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Astruc A, Roux L, Robin F, Sall NR, Dion L, Lavoué V, Legendre G, Leveque J, Bessede T, Bertrand M, Odimba Mpoy J, Nzau-Ngoma E, Morandi X, Chedotal A, Le Lous M, Nyangoh Timoh K. Advanced Insights into Human Uterine Innervation: Implications for Endometriosis and Pelvic Pain. J Clin Med 2024; 13:1433. [PMID: 38592287 PMCID: PMC10932059 DOI: 10.3390/jcm13051433] [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: 12/31/2023] [Revised: 02/08/2024] [Accepted: 02/16/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: Understanding uterine innervation, an essential aspect of female reproductive biology, has often been overlooked. Nevertheless, the complex architecture of uterine innervation plays a significant role in conditions such as endometriosis. Recently, advances in histological techniques have provided unprecedented details about uterine innervation, highlighting its intricate structure, distribution, and density. The intricate nature of uterine innervation and its influence on pathologies such as endometriosis has garnered increasing attention. (2) Objectives: This review aims to compile, analyze, and summarize the existing research on uterine innervation, and investigate its implications for the pathogenesis of endometriosis and associated pain. (3) Methods: A systematic review was conducted in line with PRISMA guidelines. Using the PubMed database, we searched relevant keywords such as "uterine innervation", "endometriosis", and "pain association". (4) Results: The initial literature search yielded a total of 3300 potential studies. Of these, 45 studies met our inclusion criteria and were included in the final review. The analyzed studies consistently demonstrated that the majority of studies focused on macroscopic dissection of uterine innervation for surgical purposes. Fewer studies focused on micro-innervation for uterine innervation. For endometriosis, few studies focused on neural pain pathways whereas many studies underlined an increase in nerve fiber density within ectopic endometrial tissue. This heightened innervation is suggested as a key contributor to the chronic pain experienced by endometriosis patients. (5) Conclusions: The understanding of uterine innervation, and its alterations in endometriosis, offer promising avenues for research and potential treatment.
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Affiliation(s)
- Audrey Astruc
- Laboratoire d’Anatomie et d’Organogenèse, Faculté de Médecine, Centre Hospitalier Universitaire de Rennes, 35000 Rennes, France; (A.A.); (L.R.); (X.M.)
- Department of Obstetrics and Gynecology, Rennes University Hospital, 35000 Rennes, France; (N.R.S.); (L.D.); (V.L.); (J.L.); (M.L.L.)
- Department of Obstetrics and Gynecology, Angers University Hospital, 49100 Angers, France;
| | - Léa Roux
- Laboratoire d’Anatomie et d’Organogenèse, Faculté de Médecine, Centre Hospitalier Universitaire de Rennes, 35000 Rennes, France; (A.A.); (L.R.); (X.M.)
- Department of Obstetrics and Gynecology, Rennes University Hospital, 35000 Rennes, France; (N.R.S.); (L.D.); (V.L.); (J.L.); (M.L.L.)
| | - Fabien Robin
- H2P2 Histopathology Laboratory, Rennes 1 University, 35000 Rennes, France;
- Department of Hepatobiliary and Digestive Surgery, University Hospital, Rennes 1 University, 35000 Rennes, France
- INSERM U1242, Chemistry Oncogenesis Stress Signaling, Rennes 1 University, 35000 Rennes, France
| | - Ndeye Racky Sall
- Department of Obstetrics and Gynecology, Rennes University Hospital, 35000 Rennes, France; (N.R.S.); (L.D.); (V.L.); (J.L.); (M.L.L.)
- INSERM, LTSI—UMR 1099, Rennes 1 University, 35000 Rennes, France
| | - Ludivine Dion
- Department of Obstetrics and Gynecology, Rennes University Hospital, 35000 Rennes, France; (N.R.S.); (L.D.); (V.L.); (J.L.); (M.L.L.)
- INSERM, IRSET—UMR_S 1085, 35000 Rennes, France
| | - Vincent Lavoué
- Department of Obstetrics and Gynecology, Rennes University Hospital, 35000 Rennes, France; (N.R.S.); (L.D.); (V.L.); (J.L.); (M.L.L.)
- INSERM, IRSET—UMR_S 1085, 35000 Rennes, France
| | - Guillaume Legendre
- Department of Obstetrics and Gynecology, Angers University Hospital, 49100 Angers, France;
| | - Jean Leveque
- Department of Obstetrics and Gynecology, Rennes University Hospital, 35000 Rennes, France; (N.R.S.); (L.D.); (V.L.); (J.L.); (M.L.L.)
| | - Thomas Bessede
- Urology Department, APHP, Université Paris-Saclay, 94270 Le Kremlin-Bicetre, France;
| | - Martin Bertrand
- Surgery Department, Nîmes University Hospital, University of Montpellier, 30900 Nîmes, France;
| | - Jules Odimba Mpoy
- Department of Obstetrics and Gynecology, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo; (J.O.M.); (E.N.-N.)
| | - Emmanuel Nzau-Ngoma
- Department of Obstetrics and Gynecology, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo; (J.O.M.); (E.N.-N.)
| | - Xavier Morandi
- Laboratoire d’Anatomie et d’Organogenèse, Faculté de Médecine, Centre Hospitalier Universitaire de Rennes, 35000 Rennes, France; (A.A.); (L.R.); (X.M.)
