Center for Research in Epidemiology and POPulation Health), Team SPHERE, University Toulouse III, Toulouse, France
| | - Olivier Parant
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France
| | - Lola Loussert
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France
| | - Paul Guerby
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France.,Infinity CNRS Inserm UMR 1291, University Toulouse III, Toulouse, France
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13
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Laine K, Yli BM, Cole V, Schwarz C, Kwee A, Ayres-de-Campos D, Vayssiere C, Roth E, Gliozheni E, Savochkina Y, Ivanisevic M, Kalis V, Timonen S, Verspyck E, Anstaklis P, Beke A, Eriksen BH, Santo S, Kavsek G, Duvekot H, Dadak C. European guidelines on perinatal care- Peripartum care Episiotomy. J Matern Fetal Neonatal Med 2021; 35:8797-8802. [PMID: 34895000 DOI: 10.1080/14767058.2021.2005022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OF RECOMMENDATIONS1. Episiotomy should be performed by indication only, and not routinely (Moderate quality evidence +++-; Strong recommendation). Accepted indications for episiotomy are to shorten the second stage of labor when there is suspected fetal hypoxia (Low quality evidence ++-; Weak recommendation); to prevent obstetric anal sphincter injury in vaginal operative deliveries, or when obstetric sphincter injury occurred in previous deliveries (Moderate quality evidence +++-; Strong recommendation)2. Mediolateral or lateral episiotomy technique should be used (Moderate quality evidence +++-; Strong recommendation). Labor ward staff should be offered regular training in correct episiotomy techniques (Moderate quality evidence +++-; Strong recommendation).3. Pain relief needs to be considered before episiotomy is performed, and epidural analgesia may be insufficient. The perineal skin needs to be tested for pain before an episiotomy is performed, even when an epidural is in place. Local anesthetics or pudendal block need to be considered as isolated or additional pain relief methods (Low quality evidence ++-; Strong recommendation).4. After childbirth the perineum should be carefully inspected, and the anal sphincter palpated to identify possible injury (Moderate quality evidence +++-; Strong recommendation). Primary suturing immediately after childbirth should be offered and a continuous suturing technique should be used when repairing an uncomplicated episiotomy (High quality evidence ++++; Strong recommendation).
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Affiliation(s)
- Katariina Laine
- Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway.,Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway
| | | | - Vanessa Cole
- Kingston Hospital NHS Foundation Trust, Kingston upon Thames, United Kingdom of Great Britain and Northern Ireland
| | | | | | | | | | | | | | | | | | - Vladimir Kalis
- Czech Society of Perinatology and Feto-Maternal Medicine
| | | | | | | | - Artur Beke
- Hungarian Society of Perinatology and Obstetric Anesthesiology
| | | | - Susana Santo
- Portuguese Society of Obstetrics and Maternal-Fetal Medicine
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14
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Nunes I, Dupont C, Timonen S, Ayres de Campos D, Cole V, Schwarz C, Kwee A, Yli B, Vayssiere C, Roth GE, Gliozheni E, Savochkina Y, Ivanisevic M, Janku P, Timonen S, Daskalakis G, Beke A, Santo S, Druškovič M, Duvekot JJ, Farr A, Dreyfus M. European Guidelines on Perinatal Care - Oxytocin for induction and augmentation of labor[Formula: see text]. J Matern Fetal Neonatal Med 2021; 35:7166-7172. [PMID: 34470113 DOI: 10.1080/14767058.2021.1945577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OF RECOMMENDATIONS1. Oxytocin for induction or augmentation of labor should not be started when there is a previous scar on the body of the uterus (such as previous classical cesarean section, uterine perforation or myomectomy when uterine cavity is reached) or in any other condition where labor or vaginal delivery are contraindicated. (Moderate quality evidence +++-; Strong recommendation).2. Oxytocin should not be started before at least 1 h has elapsed since amniotomy, 6 h since the use of dinoprostone (30 min if vaginal insert) and 4 h since the use of misoprostol (Low quality evidence ++- -; Moderate recommendation).3. Cardiotocography (CTG) should be performed and a normal pattern without tachysystole should be documented for at least 30 min before oxytocin is used. Continuous CTG, with adequate monitoring of both fetal heart rate and uterine contractions, should be maintained for as long as oxytocin is used, and thereafter until delivery (Low ++- - to moderate +++- quality evidence; Strong recommendation).4. For labor induction, at least 1-h should be allowed after amniotomy before oxytocin infusion is started, to evaluate whether adequate uterine contractility has meanwhile ensued. For augmentation of labor, if the membranes are intact and there are conditions for a safe amniotomy, the latter should be considered before oxytocin is started (Very low quality evidence +- --; Weak recommendation).5. Oxytocin should be administered intravenously using the following regimen: 5 IU oxytocin diluted in 500 mL of 0.9% normal saline (NaCl) (each mL contains 10 mIU of oxytocin), in an infusion pump at increasing rates, as shown in Table 1, until a frequency of 3-4 contractions per 10 min is reached, a non-reassuring CTG pattern ensues, or maximum rates are reached (Low quality evidence ++ - -; Strong recommendation). If the frequency of contractions exceeds 5 in 10 min, the infusion rate should be reduced, even if a normal CTG pattern is present. With a non-reassuring CTG pattern, urgent clinical assessment by an obstetrician is indicated, and strong consideration should be given to reducing or stopping the oxytocin infusion. The minimal effective dose of oxytocin should always be used. (Low ++- - to Moderate +++- - quality evidence; Strong recommendation).[Table: see text]6. Use of oxytocin for induction and augmentation of labor should be regularly audited (Low quality evidence ++--; Strong recommendation).
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Affiliation(s)
| | - Inês Nunes
- School of Medicine and Biomedical Sciences (ICBAS), University Hospital Center of Porto, CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Corinne Dupont
- University Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE) INSERM U1290; AURORE Perinatal Network, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France
| | - Susanna Timonen
- Finnish Society of Perinatology, Turku University Hospital, Turku University, Turku, Finland
| | | | | | | | - Christiane Schwarz
- Dept. Midwifery Science, University Lubeck, Institute for Health Sciences, Lubeck, Germany
| | - Anneke Kwee
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Branka Yli
- Delivery Deparment, Oslo University Hospital, Oslo, Norway
| | - Christophe Vayssiere
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse; UMR1295 CERPOP (Centre for Epidemiology and Population Health Research), Team SPHERE (Study of Perinatal, Paedriatric and Adolescent Health: Epidemiological Research and Evaluation) Toulouse III University, Toulouse, France
| | | | - Elko Gliozheni
- Albanian Association of Perinatology, Department of Obstetrics and Gynecology, University Hospital of Obstetrics and Gynaecology 'Koco Gliozheni', Tirana, Albania
| | - Yuliya Savochkina
- Bielorussian Society of Human Reproduction, 5th Minsk City Hospital and Belarus Medical Academy of Postgraduate Education, Minsk, Belarus
| | - Marina Ivanisevic
- Croatian Association of Perinatal Medicine, University Clinic for Obstetrics and Gynecology, School of Medicine, Zagreb, Croatia
| | - Petr Janku
- Czech Society of Perinatology and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, University Hospital Brno, Masaryk University Brno, Brno, Czech Republic; Department of Nursing and Midwifery, Masaryk University Brno, Czech Republic
| | - Susanna Timonen
- Finnish Society of Perinatology, Turku University Hospital, Turku University, Turku, Finland
| | - George Daskalakis
- Hellenic Society of Perinatal Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Artur Beke
- Hungarian Society of Perinatology and Obstetric Anesthesiology, Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Susana Santo
- Portuguese Society of Obstetrics and Maternal-Fetal Medicine, Santa Maria Hospital, University of Lisbon Medical School, Lisbon, Portugal
| | - Mirjam Druškovič
- Slovenia Medical Association - Society of Perinatal Medicine, Division of Obstetrics and Gynecology, UMC Ljubljana, Ljubljana, Slovenia
| | - J J Duvekot
- Dutch Society of Obstetrics and Gynecology, Department of Obstetrics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Alex Farr
- Austrian Society for Pre- and Perinatal Medicine, Department of Obstetrics and Gynecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Michel Dreyfus
- Societé Française de Medicine Perinatale, Service d'Obstétrique, Gynécologie et Médecine de la Reproduction, Centre Hospitalier Universitaire de Caen, Caen, France
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15
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Tasta O, Parant O, Hamdi SM, Allouche M, Vayssiere C, Guerby P. Evaluation of the Prognostic Value of the sFlt-1/PlGF Ratio in Early-Onset Preeclampsia. Am J Perinatol 2021; 38:e292-e298. [PMID: 32446261 DOI: 10.1055/s-0040-1709696] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Increased expression of soluble fms-like tyrosine kinase 1 (sFlt-1), associated with a decrease in placental growth factor (PlGF), plays a key role in the pathogenesis of preeclampsia (PE). We evaluated the prognostic value of the sFlt-1/PlGF ratio for the onset of adverse maternofetal outcomes (AMFO) in case of early-onset PE with attempted expectant management. STUDY DESIGN From October 2016 through November 2018, all singleton pregnancies complicated by early-onset PE (before 34 weeks of gestation) were included in a cohort study. The plasma levels of sFlt-1 and PlGF were blindly measured on admission. For the statistical analysis, we performed a bivariate analysis, a comparison of the receiving operating characteristic curves and a survival analysis estimated by the Kaplan-Meier method. RESULTS Among 109 early PE, AMFO occurred in 87 pregnancies (79.8%), mainly hemolysis, elevated liver enzymes, and low platelet count syndrome and severe fetal heart rate abnormalities requiring urgent delivery. The area under the curve (AUC) of sFlt-1/PlGF ratio was 0.82 (95% confidence interval [CI]: 0.73-0.88) for the risk of AMFO and the difference between the AUCs was significant for each separate standard parameter (p = 0.018 for initial diastolic blood pressure, p = 0.013 for alanine aminotransferase, p < 0.001 for uric acid). Pregnancies were best classified by a cutoff ratio of 293, with a sensitivity of 95% and a specificity of 50%. With a ratio value less than 293, no pregnancy was complicated or had been stopped during the first 5 days. A ratio more than 293 was associated with an increased risk of AMFO onset (hazard ratio [HR]: 3.61; 95% CI: 2.13-6.10; p < 0.001) and had a significant association with the length of time between the diagnosis of PE and delivery (HR: 2.49; 95% CI: 1.56-3.96; p < 0.001). CONCLUSION The sFlt-1/PlGF ratio is an additional tool in the prediction of AMFO in proven early-onset PE, which is likely to improve care by anticipating severe complications. KEY POINTS · The sFlt-1/PlGF ratio is associated with AMFO.. · It is an additional tool for physician.. · We proposed a 293 cutoff value for the ratio..