- INSERM, LTSI—UMR 1099, Rennes 1 University, 35000 Rennes, France
| | - Alain Chedotal
- INSERM, CNRS, Institut de la Vision, Sorbonne Université, 75012 Paris, France;
| | - Maela Le Lous
- Department of Obstetrics and Gynecology, Rennes University Hospital, 35000 Rennes, France; (N.R.S.); (L.D.); (V.L.); (J.L.); (M.L.L.)
- INSERM, LTSI—UMR 1099, Rennes 1 University, 35000 Rennes, France
| | - Krystel Nyangoh Timoh
- Laboratoire d’Anatomie et d’Organogenèse, Faculté de Médecine, Centre Hospitalier Universitaire de Rennes, 35000 Rennes, France; (A.A.); (L.R.); (X.M.)
- Department of Obstetrics and Gynecology, Rennes University Hospital, 35000 Rennes, France; (N.R.S.); (L.D.); (V.L.); (J.L.); (M.L.L.)
- INSERM, LTSI—UMR 1099, Rennes 1 University, 35000 Rennes, France
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Le Lous M, Dion L, Le Ray C. Simulation training for pelvic examination: A systematic review. J Gynecol Obstet Hum Reprod 2023; 52:102666. [PMID: 37739264 DOI: 10.1016/j.jogoh.2023.102666] [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: 04/12/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE Pelvic examination including vaginal digital examination and speculum inspection are crucial medical skills that are challenging to teach for both professors and students, because of its intimate nature. Consequently, education has shifted from a traditional approach to a simulation-enhanced education. This literature review summarizes the level of evidence for these not-so-new training modalities. METHODS For this systematic review, the Pudmed database have been consulted using the following keywords: (Pelvic examination OR Vaginal examination) AND simulation. Eligible studies had to be published in French or English within the past 20 years and investigate simulation training for pelvic examination in the field of gynecology and obstetrics. For each paper, the following outcomes were analyzed: Competence, confidence and communication, and were classified according to the Kirkpatrick hierarchy. RESULTS About competence, in initial training, one meta-analysis (9 studies of which 4 randomized studies) about pelvic examination teaching on procedural simulators have shown a significant benefit of simulation. One meta-analysis and one systematic review also demonstrated that Gynecological Teaching Associates (GTAs) teaching, who exist in Northern America and Scandinavian countries, was better that pelvic task trainers in terms of technical competence, and comfort. For the vaginal examination of women in labor, two randomized trials also showed a positive impact of pelvic task trainer on students' accuracy. CONCLUSION Simulation-enhanced education of pelvic examination brings a significant benefit in comparison to a classic education without simulation in terms of competence, confidence and communication. GTAs have the best impact on competence and communication, but they do not exist currently in France. Hybrid simulation (a patient actor combined with a pelvic task trainer) could be a solution to teach both technical skills and communication.
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Affiliation(s)
- Maela Le Lous
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France; LTSI - INSERM UMR 1099, University of Rennes 1, Rennes F35000, France; Academic Visitor at University College of London, Institute for Women's Health, London, UK.
| | - Ludivine Dion
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France
| | - Camille Le Ray
- Maternité Port-Royal, Groupe Hospitalier Paris Centre, AP-HP, Université Paris Cité, FHU Préma, 75014 Paris, France
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Deffieux X, Pizzoferrato AC, Gaucher L, Rousset-Jablonski C, Le Ray C, Brillac T, Maruani J, Maitrot-Mantelet L, Mignot S, Athiel Y, Baffet H, Bailleul A, Bernard V, Bourdon M, Cardaillac C, Carneiro Y, Chariot P, Corroenne R, Dabi Y, Dahlem L, Frank S, Freyens A, Grouthier V, Hernandez I, Iraola E, Lambert M, Lauchet N, Legendre G, Le Lous M, Louis-Vahdat C, Martinat Sainte-Beuve A, Masson M, Matteo C, Pinton A, Sabbagh E, Sallee C, Thubert T, Heron I, Artzner F, Tavenet A, Gantois A, Fauconnier A. Pelvic exam in Gynecology and Obstetrics: French Guidelines for Clinical Practice. Eur J Obstet Gynecol Reprod Biol 2023; 291:131-140. [PMID: 37871350 DOI: 10.1016/j.ejogrb.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/18/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023]
Affiliation(s)
- Xavier Deffieux
- Université Paris-Saclay, AP-HP, Hôpital Antoine Béclère, Service de gynécologie obstétrique, Clamart F-92140, France.