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Affiliation(s)
- Oriane Tasta
- Department of Obstetrics and Gynecology, Paule de Viguier Maternity, CHU Toulouse, Toulouse, France
| | - Olivier Parant
- Department of Obstetrics and Gynecology, Paule de Viguier Maternity, CHU Toulouse, Toulouse, France
| | - Safouane M Hamdi
- Department of Biochemistry and Hormonology, Paul Sabatier University, Toulouse, France
| | - Mickael Allouche
- Department of Obstetrics and Gynecology, Paule de Viguier Maternity, CHU Toulouse, Toulouse, France
| | - Christophe Vayssiere
- Department of Obstetrics and Gynecology, Paule de Viguier Maternity, CHU Toulouse, Toulouse, France
| | - Paul Guerby
- Department of Obstetrics and Gynecology, Paule de Viguier Maternity, CHU Toulouse, Toulouse, France.,INSERM UMR 1048 I2MC, Université de Toulouse III, Toulouse, France
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Verspyck E, Senat MV, Subtil D, Vayssiere C. [E. Verspyck et al. in response to the correspondence by R. Bessis et al. about the editorial by E. Verspyck et al.: Which fetal growth curve reference should be now chosen for our country? Gynécologie-Obstétrique Fertilité & Sénologie 2021; 49 (10): S246871892100129X. https://doi.org/10.1016/j.gofs.2021.05.001]. ACTA ACUST UNITED AC 2021; 49:876-877. [PMID: 34146755 DOI: 10.1016/j.gofs.2021.06.007] [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] [Received: 06/14/2021] [Indexed: 10/21/2022]
Affiliation(s)
- E Verspyck
- Service de gynécologie-obstétrique, université de Rouen, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
| | - M V Senat
- Service de Gynécologie-Obstétrique, Université du Kremlin-Bicêtre, CHU du Kremlin-Bicêtre, France
| | - D Subtil
- Service de Gynécologie-Obstétrique, Université de Lille, CHU de Lille, France
| | - C Vayssiere
- Service de Gynécologie-Obstétrique, Université de Toulouse, CHU de Toulouse, France
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17
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Verspyck E, Senat MV, Subtil D, Vayssiere C. [Which fetal growth curve reference should be now chosen for our country?]. ACTA ACUST UNITED AC 2021; 49:801-802. [PMID: 33989829 DOI: 10.1016/j.gofs.2021.05.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 05/09/2021] [Indexed: 10/21/2022]
Affiliation(s)
- E Verspyck
- Service de gynécologie-obstétrique, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
| | - M V Senat
- Service de gynécologie-obstétrique, université du Kremlin-Bicêtre, CHU du Kremlin-Bicêtre, Kremlin-Bicêtre, France
| | - D Subtil
- Service de gynécologie-obstétrique, université de Lille, CHU de Lille, Lille, France
| | - C Vayssiere
- Service de gynécologie-obstétrique, université de Toulouse, CHU de Toulouse, Toulouse, France
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Rozenberg P, Sentilhes L, Winer N, goffinet F, Vayssiere C, senat MV, Morel O, Haddad B, Garabédian C, Vivanti A, Perrotin F, Kayem G, Raynal P, Blanc J, Verspyck E, Gallot D, Sananes N, séco A, Desbrière R, Deneux-Tharaux C. 485 Efficacy of early versus late intrauterine balloon tamponade in the management of severe postpartum hemorrhage. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Guerby P, Tasta O, Swiader A, Pont F, Bujold E, Parant O, Vayssiere C, Salvayre R, Negre-Salvayre A. Role of oxidative stress in the dysfunction of the placental endothelial nitric oxide synthase in preeclampsia. Redox Biol 2021; 40:101861. [PMID: 33548859 PMCID: PMC7873691 DOI: 10.1016/j.redox.2021.101861] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 12/25/2022] Open
Abstract
Preeclampsia (PE) is a multifactorial pregnancy disease, characterized by new-onset gestational hypertension with (or without) proteinuria or end-organ failure, exclusively observed in humans. It is a leading cause of maternal morbidity affecting 3–7% of pregnant women worldwide. PE pathophysiology could result from abnormal placentation due to a defective trophoblastic invasion and an impaired remodeling of uterine spiral arteries, leading to a poor adaptation of utero-placental circulation. This would be associated with hypoxia/reoxygenation phenomena, oxygen gradient fluctuations, altered antioxidant capacity, oxidative stress, and reduced nitric oxide (NO) bioavailability. This results in part from the reaction of NO with the radical anion superoxide (O2•−), which produces peroxynitrite ONOO-, a powerful pro-oxidant and inflammatory agent. Another mechanism is the progressive inhibition of the placental endothelial nitric oxide synthase (eNOS) by oxidative stress, which results in eNOS uncoupling via several events such as a depletion of the eNOS substrate L-arginine due to increased arginase activity, an oxidation of the eNOS cofactor tetrahydrobiopterin (BH4), or eNOS post-translational modifications (for instance by S-glutathionylation). The uncoupling of eNOS triggers a switch of its activity from a NO-producing enzyme to a NADPH oxidase-like system generating O2•−, thereby potentiating ROS production and oxidative stress. Moreover, in PE placentas, eNOS could be post-translationally modified by lipid peroxidation-derived aldehydes such as 4-oxononenal (ONE) a highly bioreactive agent, able to inhibit eNOS activity and NO production. This review summarizes the dysfunction of placental eNOS evoked by oxidative stress and lipid peroxidation products, and the potential consequences on PE pathogenesis. Physiological ROS production is enhanced during pregnancy. eNOS is one of the main target of oxidative stress in PE placenta. eNOS is S-glutathionylated in PE placentas. eNOS is modified by lipid oxidation products in PE placentas.
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Affiliation(s)
- Paul Guerby
- Inserm U1048, Université de Toulouse, France; Gynecology and Obstetrics Department, Paule-de-Viguier Hospital, Toulouse University Hospital, France; Pôle Technologique du CRCT, Toulouse, France
| | - Oriane Tasta
- Inserm U1048, Université de Toulouse, France; Gynecology and Obstetrics Department, Paule-de-Viguier Hospital, Toulouse University Hospital, France
| | | | | | - Emmanuel Bujold
- Reproduction, Mother and Child Health Unit, CHU de Québec - Université Laval Research Centre, Université Laval, Québec, Canada
| | - Olivier Parant
- Gynecology and Obstetrics Department, Paule-de-Viguier Hospital, Toulouse University Hospital, France
| | - Christophe Vayssiere
- Gynecology and Obstetrics Department, Paule-de-Viguier Hospital, Toulouse University Hospital, France
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20
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Morin M, Claris O, Dussart C, Frelat A, De Place A, Molinier L, Matillon Y, Ehlinger V, Vayssiere C. Quality of Life During Pregnancy: Is There a Link with Breastfeeding at Birth? Breastfeed Med 2020; 15:321-330. [PMID: 32091916 DOI: 10.1089/bfm.2019.0123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: In France, the proportion of children who are exclusively breastfed has been decreasing in recent years. The aim of the study is to assess the link between quality of life (QOL) in pregnant women from the first trimester to the end of pregnancy using the French version EQ5D-3L questionnaire and the feeding method at birth (breast or bottle). Materials and Methods: Five hundred pregnant adult women were monitored between 2015 and 2017 at the Toulouse University Hospital (France). The data were collected monthly. After analyzing the QOL (EQ-5D-Index) and health status (EQ-5D-Visual Analogue Scale) for 1 month, we carried out a nine-group category analysis based on their QOL in the third month (low QOL [score <0.50 out of 1], intermediate [score between 0.50 and 0.90 out of 1], or high [score ≥0.90 out of 1]) and then based on changes in their QOL between the third and eighth month [marked reduction (low >0.6 point), intermediate (low between 0.1 and 0.6 point), and slight reduction (low <0.1 points increase)]. Results: Around1,847 questionnaires were collected and analyzed from 500 women. The monthly analysis did not highlight any link between QOL or health status reported during pregnancy and the feeding method at birth. As regard to the category analysis, following adjustment, the logistic regression model shows that breastfeeding is not linked to QOL in the third month of pregnancy (p = 0.171) or to changes in QOL during pregnancy (p = 0.426). However, there is less of a tendency to breastfeed in individuals with a high QOL in the third month of pregnancy compared to an intermediate QOL during the third month of pregnancy (p = 0.06). Conclusion: In this cohort of pregnant women for whom QOL was assessed throughout pregnancy, no link between QOL and feeding method was highlighted.
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Affiliation(s)
- Mathieu Morin
- Department of Obstetrics and Gynaecology, Toulouse University Hospital, Toulouse, France.,Department of Pathways to Systemic Health-P2S-EA 4129, University Claude Bernard Lyon I, Lyon, France
| | - Olivier Claris
- Department of Pathways to Systemic Health-P2S-EA 4129, University Claude Bernard Lyon I, Lyon, France.,Department of Neonatolgy and Neonatal Intensive Care, Lyon University Hospital, Lyon, France
| | - Claude Dussart
- Department of Pathways to Systemic Health-P2S-EA 4129, University Claude Bernard Lyon I, Lyon, France
| | - Alais Frelat
- Department of Obstetrics and Gynaecology, Toulouse University Hospital, Toulouse, France
| | - Alice De Place
- Department of Obstetrics and Gynaecology, Toulouse University Hospital, Toulouse, France
| | - Laurent Molinier
- Department of Medical Information, Toulouse University Hospital, Toulouse, France.,Research Unit 1027, UMR 1027, INSERM, University of Toulouse III, Toulouse, France
| | - Yves Matillon
- Department of Pathways to Systemic Health-P2S-EA 4129, University Claude Bernard Lyon I, Lyon, France
| | - Virginie Ehlinger
- Research Unit 1027, UMR 1027, INSERM, University of Toulouse III, Toulouse, France
| | - Christophe Vayssiere
- Department of Obstetrics and Gynaecology, Toulouse University Hospital, Toulouse, France.,Research Unit 1027, UMR 1027, INSERM, University of Toulouse III, Toulouse, France
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21
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Cadoret F, Guerby P, Cavaignac-Vitalis M, Vayssiere C, Parant O, Vidal F. Expectant management in HELLP syndrome: predictive factors of disease evolution. J Matern Fetal Neonatal Med 2020; 34:4029-4034. [PMID: 32146852 DOI: 10.1080/14767058.2019.1702956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: HELLP syndrome is a rare and severe pregnancy complication which exposes to severe maternal and fetal morbidity. Management of HELLP syndrome occurring before 34 weeks of gestation (WG) is still controversial but conservative management may be beneficial in patients with stable HELLP syndrome. The aim of the study was thus to identify which maternal and fetal prognostic factors could be predictive of HELLP syndrome evolution.Methods: From 2003 to 2016, all patients with HELLP syndrome occurring between 26 and 34 WG were retrospectively enrolled. Study population was stratified according to obstetrical management. Patients in whom delivery was initiated within 48 h following diagnosis constituted the active management group. In the expectant management group, pregnancy was prolonged until maternal or fetal follow up indicated delivery.Results: Ninety-nine patients were included in our study. Among them, 61 were managed expectantly. At baseline, the active management group was more likely to suffer from persistent hyperreflexia (p < .001), headache (p = .006) and confusion (p < .01). Moreover, this group was associated with worst biological and ultrasound features, namely decreased prothrombin ratio (p = .04), increased creatinine value (p = .01), and increased rates of pathological umbilical cord flow (p = .05) and abnormal ductus venosus flow (p = .007). After logistic regression, baseline significant prognostic factors were hyperreflexia (RR = 12.35; CI = 3.8 - 39.9), creatinine level (RR = 1.03; CI = 1002 - 1058) and abnormal umbilical cord flow (RR = 3.95; CI = 1.05 - 14.81). Last, expectant management leads to longer gestation time after diagnosis with an average value of 7.75 days without increasing maternal nor fetal mortality.Conclusion: While expectant management in HELLP syndrome might be beneficial through its reduction of prematurity, it cannot be conducted in all patients. Identification of baseline parameters predictive of disease evolution is thus of tremendous importance to define which obstetrical approach should be prioritized.
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Affiliation(s)
- Florence Cadoret
- CHU Toulouse, Pôle de Gynécologie Obstétrique, Hôpital Paule de Viguier, Toulouse, France
| | - Paul Guerby
- CHU Toulouse, Pôle de Gynécologie Obstétrique, Hôpital Paule de Viguier, Toulouse, France
| | | | - Christophe Vayssiere
- CHU Toulouse, Pôle de Gynécologie Obstétrique, Hôpital Paule de Viguier, Toulouse, France.,UMR1027, Université de Toulouse III, Toulouse, France.,UMR1027, Inserm, Toulouse, France
| | - Olivier Parant
- CHU Toulouse, Pôle de Gynécologie Obstétrique, Hôpital Paule de Viguier, Toulouse, France.,UMR1027, Université de Toulouse III, Toulouse, France.,UMR1027, Inserm, Toulouse, France
| | - Fabien Vidal
- CHU Toulouse, Pôle de Gynécologie Obstétrique, Hôpital Paule de Viguier, Toulouse, France.,UMR1027, Université de Toulouse III, Toulouse, France
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22
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Loussert L, Vidal F, Parant O, Hamdi SM, Vayssiere C, Guerby P. Aspirin for prevention of preeclampsia and fetal growth restriction. Prenat Diagn 2020; 40:519-527. [PMID: 31955436 DOI: 10.1002/pd.5645] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/23/2019] [Accepted: 01/02/2020] [Indexed: 12/12/2022]
Abstract
For the past decades, growing attention has been given to aspirin use during pregnancy. It favors placentation by its proangiogenic, antithrombotic, and anti-inflammatory effects. Therefore, low doses of aspirin are prescribed in the prevention of placenta-mediated complications, mainly preeclampsia and fetal growth restriction. However, questions regarding its clinical application are still debated. Aspirin is effective in preventing preeclampsia in a high-risk population. Most guidelines recommend that risk stratification should rely on medical history. Nevertheless, screening performances dramatically improve if biochemical and biophysical markers are included. Concerning the appropriate timing and dose, latest studies suggest aspirin should be started before 16 weeks of pregnancy and at a daily dose of 100 mg or more. Further studies are needed to improve the identification of patients likely to benefit from prophylactic aspirin. Besides, the role of aspirin in the prevention of fetal growth restriction is still questioned.
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Affiliation(s)
- Lola Loussert
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France
| | - Fabien Vidal
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France
| | - Olivier Parant
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France
| | - Safouane M Hamdi
- Laboratoire de Biochimie et d'Hormonologie, Institut Fédératif de Biologie, CHU Toulouse, Toulouse, France
| | - Christophe Vayssiere
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France
| | - Paul Guerby
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France.,Inserm U-1048, Université de Toulouse, Toulouse, France
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Kerbage Y, Senat MV, Drumez E, Subtil D, Vayssiere C, Deruelle P. Risk factors for failed induction of labor among pregnant women with Class III obesity. Acta Obstet Gynecol Scand 2019; 99:637-643. [PMID: 31863451 DOI: 10.1111/aogs.13794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 06/06/2019] [Revised: 11/28/2019] [Accepted: 11/28/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Our aim was to identify risk factors for failed induction in morbidly obese patients undergoing the induction of labor at term. MATERIAL AND METHODS This was a retrospective multicenter study on a cohort of 235 patients with a body mass index greater than 40 kg/m2 and giving birth to a singleton in cephalic presentation, who had an induction of labor from 38 weeks of amenorrhea. Scheduled cesareans and spontaneous vaginal deliveries were excluded. Maternal, peri-partum and neonatal characteristics were analyzed according to the delivery route. RESULTS In all, 235 patients were included. Of these, 62.5% patients delivered vaginally and 37.5% by cesarean section. The frequency of nulliparity was greater in patients who had a cesarean section (56 [interquartile range, IQR, 38.1] vs 56 [IQR 63.6], P < .001). In multivariate analysis, nulliparity (odds ratio [OR] 2.81, 95% confidence interval [CI] 1.58-4.97], P < .001), low Bishop's score (OR .794, 95% CI .70-.90, P < .001) and weight gain (OR 1.04, 95% CI 1.01-1.08, P = .033) were independent risk factors for failed induction. Umbilical cord pH at birth lower than 7 (0 vs 7 [IQR 8.0], P < .001) and lower than 7.20 (36 [IQR 24.5] vs 35 [IQR 39.8], P = .014) as well as the Apgar at 1 minute (14 [IQR 9.5] vs 17 [IQR 19.3], P = .032) was significantly higher in infants born by cesarean section. CONCLUSIONS In this cohort, 63% of women with Class III obesity had successful inductions of labor; risk factors for failed induction include nulliparity and unfavorable Bishop score.