| | - Anne-Cécile Pizzoferrato
- Service de Gynécologie Obstétrique, Hôpital Universitaire de La Miletrie, Poitiers F-86000, France; INSERM CIC 1402, Université de Poitiers, Poitiers F-86000, France
| | - Laurent Gaucher
- Collège National des Sages-Femmes de France, CNSF, Paris F-75010, France; Public Health Unit, Hospices Civils de Lyon, Bron F-69500, France; INSERM U1290, Research on Healthcare Performance (RESHAPE), Université Claude Bernard, Lyon 1, Lyon F-69008, France; Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1206 Geneva, Switzerland
| | - Christine Rousset-Jablonski
- Centre Léon Bérard, Département de Chirurgie, et Centre Hospitalier Lyon Sud, Service de Gynécologie-Obstétrique, INSERM U1290 RESHAPE, Lyon F-69000, France
| | - Camille Le Ray
- Maternité Port Royal, Groupe Hospitalier Paris Centre, APHP, Université Paris Cité, FHU Prema, Paris F-75014, France
| | | | - Julia Maruani
- Cabinet Médical, 6 Rue Docteur Albert Schweitzer, Marseille F-13006, France
| | - Lorraine Maitrot-Mantelet
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paris Centre (HUPC), Unité de gynécologie médicale, hôpital Port-Royal, Paris F-75014, France
| | | | - Yoann Athiel
- Maternité Port Royal, Groupe Hospitalier Paris Centre, APHP, Université Paris Cité, FHU Prema, Paris F-75014, France
| | - Hortense Baffet
- Service de gynécologie médicale, orthogénie et sexologie, CHU de Lille, Université de Lille, Lille F-59000, France
| | - Alexandre Bailleul
- Service de Gynécologie Obstétrique, Center Hospitalier de Poissy Saint Germain en Laye, Poissy F-78300, France; Equipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », Université Paris Saclay, UVSQ, Montigny le Bretonneux F-78180, France
| | - Valérie Bernard
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, Centre Hospitalo-Universitaire Pellegrin, Bordeaux F-33000, France
| | - Mathilde Bourdon
- Université Paris Cité, APHP, Center Hospitalier Universitaire (CHU) Cochin Port Royal, Service de Gynécologie Obstétrique II et Médecine de la Reproduction, F-75014, France
| | - Claire Cardaillac
- Service de gynécologie-obstétrique, CHU de Nantes, Nantes F-44000, France
| | | | - Patrick Chariot
- Département de médecine légale et sociale, Assistance Publique - Hôpitaux de Paris, Bondy F-93140, France; Institut de Recherche Interdisciplinaire sur Les Enjeux Sociaux, UMR 8156-997, UFR SMBH, Université Sorbonne Paris Nord, Bobigny F-9300, France
| | - Romain Corroenne
- Service de gynécologue-obstétrique, CHU Angers, Angers F-49000, France
| | - Yohann Dabi
- Sorbonne université - APHP - Hôpital Tenon, Service de gynécologie obstétrique et médecine de la reproduction, Paris F75020, France
| | - Laurence Dahlem
- Département universitaire de médecine générale, Faculté de médecine, Université de Bordeaux, 146 rue Léo Saignat, Bordeaux F-33076, France
| | - Sophie Frank
- Service d'oncogénétique, Institut Curie, Paris F-75005, France
| | - Anne Freyens
- DUMG (Département Universitaire de Médecine Générale), Université Paul Sabatier, Toulouse F-31000, France
| | - Virginie Grouthier
- Department of Endocrinology, Diabetes and Nutrition, University of Bordeaux, Bordeaux, France; Univ. Bordeaux, Inserm U1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Isabelle Hernandez
- Département de maïeutique, Center hospitalier de Melun Santepole, Melun F-77000, France
| | - Elisabeth Iraola
- Institut de Recherche interdisciplinaire sur les Enjeux Sociaux (IRIS), UMR 8156-997, CNRS U997 Inserm EHESS UP13 UFR SMBH, Université Sorbonne Paris Nord, Paris, France; Direction de la protection maternelle et infantile et promotion de la santé, Conseil départemental du Val-de-Marne, Créteil F-94000, France
| | - Marie Lambert
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, Centre Hospitalo-Universitaire Pellegrin, Bordeaux F-33000, France; Université de Bordeaux, Bordeaux Institute of Oncology - Unité Inserm 1312, Bordeaux F-33000, France
| | - Nadege Lauchet
- Groupe Médical François Perrin, 9 rue François Perrin, Limoges F-87000, France
| | - Guillaume Legendre
- Service de gynécologue-obstétrique, CHU Angers, Angers F-49000, France; UMR_S1085, Université d'Angers, CHU Angers, University of Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), Angers, France
| | - Maela Le Lous
- Université de Rennes 1, INSERM, LTSI - UMR 1099, Rennes F-35000, France; Département de gynécologie et obstétrique, CHU de Rennes, Rennes F-35000, France
| | - Christine Louis-Vahdat
- Cabinet de gynécologie et obstétrique, 126 Boulevard Saint Germain, Paris F-75006, France
| | | | - Marine Masson
- Département de médecine générale, Poitiers F-86000, France
| | - Caroline Matteo
- Cabinet de maïeutique, 181 rue du Docteur Cauvin, Marseille F-13015, France
| | - Anne Pinton
- Service de gynécologie obstétrique, Hôpital Trousseau, APHP, 26, avenue du Dr-Arnold-Netter, Paris F-75012, France; Sorbonne Université, Paris F-75013, France