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Affiliation(s)
- Yohan Kerbage
- Department of Obstetrics, Jeanne de Flandre University Hospital (CHRU), Lille, France
| | - Marie V Senat
- Gynecology-Obstetrics Service, Le Kremlin-Bicêtre Hospital, Public Hospital Assistance of Paris (APHP), Université Paris Sud, Orsay, France
| | - Elodie Drumez
- Department of Biostatistics, University of Lille, EA 2694 - Public Health: Epidemiology and Quality of Care, University Hospital of Lille (CHU), Lille, France
| | - Damien Subtil
- Department of Obstetrics, Jeanne de Flandre University Hospital (CHRU), Lille, France
| | - Christophe Vayssiere
- Women's-Maternity-Couple Center, Gynecology-Obstetrics Department, Paule de Viguier Hospital, University Hospital of Toulouse, Toulouse, France.,UMR 1027 INSERM, Université Paul-Sabatier Toulouse III, Toulouse, France
| | - Philippe Deruelle
- Department of Obstetrics, Jeanne de Flandre University Hospital (CHRU), Lille, France
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Amer-Wåhlin I, Ugwumadu A, Yli BM, Kwee A, Timonen S, Cole V, Ayres-de-Campos D, Roth GE, Schwarz C, Ramenghi LA, Todros T, Ehlinger V, Vayssiere C. Fetal electrocardiography ST-segment analysis for intrapartum monitoring: a critical appraisal of conflicting evidence and a way forward. Am J Obstet Gynecol 2019; 221:577-601.e11. [PMID: 30980794 DOI: 10.1016/j.ajog.2019.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 03/31/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND In the past century, some areas of obstetric including intrapartum care have been slow to benefit from the dramatic advances in technology and medical care. Although fetal heart rate monitoring (cardiotocography) became available a half century ago, its interpretation often differs between institutions and countries, its diagnostic accuracy needs improvement, and a technology to help reduce the unnecessary obstetric interventions that have accompanied the cardiotocography is urgently needed. STUDY DESIGN During the second half of the 20th century, key findings in animal experiments captured the close relationship between myocardial glycogenolysis, myocardial workload, and ST changes, thus demonstrating that ST waveform analysis of the fetal electrocardiogram can provide information on oxygenation of the fetal myocardium and establishing the physiological basis for the use of electrocardiogram in intrapartum fetal surveillance. RESULTS Six randomized controlled trials, 10 meta-analyses, and more than 20 observational studies have evaluated the technology developed based on this principle. Nonetheless, despite this intensive assessment, differences in study protocols, inclusion criteria, enrollment rates, clinical guidelines, use of fetal blood sampling, and definitions of key outcome parameters, as well as inconsistencies in randomized controlled trial data handling and statistical methodology, have made this voluminous evidence difficult to interpret. Enormous resources spent on randomized controlled trials have failed to guarantee the generalizability of their results to other settings or their ability to reflect everyday clinical practice. CONCLUSION The latest meta-analysis used revised data from primary randomized controlled trials and data from the largest randomized controlled trials from the United States to demonstrate a significant reduction of metabolic acidosis rates by 36% (odds ratio, 0.64; 95% confidence interval, 0.46-0.88) and operative vaginal delivery rates by 8% (relative risk, 0.92; 95% confidence interval, 0.86-0.99), compared with cardiotocography alone.
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Morin M, Claris O, Dussart C, Frelat A, de Place A, Molinier L, Matillon Y, Elhinger V, Vayssiere C. Health-related quality of life during pregnancy: A repeated measures study of changes from the first trimester to birth. Acta Obstet Gynecol Scand 2019; 98:1282-1291. [PMID: 30985917 DOI: 10.1111/aogs.13624] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 07/16/2018] [Revised: 04/04/2019] [Accepted: 04/08/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The objective was to evaluate the quality of life of pregnant women with a full-term birth from the first trimester to the 9th month using the EQ5D-3L questionnaire, comparing physiological, simple pathological, or complex pathological pregnancies. MATERIAL AND METHODS A prospective cohort of 500 pregnant women over the age of 18 was monitored between 2015 and 2017 at the Toulouse University Hospital (France). The data were collected monthly with an online report. Given that the decrease in quality of life was not linear during pregnancy, unadjusted and adjusted piecewise linear regression models were performed, considering 3 periods of time during pregnancy: 3-4, 4-8, and 8-9 months. The 5 dimensions of the EQ5D-Index and perceived health status were also analyzed. RESULTS In total, 1847 questionnaires were collected. Between the 4th and 8th months, the quality of life was lower for pathological pregnancies (P < 0.001) than for physiological ones and decreased over time for each type of pregnancy (physiological: -0.08 points per month, P < 0.001; simple pathological: -0.12 points per month, P < 0.001; complex pathological: -0.11 points per month, P < 0.001). Interestingly, the perceived health status was lower at the 9th month than at the 3rd month of pregnancy, for physiological pregnancies (mean difference = -10.5 points, P < 0.001), pathological pregnancies (mean difference = -10.0 points, P < 0.002), and for complex pathological pregnancies (mean difference = -7.8 points, P = 0.058). CONCLUSIONS In our population, the quality of life decreased between the 4th and 8th months, and decreased to a greater degree in a pathological pregnancy.
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Affiliation(s)
- Mathieu Morin
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France.,Department of Pathways to Systemic Health-P2S-EA 4129, University Claude Bernard of Lyon I, Lyon, France
| | - Olivier Claris
- Department of Pathways to Systemic Health-P2S-EA 4129, University Claude Bernard of Lyon I, Lyon, France.,Department of Neonatology and Neonatal Intensive Care, Lyon University Hospital, Lyon, France
| | - Claude Dussart
- Department of Pathways to Systemic Health-P2S-EA 4129, University Claude Bernard of Lyon I, Lyon, France
| | - Alais Frelat
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France
| | - Alice de Place
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France
| | - Laurent Molinier
- Department of Medical Information, CHU Toulouse, Toulouse III University, Toulouse, France.,UMR 1027 INSERM, Team 5-Cancer and Chronic Disease: Social Inequalities in Health, Primary and Secondary Access to Care, Toulouse III University, Toulouse, France
| | - Yves Matillon
- Department of Pathways to Systemic Health-P2S-EA 4129, University Claude Bernard of Lyon I, Lyon, France
| | - Virginie Elhinger
- UMR 1027 INSERM, Team SPHERE-Study of Perinatal, Pediatric and Adolescent Health: Epidemiological Research and Evaluation, Toulouse III University, Toulouse, France
| | - Christophe Vayssiere
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France.,UMR 1027 INSERM, Team SPHERE-Study of Perinatal, Pediatric and Adolescent Health: Epidemiological Research and Evaluation, Toulouse III University, Toulouse, France
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Cadoret F, Vidal F, Parant O, Vayssiere C, Guerby P. Expectant versus active management of HELLP syndrome. Eur J Obstet Gynecol Reprod Biol 2019. [DOI: 10.1016/j.ejogrb.2018.08.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Guerby P, Parant O, Vayssiere C, Vidal F. Comment on: Higher Rates of Operative Delivery and Maternal and Neonatal Complications in Persistent Occiput Posterior Position with a Large Head Circumference: A Retrospective Cohort Study. Fetal Diagn Ther 2018; 44:77. [PMID: 29462820 DOI: 10.1159/000486783] [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] [Received: 12/21/2017] [Accepted: 01/08/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Paul Guerby
- Department of Obstetrics and Gynaecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France
| | - Olivier Parant
- Department of Obstetrics and Gynaecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France.,UMR 1027 INSERM, University Paul Sabatier Toulouse III, Toulouse, France
| | - Christophe Vayssiere
- Department of Obstetrics and Gynaecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France.,UMR 1027 INSERM, University Paul Sabatier Toulouse III, Toulouse, France
| | - Fabien Vidal
- Department of Obstetrics and Gynaecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France
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Vayssiere C, Gaudineau A, Gallini A, Rozenberg P, Morin M, Roth E, Orusco E, Javoise S, Fort J, Lavergne C, Ehlinger V, Senat MV, Arnaud C. 93: Induction of labor at term with a live fetus: is 25μg of vaginal misoprostol non inferior to slow release 10mg PGE2 Pessary? CYTOPRO, A french multicentre randomized controlled trial, (NCT01765881). Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.10.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lorthe E, Goffinet F, Marret S, Vayssiere C, Flamant C, Quere M, Benhammou V, Ancel PY, Kayem G. Tocolysis after preterm premature rupture of membranes and neonatal outcome: a propensity-score analysis. Am J Obstet Gynecol 2017; 217:212.e1-212.e12. [PMID: 28412086 DOI: 10.1016/j.ajog.2017.04.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 01/06/2017] [Revised: 03/29/2017] [Accepted: 04/05/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND There are conflicting results regarding tocolysis in cases of preterm premature rupture of membranes. Delaying delivery may reduce neonatal morbidity because of prematurity and allow for prenatal corticosteroids and, if necessary, in utero transfer. However, that may increase the risks of maternofetal infection and its adverse consequences. OBJECTIVE The objective of the study was to investigate whether tocolytic therapy in cases of preterm premature rupture of membranes is associated with improved neonatal or obstetric outcomes. STUDY DESIGN Etude Epidémiologique sur les Petits Ages Gestationnels 2 is a French national prospective, population-based cohort study of preterm births that occurred in 546 maternity units in 2011. Inclusion criteria in this analysis were women with preterm premature rupture of membranes at 24-32 weeks' gestation and singleton gestations. Outcomes were survival to discharge without severe morbidity, latency prolonged by ≥48 hours and histological chorioamnionitis. Uterine contractions at admission, individual and obstetric characteristics, and neonatal outcomes were compared by tocolytic treatment or not. Propensity scores and inverse probability of treatment weighting for each woman were used to minimize indication bias in estimating the association of tocolytic therapy with outcomes. RESULTS The study population consisted of 803 women; 596 (73.4%) received tocolysis. Women with and without tocolysis did not differ in neonatal survival without severe morbidity (86.7% vs 83.9%, P = .39), latency prolonged by ≥48 hours (75.1% vs 77.4%, P = .59), or histological chorioamnionitis (50.0% vs 47.6%, P = .73). After applying propensity scores and assigning inverse probability of treatment weighting, tocolysis was not associated with improved survival without severe morbidity as compared with no tocolysis (odds ratio, 1.01 [95% confidence interval, 0.94-1.09], latency prolonged by ≥48 hours (1.03 [95% confidence interval, 0.95-1.11]), or histological chorioamnionitis (1.03 [95% confidence interval, 0.92-1.17]). There was no association between the initial tocolytic drug used (oxytocin receptor antagonists or calcium-channel blockers vs no tocolysis) and the 3 outcomes. Sensitivity analyses of women with preterm premature rupture of membranes at 26-31 weeks' gestation, women who delivered at least 12 hours after rupture of membranes, women with direct admission after the rupture of membranes and the presence or absence of contractions gave similar results. CONCLUSION Tocolysis in cases of preterm premature rupture of membranes is not associated with improved obstetric or neonatal outcomes; its clinical benefit remains unproven.
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Affiliation(s)
- Elsa Lorthe
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, and Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Sorbonne Universités, Université Pierre and Marie Curie, Institut de Formation Doctorale, Paris, France.
| | - François Goffinet
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, and Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Department of Obstetrics and Gynecology, Cochin, Broca, Hôtel Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stéphane Marret
- Department of Neonatal Medicine, Rouen University Hospital and Région-Institut National de la Santé et de la Recherche Médicale (ERI 28), Normandy University, Rouen, France
| | - Christophe Vayssiere
- Department of Obstetrics and Gynecology, University Hospital, Toulouse, France; Research Unit on Perinatal Epidemiology, Childhood Disabilities, and Adolescent Health, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1027, Paul Sabatier University, Toulouse, France
| | - Cyril Flamant
- Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
| | - Mathilde Quere
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, and Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Valérie Benhammou
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, and Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Pierre-Yves Ancel
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, and Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Unité de Recherche Clinique-Centre d'Investigations Cliniques P1419, Département Hospitalo-Universitaire Risks in Pregnancy, Cochin Hotel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gilles Kayem
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, and Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Sorbonne Universités, Université Pierre and Marie Curie, Institut de Formation Doctorale, Paris, France; Department of Obstetrics and Gynecology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Lorthe E, Ancel PY, Torchin H, Kaminski M, Langer B, Subtil D, Sentilhes L, Arnaud C, Carbonne B, Debillon T, Delorme P, D'Ercole C, Dreyfus M, Lebeaux C, Galimard JE, Vayssiere C, Winer N, L'Helias LF, Goffinet F, Kayem G. Impact of Latency Duration on the Prognosis of Preterm Infants after Preterm Premature Rupture of Membranes at 24 to 32 Weeks' Gestation: A National Population-Based Cohort Study. J Pediatr 2017; 182:47-52.e2. [PMID: 28081890 DOI: 10.1016/j.jpeds.2016.11.074] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/20/2016] [Accepted: 11/28/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess the impact of latency duration on survival, survival without severe morbidity, and early-onset sepsis in infants born after preterm premature rupture of membranes (PPROM) at 24-32 weeks' gestation. STUDY DESIGN This study was based on the prospective national population-based Etude Épidémiologique sur les Petits Ȃges Gestationnels 2 cohort of preterm births and included 702 singletons delivered in France after PPROM at 24-32 weeks' gestation. Latency duration was defined as the time from spontaneous rupture of membranes to delivery, divided into 4 periods (12 hours to 2 days [reference], 3-7 days, 8-14 days, and >14 days). Multivariable logistic regression was used to assess the relationship between latency duration and survival, survival without severe morbidity at discharge, or early-onset sepsis. RESULTS Latency duration ranged from 12 hours to 2 days (18%), 3-7 days (38%), 8-14 days (24%), and >14 days (20%). Rates of survival, survival without severe morbidity, and early-onset sepsis were 93.5% (95% CI 91.8-94.8), 85.4% (82.4-87.9), and 3.4% (2.0-5.7), respectively. A crude association found between prolonged latency duration and improved survival disappeared on adjusting for gestational age at birth (aOR 1.0 [reference], 1.6 [95% CI 0.8-3.2], 1.2 [0.5-2.9], and 1.0 [0.3-3.2] for latency durations from 12 hours to 2 days, 3-7 days, 8-14 days, and >14 days, respectively). Prolonged latency duration was not associated with survival without severe morbidity or early-onset sepsis. CONCLUSION For a given gestational age at birth, prolonged latency duration after PPROM does not worsen neonatal prognosis.
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Affiliation(s)
- Elsa Lorthe
- Inserm Unité Mixte de Recherche (UMR) 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Sorbonne Universités, University Pierre and Marie Curie, Paris 06, Institut de Formation Doctorale, Paris, France.