| | - Emmanuelle Sabbagh
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paris Centre (HUPC), Unité de gynécologie médicale, hôpital Port-Royal, Paris F-75014, France
| | - Camille Sallee
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU de Limoges, Limoges F-87000 France
| | - Thibault Thubert
- Service de Gynécologie-Obstétrique, CHU de Nantes, Nantes F- 44000, France; Laboratoire Mouvement, Interactions, Performance (MIP), EA 4334, Nantes Université, Nantes F- 44322, France
| | - Isabelle Heron
- Service d'endocrinologie, Université de Rouen, Hôpital Charles Nicolle, Rouen F-76000, France; Cabinet médical, 7 rue de Lessard, Rouen F-76100, France
| | - France Artzner
- CIANE, Collectif interassociatif autour de la naissance, c/o Anne Evrard, 101 rue Pierre Corneille, Lyon F-69003, France
| | - Arounie Tavenet
- ENDOFRANCE, Association de lutte contre l'endométriose. 3 rue de la Gare, Tresilley F-70190, France
| | - Adrien Gantois
- Collège National des Sages-Femmes de France hébergé au Réseau de Santé Périnatal Parisien (RSPP), Paris F75010, France
| | - Arnaud Fauconnier
- Service de Gynécologie Obstétrique, Center Hospitalier de Poissy Saint Germain en Laye, Poissy F-78300, France; Equipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », Université Paris Saclay, UVSQ, Montigny le Bretonneux F-78180, France
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Mercier M, Meneu A, Tesson C, Lassel L, Le Lous M, Enderle I. Retrospective evaluation of labor induction with scar uterus at the university hospital of Rennes. J Gynecol Obstet Hum Reprod 2023; 52:102641. [PMID: 37595753 DOI: 10.1016/j.jogoh.2023.102641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/31/2023] [Accepted: 08/05/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE The aim of the study was a retrospective evaluation of labor induction in women with one previous cesarean section. The primary outcome was the mode of delivery. We also studied the severe maternal and neonatal morbidity and identify some prediction factors of vaginal delivery after labor induction after one previous cesarean section. STUDY DESIGN This was a retrospective observational monocentric study performed over the period from January 1st, 2016 to April 30th, 2020 at the university hospital of Rennes. Were included women with scar uterus because of one previous cesarean section with a viable singleton fetus in cephalic presentation and an induction of labor for medical reason, at term. Multivariate logistic regression analysis was used to analyze prediction of vaginal delivery after labor induction after one previous cesarean section. We also studied maternal (included uterine rupture, loss of blood, obstetrical injury of anus sphincter) and neonatal (APGAR score, arterial umbilical pH after 1 minute of life and eventual admission to neonatal unit) morbidity. We used a stepwise multivariate logistic regression model to select variables for multivariate analysis. The model with the lowest Akaike Index Criteria was chosen. RESULTS The study enrolled 353 women with scar uterus: 121 women were induced by balloon catheter, 57 by osmotic cervical dilatators, 91 by oxytocin alone, 84 by amniotomy. Vaginal delivery rate was 47,9%. There was 45% of vaginal delivery in the group with Bishop < 6 before induction of labor versus 62% in the group with Bishop ≥ 6. There was no statistically significative difference in neonatal and maternal severe morbidities between vaginal delivery and cesarean section: 4,5% of severe maternal morbidities (n = 16). Among their, we highlighted 7 uterine ruptures (3,8%). We observed also 3% of postpartum severe hemorrhage in vaginal delivery group (n = 5) against 1,6% in cesarian section group (n = 3) with no statistical significant difference (p = 0,632). Regarding to the obstetric perineal tears and lacerations we noticed 1,2% of OASIS 3 (n = 2) and 0,6% of OASIS 4 (n = 1). Severe neonatal morbidities were comparable by mode of delivery without significant difference: APGAR score at 5 min was similar (p = 1), as well as arterial umbilical pH after 1 min. (p = 0.719) and admissions to a neonatal unit (p = 1). Two variables were statistically associated with vaginal delivery after labor induction in women with scar uterus: Bishop score ≥ 6 (OR = 0,44; 95%CI: 0,25-0,81) and/or previous vaginal delivery after cesarean section (OR = 0,17; 95%CI: 0,08-0,35). CONCLUSION With 47,9% of vaginal delivery after labor induction in women with scar uterus, only 3.8% (n = 7/353) of uterine ruptures, less than 1% APGAR < 7 at 5 min (n = 3/353), induction on scar uterus should be consider in obstetrical practice. Bishop score ≥ 6 and/or previous vaginal delivery after cesarean section are associated to vaginal delivery after labor induction.