| | - Pierre-Yves Ancel
- Inserm Unité Mixte de Recherche (UMR) 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Unité de Recherche Clinique-Centre d'Investigations Cliniques P1419, Cochin Hotel-Dieu Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Héloïse Torchin
- Inserm Unité Mixte de Recherche (UMR) 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Monique Kaminski
- Inserm Unité Mixte de Recherche (UMR) 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Bruno Langer
- Department of Obstetrics and Gynecology, Hautepierre Hospital, Strasbourg, France
| | - Damien Subtil
- Department of Obstetrics and Gynecology, Jeanne de Flandre Hospital, Lille, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Catherine Arnaud
- Research Unit on Perinatal Epidemiology, Childhood Disabilities and Adolescent Health, Inserm UMR 1027, Paul Sabatier University, Toulouse, France
| | - Bruno Carbonne
- Department of Obstetrics and Gynecology, Princess Grace Hospital, Monaco
| | - Thierry Debillon
- Department of Neonatal Pediatrics, University Hospital, Grenoble, France
| | - Pierre Delorme
- Inserm Unité Mixte de Recherche (UMR) 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Department of Obstetrics and Gynecology, Cochin, Broca, Hôtel Dieu Hospital, AP-HP, Paris, France
| | - Claude D'Ercole
- Department of Obstetrics and Gynecology, Nord Hospital, Assistance Publique des Hôpitaux de Marseille (AP-HM), Aix Marseille Université, Marseille, France
| | - Michel Dreyfus
- Department of Gynecology and Obstetrics, University Hospital, Caen, France
| | - Cécile Lebeaux
- Inserm Unité Mixte de Recherche (UMR) 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Jacques-Emmanuel Galimard
- Department of Biostatistics and Medical Information (ECSTRA Team), Centre of Research in Epidemiology and Statistics Sorbonne, Inserm UMR 1153, Université Paris Diderot, Paris, France
| | - Christophe Vayssiere
- Research Unit on Perinatal Epidemiology, Childhood Disabilities and Adolescent Health, Inserm UMR 1027, Paul Sabatier University, Toulouse, France; Department of Obstetrics and Gynecology, University Hospital, Toulouse, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, University Hospital, National Institute for Agricultural Research, UMR 1280 Physiologie des adaptations nutritionnelles, Nantes, France
| | - Laurence Foix L'Helias
- Inserm Unité Mixte de Recherche (UMR) 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Department of Neonatal Pediatrics, Trousseau Hospital, AP-HP, Paris, France
| | - François Goffinet
- Inserm Unité Mixte de Recherche (UMR) 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Department of Obstetrics and Gynecology, Cochin, Broca, Hôtel Dieu Hospital, AP-HP, Paris, France
| | - Gilles Kayem
- Inserm Unité Mixte de Recherche (UMR) 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Sorbonne Universités, University Pierre and Marie Curie, Paris 06, Institut de Formation Doctorale, Paris, France; Department of Obstetrics and Gynecology, Trousseau Hospital, AP-HP, Paris, France
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Guerby P, Allouche M, Simon-Toulza C, Vayssiere C, Parant O, Vidal F. Management of persistent occiput posterior position: a substantial role of instrumental rotation in the setting of failed manual rotation. J Matern Fetal Neonatal Med 2017; 31:80-86. [DOI: 10.1080/14767058.2016.1275552] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Paul Guerby
- Gynecology and Obstetrics Department, Paule de Viguier Hospital, CHU Toulouse, France
| | - Mickael Allouche
- Gynecology and Obstetrics Department, Paule de Viguier Hospital, CHU Toulouse, France
| | - Caroline Simon-Toulza
- Gynecology and Obstetrics Department, Paule de Viguier Hospital, CHU Toulouse, France
| | - Christophe Vayssiere
- Gynecology and Obstetrics Department, Paule de Viguier Hospital, CHU Toulouse, France
- UMR 1027 INSERM, University Paul Sabatier Toulouse III, Toulouse, France
| | - Olivier Parant
- Gynecology and Obstetrics Department, Paule de Viguier Hospital, CHU Toulouse, France
- UMR 1027 INSERM, University Paul Sabatier Toulouse III, Toulouse, France
| | - Fabien Vidal
- Gynecology and Obstetrics Department, Paule de Viguier Hospital, CHU Toulouse, France
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32
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Sananes N, Roth GE, Aissi GA, Meyer N, Bigler A, Bouschbacher JM, Helmlinger C, Viville B, Guilpain M, Gaudineau A, Akladios CY, Nisand I, Langer B, Vayssiere C, Favre R. Acupuncture version of breech presentation: a randomized sham-controlled single-blinded trial. Eur J Obstet Gynecol Reprod Biol 2016; 204:24-30. [DOI: 10.1016/j.ejogrb.2016.07.492] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 07/17/2016] [Accepted: 07/26/2016] [Indexed: 11/26/2022]
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Ugwumadu A, Steer P, Parer B, Carbonne B, Vayssiere C, Maso G, Arulkumaran S. Time to optimise and enforce training in interpretation of intrapartum cardiotocograph. BJOG 2016; 123:866-9. [PMID: 26773808 DOI: 10.1111/1471-0528.13846] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2015] [Indexed: 11/26/2022]
Affiliation(s)
- A Ugwumadu
- Department of Obstetrics & Gynaecology, St George's University Hospital NHS Foundation Trust, London, UK
| | - P Steer
- Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK
| | - B Parer
- Department of Obstetrics and Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - B Carbonne
- Service de Gynécologie-Obstétrique, Centre Hospitalier Princesse Grace, Monaco
| | | | - G Maso
- Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health, IRCCS- Burlo Garofolo, Trieste, Italy
| | - S Arulkumaran
- Department of Obstetrics & Gynaecology, St George's University Hospital NHS Foundation Trust, London, UK
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Jamin C, Agostini A, Asselin I, Ben M'barek I, Bettahar K, Carbonne B, David P, Faucher P, Fernandez H, Fournet P, Goffinet F, Guilbaud L, Hassoun D, Lachowsky M, Letombe B, Levy G, Trignol-Viguier N, Vayssiere C, Vigoureux S. [Emergency contraceptions: Propositions of the Orthogenics Commission of the French National College of Gynecology and Obstetrics]. Gynecol Obstet Fertil 2015; 43:571-4. [PMID: 26298815 DOI: 10.1016/j.gyobfe.2015.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 07/07/2015] [Indexed: 12/30/2022]
Affiliation(s)
- C Jamin
- 169, boulevard Haussmann, 75008 Paris, France.
| | - A Agostini
- 169, boulevard Haussmann, 75008 Paris, France
| | - I Asselin
- 169, boulevard Haussmann, 75008 Paris, France
| | | | - K Bettahar
- 169, boulevard Haussmann, 75008 Paris, France
| | - B Carbonne
- 169, boulevard Haussmann, 75008 Paris, France
| | - P David
- 169, boulevard Haussmann, 75008 Paris, France
| | - P Faucher
- 169, boulevard Haussmann, 75008 Paris, France
| | - H Fernandez
- 169, boulevard Haussmann, 75008 Paris, France
| | - P Fournet
- 169, boulevard Haussmann, 75008 Paris, France
| | - F Goffinet
- 169, boulevard Haussmann, 75008 Paris, France
| | - L Guilbaud
- 169, boulevard Haussmann, 75008 Paris, France
| | - D Hassoun
- 169, boulevard Haussmann, 75008 Paris, France
| | - M Lachowsky
- 169, boulevard Haussmann, 75008 Paris, France
| | - B Letombe
- 169, boulevard Haussmann, 75008 Paris, France
| | - G Levy
- 169, boulevard Haussmann, 75008 Paris, France
| | | | - C Vayssiere
- 169, boulevard Haussmann, 75008 Paris, France
| | - S Vigoureux
- 169, boulevard Haussmann, 75008 Paris, France
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Paret L, Favre N, Vayssière C, Baglin A, Fehri T, Heintzelmann M, Groussolles M, Vayssiere C. [Case report: Vasa previa diagnosis and management. How to prevent Benckiser's hemorrhage?]. ACTA ACUST UNITED AC 2015; 44:891-4. [PMID: 26096350 DOI: 10.1016/j.jgyn.2015.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 02/25/2015] [Revised: 04/27/2015] [Accepted: 05/06/2015] [Indexed: 11/20/2022]
Abstract
Benckiser's haemorrhage is a serious obstetrical complication, following a vasa previa rupture. Incidence of vasa previa is estimated between 1/1150 and 1/5000 pregnancies. This case report illustrates the consequences of a suspected vasa previa rupture. There is no French recommendation of how to treat vasa previa. Different methods of prevention are described and examined thanks to a literature review.
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Affiliation(s)
- L Paret
- Département de gynécolgie-obstétrique, hôpital Paule-de-Viguier, CHU de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse, France.