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Affiliation(s)
- Marion Mercier
- Department of Obstetrics and Gynecology and Reproductive Medicine, Anne de Bretagne University Hospital, Rennes, France.
| | - Alisée Meneu
- Department of Obstetrics and Gynecology and Reproductive Medicine, Anne de Bretagne University Hospital, Rennes, France
| | - Caroline Tesson
- Department of Obstetrics and Gynecology and Reproductive Medicine, Anne de Bretagne University Hospital, Rennes, France
| | - Linda Lassel
- Department of Obstetrics and Gynecology and Reproductive Medicine, Anne de Bretagne University Hospital, Rennes, France
| | - Maela Le Lous
- Department of Obstetrics and Gynecology and Reproductive Medicine, Anne de Bretagne University Hospital, Rennes, France
| | - Isabelle Enderle
- Department of Obstetrics and Gynecology and Reproductive Medicine, Anne de Bretagne University Hospital, Rennes, France
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Le Lous M, Beridot C, Baxter JSH, Huaulme A, Vasconcelos F, Stoyanov D, Siassakos D, Jannin P. Physical environment of the operating room during cesarean section: A systematic review. Eur J Obstet Gynecol Reprod Biol 2023; 288:1-6. [PMID: 37406465 DOI: 10.1016/j.ejogrb.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/27/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION Environmental factors in the operating room during cesarean sections are likely important for both women/birthing people and their babies but there is currently a lack of rigorous literature about their evaluation. The principal aim of this study was to systematically examine studies published on the physical environment in the obstetrical operating room during c-sections and its impact on mother and neonate outcomes. The secondary objective was to identify the sensors used to investigate the operating room environment during cesarean sections. METHODS In this literature review, we searched MEDLINE a database using the following keywords: Cesarean section AND (operating room environment OR Noise OR Music OR Video recording OR Light level OR Gentle OR Temperature OR Motion Data). Eligible studies had to be published in English or French within the past 10 years and had to investigate the operating room environment during cesarean sections in women. For each study we reported which aspects of the physical environment were investigated in the OR (i.e., noise, music, movement, light or temperature) and the involved sensors. RESULTS Of a total of 105 studies screened, we selected 8 articles from title and abstract in PubMed. This small number shows that the field is poorly investigated. The most evaluated environment factors to date are operating room noise and temperature, and the presence of music. Few studies used advanced sensors in the operating room to evaluate environmental factors in a more nuanced and complete way. Two studies concern the sound level, four concern music, one concerns temperature and one analyzed the number of entrances/exits into the OR. No study analyzed light level or more fine-grained movement data. CONCLUSIONS Main findings include increase of noise and motion at specific time-points, for example during delivery or anaesthesia; the positive impact of music on parents and staff alike; and that a warmer theatre is better for babies but more uncomfortable for surgeons.
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Affiliation(s)
- Maela Le Lous
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France; LTSI - INSERM UMR 1099, University of Rennes 1, F35000 Rennes, France; Department of Computer Science, Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom.
| | - Caroline Beridot
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France
| | - John S H Baxter
- LTSI - INSERM UMR 1099, University of Rennes 1, F35000 Rennes, France
| | - Arnaud Huaulme
- LTSI - INSERM UMR 1099, University of Rennes 1, F35000 Rennes, France
| | - Francisco Vasconcelos
- Department of Computer Science, Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom
| | - Danail Stoyanov
- Department of Computer Science, Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom
| | - Dimitrios Siassakos
- Department of Computer Science, Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom; EGA Institute for Women's Health, University College London, London, United Kingdom
| | - Pierre Jannin
- LTSI - INSERM UMR 1099, University of Rennes 1, F35000 Rennes, France
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Deffieux X, Rousset-Jablonski C, Gantois A, Brillac T, Maruani J, Maitrot-Mantelet L, Mignot S, Gaucher L, Athiel Y, Baffet H, Bailleul A, Bernard V, Bourdon M, Cardaillac C, Carneiro Y, Chariot P, Corroenne R, Dabi Y, Dahlem L, Frank S, Freyens A, Grouthier V, Hernandez I, Iraola E, Lambert M, Lauchet N, Legendre G, Le Lous M, Louis-Vahdat C, Martinat Sainte-Beuve A, Masson M, Matteo C, Pinton A, Sabbagh E, Sallee C, Thubert T, Heron I, Pizzoferrato AC, Artzner F, Tavenet A, Le Ray C, Fauconnier A. [Pelvic exam in gynecology and obstetrics: Guidelines for clinical practice]. Gynecol Obstet Fertil Senol 2023; 51:297-330. [PMID: 37258002 DOI: 10.1016/j.gofs.2023.04.001] [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] [Received: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To provide guidelines for the pelvic clinical exam in gynecology and obstetrics. MATERIAL AND METHODS A multidisciplinary experts consensus committee of 45 experts was formed, including representatives of patients' associations and users of the health system. The entire guidelines process was conducted independently of any funding. The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS The committee studied 40 questions within 4 fields for symptomatic or asymptomatic women (emergency conditions, gynecological consultation, gynecological diseases, obstetrics, and pregnancy). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology. RESULTS The experts' synthesis work and the application of the GRADE method resulted in 27 recommendations. Among the formalized recommendations, 17 present a strong agreement, 7 a weak agreement and 3 an expert consensus agreement. Thirteen questions resulted in an absence of recommendation due to lack of evidence in the literature. CONCLUSIONS The need to perform clinical examination in gynecological and obstetrics patients was specified in 27 pre-defined situations based on scientific evidence. More research is required to investigate the benefit in other cases.
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Affiliation(s)
- Xavier Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, université Paris-Saclay, AP-HP, 92140 Clamart, France.
| | - Christine Rousset-Jablonski
- Département de chirurgie, Centre Léon Bérard, 28, rue Laënnec, 69008 Lyon, France; Inserm U1290, Research on Healthcare Performance (RESHAPE), université Claude-Bernard Lyon 1, 69008 Lyon, France; Service de Gynécologie-Obstétrique, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Adrien Gantois
- Collège national des sages-femmes de France hébergé au Réseau de santé périnatal parisien (RSPP), 75010 Paris, France
| | | | - Julia Maruani
- Cabinet médical, 6, rue Docteur-Albert-Schweitzer, 13006 Marseille, France
| | - Lorraine Maitrot-Mantelet
- Unité de gynécologie médicale, hôpital Port-Royal, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital universitaire Paris centre (HUPC), 75014 Paris, France
| | | | - Laurent Gaucher
- Collège national des sages-femmes de France, CNSF, 75010 Paris, France; Public Health Unit, hospices civils de Lyon, 69500 Bron, France; Inserm U1290, Research on Healthcare Performance (RESHAPE), université Claude-Bernard Lyon 1, 69008 Lyon, France; Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1206 Genève, Suisse
| | - Yoann Athiel
- Maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, université Paris cité, FHU Prema, 75014 Paris, France
| | - Hortense Baffet
- Service de gynécologie médicale, orthogénie et sexologie, CHU de Lille, université de Lille, 59000 Lille, France
| | - Alexandre Bailleul
- Service de gynécologie-obstétrique, centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France; Équipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », université Paris-Saclay, UVSQ, 78180 Montigny-le-Bretonneux, France
| | - Valérie Bernard
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalo-universitaire Pellegrin, 33000 Bordeaux, France; Unité Inserm 1312, université de Bordeaux, Bordeaux Institute of Oncology, 33000 Bordeaux, France
| | - Mathilde Bourdon
- Service de gynécologie-obstétrique II et médecine de la reproduction, université Paris cité, AP-HP, centre hospitalier universitaire (CHU) Cochin Port-Royal, 75014 Paris, France
| | - Claire Cardaillac
- Service de gynécologie-obstétrique, CHU de Nantes, 44000 Nantes, France
| | | | - Patrick Chariot
- Département de médecine légale et sociale, Assistance publique-Hôpitaux de Paris, 93140 Bondy, France; Institut de recherche interdisciplinaire sur les enjeux sociaux, UMR 8156-997, UFR SMBH, université Sorbonne Paris Nord, 93000 Bobigny, France
| | - Romain Corroenne
- Service de gynécologue-obstétrique, CHU d'Angers, 49000 Angers, France
| | - Yohann Dabi
- Service de gynécologie-obstétrique et médecine de la reproduction, Sorbonne université-AP-HP-hôpital Tenon, 75020 Paris, France
| | - Laurence Dahlem
- Département universitaire de médecine générale, faculté de médecine, université de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux, France
| | - Sophie Frank
- Service d'oncogénétique, Institut Curie, 75005 Paris, France
| | - Anne Freyens
- Département universitaire de médecine générale (DUMG), université Paul-Sabatier, 31000 Toulouse, France
| | - Virginie Grouthier
- Service d'endocrinologie, diabétologie, nutrition et d'endocrinologie des gonades, Hôpital Haut Lévêque, Centre Hospitalo-universitaire régional de Bordeaux, 31000 Bordeaux, France; Université de Bordeaux, Inserm U1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Isabelle Hernandez
- Collège national des sages-femmes de France hébergé au Réseau de santé périnatal parisien (RSPP), 75010 Paris, France
| | - Elisabeth Iraola
- Institut de recherche interdisciplinaire sur les enjeux sociaux (IRIS), UMR 8156-997, CNRS U997 Inserm EHESS UP13 UFR SMBH, université Sorbonne Paris Nord, Paris, France; Direction de la protection maternelle et infantile et promotion de la santé, conseil départemental du Val-de-Marne, 94000 Créteil, France
| | - Marie Lambert
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalo-universitaire Pellegrin, 33000 Bordeaux, France
| | - Nadege Lauchet
- Groupe médical François-Perrin, 9, rue François-Perrin, 87000 Limoges, France
| | - Guillaume Legendre
- Service de gynécologue-obstétrique, CHU Angers, 49000 Angers, France; UMR_S1085, université d'Angers, CHU d'Angers, université de Rennes, Inserm, EHESP, Irset (institut de recherche en santé, environnement et travail), Angers, France
| | - Maela Le Lous
- Université de Rennes 1, Inserm, LTSI - UMR 1099, 35000 Rennes, France; Département de gynécologie et obstétrique, CHU de Rennes, 35000 Rennes, France
| | - Christine Louis-Vahdat
- Cabinet de gynécologie et obstétrique, 126, boulevard Saint-Germain, 75006 Paris, France
| | | | - Marine Masson
- Département de médecine générale, 86000 Poitiers, France
| | - Caroline Matteo
- Ecole de maïeutique, Aix Marseille Université, 13015 Marseille, France
| | - Anne Pinton
- Service de gynécologie-obstétrique, hôpital Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Sorbonne université, 75013 Paris, France
| | - Emmanuelle Sabbagh
- Unité de gynécologie médicale, hôpital Port-Royal, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital universitaire Paris centre (HUPC), 75014 Paris, France
| | - Camille Sallee
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 87000 Limoges, France
| | - Thibault Thubert
- Service de gynecologie-obstétrique, CHU de Nantes, 44000 Nantes, France; EA 4334, laboratoire mouvement, interactions, performance (MIP), Nantes université, 44322 Nantes, France
| | - Isabelle Heron
- Service d'endocrinologie, université de Rouen, hôpital Charles-Nicolle, 76000 Rouen, France; Cabinet médical, Clinique Mathilde, 76100 Rouen, France
| | - Anne-Cécile Pizzoferrato
- Service de gynécologie-obstétrique, hôpital universitaire de La Miletrie, 86000 Poitiers, France; Inserm CIC 1402, université de Poitiers, 86000 Poitiers, France
| | - France Artzner