| | - N Favre
- Hôpital Joseph-Ducuing, 15, rue de Varsovie, 31300 Toulouse, France
| | - C Vayssière
- Hôpital Joseph-Ducuing, 15, rue de Varsovie, 31300 Toulouse, France
| | - A Baglin
- Hôpital Joseph-Ducuing, 15, rue de Varsovie, 31300 Toulouse, France
| | - T Fehri
- Hôpital Joseph-Ducuing, 15, rue de Varsovie, 31300 Toulouse, France
| | - M Heintzelmann
- Hôpital Joseph-Ducuing, 15, rue de Varsovie, 31300 Toulouse, France
| | - M Groussolles
- Département de gynécolgie-obstétrique, hôpital Paule-de-Viguier, CHU de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse, France; Inserm, UMR1027, 31062 Toulouse, France
| | - C Vayssiere
- Département de gynécolgie-obstétrique, hôpital Paule-de-Viguier, CHU de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse, France; Inserm, UMR1027, 31062 Toulouse, France
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Schuit E, Stock S, Rode L, Rouse DJ, Lim AC, Norman JE, Nassar AH, Serra V, Combs CA, Vayssiere C, Aboulghar MM, Wood S, Çetingöz E, Briery CM, Fonseca EB, Worda K, Tabor A, Thom EA, Caritis SN, Awwad J, Usta IM, Perales A, Meseguer J, Maurel K, Garite T, Aboulghar MA, Amin YM, Ross S, Cam C, Karateke A, Morrison JC, Magann EF, Nicolaides KH, Zuithoff NPA, Groenwold RHH, Moons KGM, Kwee A, Mol BWJ. Effectiveness of progestogens to improve perinatal outcome in twin pregnancies: an individual participant data meta-analysis. BJOG 2014; 122:27-37. [PMID: 25145491 DOI: 10.1111/1471-0528.13032] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND In twin pregnancies, the rates of adverse perinatal outcome and subsequent long-term morbidity are substantial, and mainly result from preterm birth (PTB). OBJECTIVES To assess the effectiveness of progestogen treatment in the prevention of neonatal morbidity or PTB in twin pregnancies using individual participant data meta-analysis (IPDMA). SEARCH STRATEGY We searched international scientific databases, trial registration websites, and references of identified articles. SELECTION CRITERIA Randomised clinical trials (RCTs) of 17-hydroxyprogesterone caproate (17Pc) or vaginally administered natural progesterone, compared with placebo or no treatment. DATA COLLECTION AND ANALYSIS Investigators of identified RCTs were asked to share their IPD. The primary outcome was a composite of perinatal mortality and severe neonatal morbidity. Prespecified subgroup analyses were performed for chorionicity, cervical length, and prior spontaneous PTB. MAIN RESULTS Thirteen trials included 3768 women and their 7536 babies. Neither 17Pc nor vaginal progesterone reduced the incidence of adverse perinatal outcome (17Pc relative risk, RR 1.1; 95% confidence interval, 95% CI 0.97-1.4, vaginal progesterone RR 0.97; 95% CI 0.77-1.2). In a subgroup of women with a cervical length of ≤25 mm, vaginal progesterone reduced adverse perinatal outcome when cervical length was measured at randomisation (15/56 versus 22/60; RR 0.57; 95% CI 0.47-0.70) or before 24 weeks of gestation (14/52 versus 21/56; RR 0.56; 95% CI 0.42-0.75). AUTHOR'S CONCLUSIONS In unselected women with an uncomplicated twin gestation, treatment with progestogens (intramuscular 17Pc or vaginal natural progesterone) does not improve perinatal outcome. Vaginal progesterone may be effective in the reduction of adverse perinatal outcome in women with a cervical length of ≤25 mm; however, further research is warranted to confirm this finding.
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Affiliation(s)
- E Schuit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands; Department of Obstetrics and Gynaecology, Academic Medical Centre Amsterdam, Amsterdam, the Netherlands
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Ballouhey Q, Abbo O, Baunin C, Pasquet M, Sartor A, Vayssiere C, Guitard J, Galinier P. Pulmonary and intestinal congenital anomalies masquerading as cystic suprarenal masses. Eur J Pediatr Surg 2012; 22:434-8. [PMID: 22903253 DOI: 10.1055/s-0032-1323162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The prenatal finding of a cystic suprarenal mass (CSM) presents a wide differential diagnosis. The aim of this study was to present the natural course and outcome of antenatally diagnosed CSMs. METHODS We reviewed the medical records of patients with prenatally detected CSMs that were assessed between January 1998 and December 2011. Retrospective data collection included the age at the time of diagnosis, the size of the mass, and the sonographic evolution of the mass. Surgical treatment was indicated in cases of malignant tumors and symptoms or when size increased. RESULTS The observation period ranged from 1 month to 10 years. The data of 21 patients were analyzed. The median length of follow-up was 32 months (ranging from 2 to 131 months). A total of 13 masses were detected on the left side and 8 on the right side. In 13 patients, the lesions disappeared after a median of 7 months (ranging from 0 to 37 months). Surgery was performed in two neonates: one for a teratoma at 10 days postpartum, and one for a neuroblastoma at 17 days postpartum. Six patients had an extralobar pulmonary sequestration (ELPS), and in four patients, surgical resection was performed at an average of 9.2 months (ranging from 1 to 20 months) postpartum, because of an infection or increase in ELPS size. Histological examination confirmed the pulmonary sequestration. An association with congenital cystic adenomatoid malformation (CCAM) was found in one patient, and ectopic pancreatic tissue was discovered in another patient. Two patients conservatively managed remain under observation. CONCLUSIONS During the neonatal period, the accurate assessment of CSMs is necessary to exclude the presence of malignant tumors. Most patients can be conservatively managed, with close follow-up, including radiological assessment. If the mass persists after 1 year of age, ELPS should be considered as a probable diagnosis, and minimally invasive laparoscopic surgery can be performed, as it provides both definitive diagnosis and treatment.
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Affiliation(s)
- Quentin Ballouhey
- Department of Pediatric Surgery, Hôpital des Enfants, Toulouse, France.
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Batlle L, Guyard-Boileau B, Thiebaugeorges O, Caubisens A, Vaquié MF, Thiery F, Parant O, Vayssiere C. [Analysis of the evitability of intrapartum asphyxia with a peers review]. ACTA ACUST UNITED AC 2012. [PMID: 23182789 DOI: 10.1016/j.jgyn.2012.10.005] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess the quality of intrapartum care in birth asphyxia cases. METHODS Prospective analysis of all cases of birth asphyxia in nine maternity units during one year (2010). Birth asphyxia was defined as the combination of at least one clinical factor (Apgar≤7 at 5 minutes, signs of encephalopathy at birth) and at least one biological factor in cord (pH≤7, BD≥12 mmol/L, lactates>10 mmol/L). These cases were analyzed with a peer review from French guidelines 2007. RESULTS Fifty cases of birth asphyxia were identified. After peer-review, they were defined as 46% non preventable, 27% possibly preventable, 24% definitely preventable and 3% not established. The main causes have been described as (i) misinterpretation of CTG during the first and second stages of labour, (ii) delayed response time to CTG anomalies and (iii) prolonged second stage. CONCLUSION In half of the cases of birth asphyxia, this dreaded event was considered as preventable by a group of peers.
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Affiliation(s)
- L Batlle
- Maternité Paule-de-Viguier, CHU de Toulouse, 330, avenue Grande-Bretagne, 31000 Toulouse, France.
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Ballouhey Q, Sartor A, Baunin C, Danjoux M, Léobon B, Galinier P, Vayssiere C. [Unusual fetal teratoma presenting as a posterior mediastinal cyst]. ACTA ACUST UNITED AC 2012; 41:338-40. [PMID: 22296937 DOI: 10.1016/j.gyobfe.2011.07.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Accepted: 07/11/2011] [Indexed: 10/14/2022]
Abstract
Mediastinal cysts are uncommon prenatal findings. As isolated and non-compressing entities, they don't compromise the course of gestation. Massive lesions can compress vital structures, resulting in fetal demise. Thus, close follow-up with sonographic monitoring is recommended until birth. Non-hydroptic fetuses can be managed expectantly. Definitive etiology is known after surgical resection only. We present the first case of posterior mediastinal teratoma associated with severe vertebral abnormalities. After CT scan and fetal MRI, medical termination of pregnancy was decided. Histological examination revealed an immature teratoma. With this unique case report, we discuss the optimal prenatal management of mediastinal cysts.
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Affiliation(s)
- Q Ballouhey
- Service de chirurgie pédiatrique, hôpital des Enfants, 330 avenue de Grande-Bretagne, Toulouse cedex 9, France.
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Vayssiere C, Leveque C, Favre R, Audibert F, Chauvet MP, Maillard F, Ehlinger V, Arnaud C. 338: Cervical length in asymptomatic twin pregnancies: prospective multicenter comparison of predictive indicators. Am J Obstet Gynecol 2012. [DOI: 10.1016/j.ajog.2011.10.356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Schuit E, Groenwold R, Amer-Wahlin I, Marsal K, Ojala K, Tekay A, Vayssiere C, Visser G, Westerhuis M, Mol BW, Moons K, Kwee A. 616: ST-analysis for intrapartum fetal monitoring in high-risk vertex singleton pregnancies beyond 36 weeks of gestation: an individual participant data metaanalysis of randomized trials. Am J Obstet Gynecol 2012. [DOI: 10.1016/j.ajog.2011.10.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Valera MC, Parant O, Vayssiere C, Arnal JF, Payrastre B. Essential thrombocythemia and pregnancy. Eur J Obstet Gynecol Reprod Biol 2011; 158:141-7. [DOI: 10.1016/j.ejogrb.2011.04.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 04/19/2011] [Accepted: 04/30/2011] [Indexed: 11/28/2022]
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Groussolles M, Merveille M, Alacoque X, Vayssiere C, Reme JM, Parant O. Rupture of a Splenic Artery Aneurysm in the First Trimester of Pregnancy. J Emerg Med 2011; 41:e13-6. [DOI: 10.1016/j.jemermed.2010.04.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 01/24/2010] [Accepted: 04/13/2010] [Indexed: 01/28/2023]
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Basarab A, Vidal F, Abbal R, Delachartre P, Vayssiere C, Leguevaque P, Kouame D. Motion estimation in ultrasound imaging applied to the diagnostic of pelvic floor disorders. Annu Int Conf IEEE Eng Med Biol Soc 2011; 2011:8058-8061. [PMID: 22256211 DOI: 10.1109/iembs.2011.6091987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The main purpose of this paper is to show the potential of tissue motion estimation in ultrasound imaging for the diagnostic of pelvic floor disorders. We propose to evaluate the tissue motion using a method based on a local deformable model and on image features (local phase and orientation) extracted from the monogenic signal. The proposed method is well adapted to the pelvic organ deformations and estimates motion with subpixel precision without the need for interpolation. The estimated motion is used to visualize the bladder local deformation and to extract quantitative figures such as the deformation parameters and the bladder angle variation. These results could potentially be interesting to characterize the degree of the pelvic organ prolapse.