- Ciane, Collectif interassociatif autour de la naissance, c/o Anne Evrard, 101, rue Pierre-Corneille, 69003 Lyon, France
| | - Arounie Tavenet
- Endofrance, Association de lutte contre l'endométriose, 3, rue de la Gare, 70190 Tresilley, France
| | - Camille Le Ray
- Maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, université Paris cité, FHU Prema, 75014 Paris, France
| | - Arnaud Fauconnier
- Service de gynécologie-obstétrique, centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France
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Roux L, Chiemlewski MC, Lassel L, Isly H, Enderle I, Beuchée A, Le Lous M. Trial of labor versus elective cesarean delivery for patients with two prior cesarean-sections: A retrospective propensity score analysis. Eur J Obstet Gynecol Reprod Biol 2023; 287:67-74. [PMID: 37295347 DOI: 10.1016/j.ejogrb.2023.05.038] [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: 02/24/2023] [Revised: 05/25/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Despite awareness of obstetricians to the constant increase in the number of cesarean sections in recent years, the fear of a uterine scar rupture is still present and influences the choice of the mode of delivery in patients with two previous cesarean sections. However, several clinical studies have suggested that, under certain conditions, vaginal birth after two cesarean sections is usually successful and safe. OBJECTIVE The objective of this study was to compare maternal and neonatal issues according to the planned mode of delivery in patients with two previous cesarean sections. METHODS It was a retrospective observational comparative study at Rennes University Hospital between January 1, 2013, and December 31, 2020. We performed a propensity score for the comparison of neonatal outcomes: cord pH, cord lactates, Apgar scores, transfer to neonatal unit and deaths, according to the planned delivery mode. Secondary outcomes were maternal issues: uterine rupture, post-partum hemorrhage, deaths. RESULTS A total of 410 patients with two previous cesarean section were eligible for our study. Prophylactic cesarean was performed in 358 cases (87.3%). Trial of labor was attempted in the 52 remaining patients (12.7%), 67.3 % of whom were successful. Neonatal weight, APGAR score at 1-5-10 min, and pH on cord blood were comparable in both groups. One case of uterine rupture occurred in the trial of labor group. CONCLUSION Trial of labor seems to be a reasonable option for women with two previous cesarean sections in a selected population.
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Affiliation(s)
- Léa Roux
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France
| | | | - Linda Lassel
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France
| | - Hélène Isly
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France
| | - Isabelle Enderle
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France; Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000, Rennes, France
| | - Alain Beuchée
- University of Rennes 1, INSERM, LTSI - UMR 1099, F35000, Rennes, France; Departement of Pediatrics, University Hospital of Rennes, France
| | - Maela Le Lous
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France; University of Rennes 1, INSERM, LTSI - UMR 1099, F35000, Rennes, France.
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8
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Enderle I, De Lauzun V, Metten MA, Monperrus M, Delva F, Blanc-Petitjean P, Dananche B, Paris C, Zaros C, Le Lous M, Béranger R, Garlantézec R. Maternal occupational exposure to organic solvents and intrauterine growth in the ELFE cohort. Environ Res 2023; 224:115187. [PMID: 36587719 DOI: 10.1016/j.envres.2022.115187] [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] [Received: 10/26/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND In developed countries, about 15% of women are occupationally exposed to solvents. Associations between this maternal occupational exposure and intrauterine fetal growth are inconsistent, but almost no existing study has investigated this relation by solvent family (oxygenated, petroleum, and chlorinated), although they may affect fetal growth differently. OBJECTIVES To investigate the relations between maternal occupational solvent exposure, by solvent family, and the risk of neonates born small for gestational age (SGA), or with low birthweight, or with small head circumference (HC). METHODS Among the 18,040 women enrolled in the Elfe rather than included in the Elfe birth cohort, we included 13,026 women who worked during pregnancy (72% of the cohort). Information about maternal occupations and industrial activities during pregnancy was collected by questionnaire at the maternity ward, and completed at 2-month when necessary. Using Matgéné job-exposure matrices, we assessed maternal occupational exposure to solvents. Logistic and multiple linear regressions were used to assess the association between maternal occupational solvent exposure and SGA status, birth weight, and HC. Analyses were conducted for exposure during pregnancy and also stratified by the trimester that pregnancy leave began. RESULTS We observed a higher risk of SGA newborns among mothers occupationally exposed during pregnancy to petroleum solvents (ORadjusted = 1.26; 95%CI: 1.01 to 1.57). Among women working until the third trimester of pregnancy, we observed a higher risk of SGA newborns to those occupationally exposed to oxygenated solvents (ORadjusted = 1.75; 95%CI: 1.11 to 2.75), a significantly lower birthweight for infants of mothers exposed to petroleum solvents (βadjusted = -47.37 g; -89.33 to -5.42), and a lower HC among newborns of those occupationally exposed to oxygenated solvents (βadjusted = -0.28; -0.49 to -0.07) and to chlorinated solvents (βadjusted = -0.29; -0.53 to -0.05). DISCUSSION Our results suggest that maternal occupational solvent exposure may influence fetal growth, especially exposure into the third trimester of pregnancy.