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Abstract
Platelets are key players in haemostasis and thrombus formation. Defects affecting platelets during pregnancy can lead to heterogeneous complications, such as thrombosis, first trimester miscarriage and postpartum haemorrhage. The incidence of complications is increased in women who have heritable platelet function disorders. Modifications of platelet count or platelet functions during normal pregnancy and preeclampsia will be summarized and the management of pregnant women with heritable platelet function disorders will be discussed.
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Affiliation(s)
- Marie-Cecile Valera
- INSERM U858, I2MR, Equipe 9, CHU Rangueil, BP 84225, 31432 Toulouse cedex 4, France
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Deffieux X, Vayssiere C, Azria E, Porcher R, Parant O, Clavier J, Guibert J, Benachi A, Houfflin-Debarge V, Jouannic JM, Rozenberg P, Andre G, Ansquer Y, Rouzier R, Benbassa A, Collinet P, Ayel JP, Jacquetin B, Morice P, Boubli L, Senat MV, Brunet L, Levy G. [Institutional review board of the French college of obstetricians and gynecologists (CEROG).]. J Gynecol Obstet Hum Reprod 2010; 39:401-408. [PMID: 20493643 DOI: 10.1016/j.jgyn.2009.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Revised: 06/30/2009] [Accepted: 12/24/2009] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To report the rules and the activity of the institutional review board of the French college of obstetricians and gynecologists (Comité d'éthique de la recherche en obstétrique et gynécologie [CEROG]) created in 2008. The submission requirements are also described. METHODS Retrospective study. RESULTS The Ethical Review Committee [institutional review board of the French college of obstetricians and gynecologists (CNGOF)] CEROG have examined 65 project studies in 2008. The median number of submitted studies was 5.5 per month (IQR: 3.75-6.25). The origins of the submission were as follows: tertiary care university hospitals (n=63, 97 %), Inserm (n=1), INRA (n=1). Researches were found to be in conformity with the French laws and regulations, to conform to generally accepted scientific principles and medical research ethical standards in 44 cases (68 %). In 13 cases (20 %), the study has been forwarded to the Persons Protection Committee (PPC) since it concerned biomedical research or "usual care research" (soin courant). In six cases (9 %), the investigators have not responded to IRB suggestions. In two cases (3 %), the information form has been judged unsatisfactory. CONCLUSION The CEROG is the first national IRB in obstetrics and gynecology. This new committee clarifies IRB submission procedure in France concerning non-interventional studies in the field of obstetrics and gynecology.
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Affiliation(s)
- X Deffieux
- Collège national des gynécologues et obstétriciens français, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
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Gaudineau A, Ehlinger V, Gabhainn SN, Vayssiere C, Arnaud C, Godeau E. Use of emergency contraceptive pill by 15-year-old girls: results from the international Health Behaviour in School-aged Children (HBSC) study. BJOG 2010; 117:1197-204. [PMID: 20560940 DOI: 10.1111/j.1471-0528.2010.02637.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe emergency contraceptive pill (ECP) use and variation across countries/regions; and to explore personal and contextual factors associated with ECP use and differences across countries/regions. DESIGN Data were obtained from 11 countries/regions in the 2006 Health Behaviour in School-aged Children cross-sectional study. SETTING Data were collected by self-report questionnaire in school classrooms. POPULATION The analysis is based on 2118 sexually active 15-year-old girls. METHODS Contraceptive behaviours were compared across countries/regions by chi-square tests. Individual factors related to ECP use were investigated with separate logistic regression models. Multilevel random-intercept models allowed the investigation of individual and contextual effects, by partitioning the variance into student, school and country/region levels. MAIN OUTCOME MEASURES ECP use at last sexual intercourse. RESULTS ECP use rate varied significantly across countries/regions. Poor communication with at least one adult (odds ratio [OR] 1.62 [1.12-2.36], P = 0.011) and daily smoking (OR 1.46 [1.00-2.11], P = 0.048) were independently associated with ECP use in comparison with condom and/or birth-control pill use. Sexual initiation at 14 years or later (OR 2.02 [1.04-3.93], P = 0.039), good perceived academic achievement (OR 1.69 [1.04-2.75], P = 0.035) and daily smoking (OR 1.63 [1.01-2.64], P = 0.045) were associated with higher levels of ECP use in comparison with unprotected girls. The country-level variance remained significant in both comparisons. CONCLUSIONS These data document the large heterogeneity in rates of ECP use between countries/regions. These differences could not be explained by individual or contextual factors, and raise further questions in relation to ECP access for adolescents and their education in its appropriate use.
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Affiliation(s)
- A Gaudineau
- UMR Inserm U558, University Paul Sabatier, Toulouse, France
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Sananes N, Guigue V, Vayssiere C, Kohler M, Girard-Lemaire F, Flori E, Carelle-Calmels N, Boehm N, Samama B, Doray B, Favre R. Contribution of 3D ultrasound and fetal face studies to the prenatal diagnosis of Pallister-Killian syndrome. J Matern Fetal Neonatal Med 2010; 23:558-62. [DOI: 10.3109/14767050903214558] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Parant O, Simon-Toulza C, Cristini C, Vayssiere C, Arnaud C, Reme JM. Faecal incontinence after first instrumental vaginal delivery using Thierry's spatulas. Int Urogynecol J 2010; 21:1195-203. [PMID: 20464371 DOI: 10.1007/s00192-010-1176-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 04/23/2010] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of this study is to estimate the prevalence of faecal incontinence after first vaginal delivery and to assess the impact of Thierry's spatulas-assisted delivery. METHODS A prospective observational study of primiparas who underwent a vaginal delivery at term was conducted. Faecal incontinence was assessed at 2 and 6 months postpartum by a questionnaire (Wexner score >or=5 was considered significant). Univariate and multivariate analyses were performed. RESULTS Five hundred thirty-eight women were recruited with undergoing 176 spatulas-assisted deliveries and 362 spontaneous vaginal deliveries. The response rate was 85.9% (2 months) and 80.5% (6 months). The prevalence of faecal incontinence was similar between the two groups at 2 months (14.3% and 9.7%). Episiotomy (odds ratio [OR] = 5.0) and maternal age over 35 years (OR = 4.1) were independently associated with faecal incontinence after adjustment. CONCLUSIONS Anal symptoms are common after the first vaginal delivery. Thierry's spatulas do not increase the prevalence of faecal incontinence after delivery given that an episiotomy is performed.
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Affiliation(s)
- Olivier Parant
- CHU de Toulouse, Service de gynécologie obstétrique, Hôpital Paule de Viguier, 330 avenue de Grande-Bretagne, 31059, Toulouse, France.
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Gaudineau A, Ehlinger V, Vayssiere C, Jouret B, Arnaud C, Godeau E. Factors associated with early menarche: results from the French Health Behaviour in School-aged Children (HBSC) study. BMC Public Health 2010; 10:175. [PMID: 20353570 PMCID: PMC2853511 DOI: 10.1186/1471-2458-10-175] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 03/30/2010] [Indexed: 11/20/2022] Open
Abstract
Background Puberty is a transition period making physiological development a challenge adolescents have to face. Early pubertal development could be associated with higher risks of poor health. Our objective was to examine risk behaviours, physical and psychological determinants associated with early menarche (<11 years). Methods Early menarche was assessed in the Health Behaviour in School-aged Children French cross-sectional survey. Data were collected in 2006 by anonymous self-reported standardized questionnaire from a nationally representative sample of 1072 15 years old girls in school classrooms. Family environment, school experience, physical and psychological factors, risk behaviours (substance use and sexual initiation) were recorded. Logistic regression models were applied (analysing for crude and adjusted relationships between early menarche and risk behaviours controlled for family context). Results Median age at menarche was 13.0 years; 57 girls (5.3%) were early-matured. Controlled for familial environment, early menarche was associated with having had more than two life-drunkenness episodes (adjusted OR = 2.5 [1.3-4.6]), early sexual initiation (adjusted OR = 2.8 [1.3-6.0]) and overweight (adjusted OR = 7.3 [3.6-14.9]). Conclusion Early-maturing girls may affiliate with older adolescents, hence engage in risk behaviours linked to their appearance rather than their maturity level. Factors associated with early menarche highlight the need to focus attention on early-matured girls to prevent further health problems linked to risk behaviours.
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