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Affiliation(s)
- Isabelle Enderle
- CHU Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000, Rennes, France; Department of Obstetrics and Gynecology and Reproductive Medicine, Anne de Bretagne University Hospital, Rennes, France.
| | - Virginie De Lauzun
- CHU Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000, Rennes, France
| | - Marie Astrid Metten
- CHU Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000, Rennes, France
| | - Marion Monperrus
- Department of Obstetrics and Gynecology and Reproductive Medicine, Anne de Bretagne University Hospital, Rennes, France
| | - Fleur Delva
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team EPICENE, UMR 1219, Bordeaux, F-33000, France
| | - Pauline Blanc-Petitjean
- CHU Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000, Rennes, France
| | - Brigitte Dananche
- CHU Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000, Rennes, France
| | - Christophe Paris
- CHU Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000, Rennes, France
| | - Cécile Zaros
- French Institute for Demographic Studies (Ined), French Institute for Medical Research and Health (Inserm), French Blood Agency, ELFE Joint Unit, F-75020, Paris, France
| | - Maela Le Lous
- Department of Obstetrics and Gynecology and Reproductive Medicine, Anne de Bretagne University Hospital, Rennes, France
| | - Rémi Béranger
- CHU Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000, Rennes, France; Department of Obstetrics and Gynecology and Reproductive Medicine, Anne de Bretagne University Hospital, Rennes, France
| | - Ronan Garlantézec
- CHU Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000, Rennes, France
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9
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Vetier O, Yanni MA, Lassel L, Isly H, Beuchee A, Nyangoh-Timoh K, Lavoue V, Beranger R, Le Lous M. Assessment of compliance with a color code protocol for non-elective cesarean section and its impact on time to delivery interval and neonatal outcomes. J Gynecol Obstet Hum Reprod 2023; 52:102520. [PMID: 36543301 DOI: 10.1016/j.jogoh.2022.102520] [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: 10/05/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION We set out to assess the compliance with a cesarean section color code protocol and its impact on maternal and neonatal outcomes since its implementation in our maternity ward. METHODS This was a retrospective study including a sample of 200 patients per year who underwent a non-elective cesarean section delivery in Rennes University Hospital from January 1, 2015 to December 31, 2018. Patients were grouped by year and by color code (red, orange or green). The main outcome was compliance with the protocol (color code in accordance with indication for cesarean section) and compliance with the corresponding decision-delivery interval. Secondary outcomes were maternal and neonatal outcomes. RESULTS Eight hundred patients were included during the study period. There was no significant difference in patient characteristics over the years. There was a significant improvement in protocol compliance: full compliance increased from 22.4% in 2015 to 76.5% in 2018 (p < 0.0001). The respect of the 15 min decision-delivery interval in red code protocol increased between 2015 and 2018 (p = 0.0020). CONCLUSION We observed a significant improvement in compliance with the color code protocol between 2015 and 2018 and in the 15 min decision-delivery deadline for the red code.
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Affiliation(s)
- Oriane Vetier
- Department of Obstetrics, Gynecology, and Human reproduction, University Hospital of Rennes, France
| | - Marie-Alice Yanni
- Department of Obstetrics, Gynecology, and Human reproduction, University Hospital of Rennes, France
| | - Linda Lassel
- Department of Obstetrics, Gynecology, and Human reproduction, University Hospital of Rennes, France
| | - Hélène Isly
- Department of Obstetrics, Gynecology, and Human reproduction, University Hospital of Rennes, France
| | - Alain Beuchee
- Department of Pediatry, University Hospital of Rennes, France; University of Rennes, INSERM, LTSI - UMR 1099, Rennes F-35000, France
| | - Krystel Nyangoh-Timoh
- Department of Obstetrics, Gynecology, and Human reproduction, University Hospital of Rennes, France; University of Rennes, INSERM, LTSI - UMR 1099, Rennes F-35000, France
| | - Vincent Lavoue
- Department of Obstetrics, Gynecology, and Human reproduction, University Hospital of Rennes, France; University of Rennes, INSERM, LTSI - UMR 1099, Rennes F-35000, France
| | - Rémi Beranger
- Department of Obstetrics, Gynecology, and Human reproduction, University Hospital of Rennes, France; University of Rennes, INSERM, EHESP, Irset-UMR_S, Rennes 1085, France
| | - Maela Le Lous
- Department of Obstetrics, Gynecology, and Human reproduction, University Hospital of Rennes, France; University of Rennes, INSERM, LTSI - UMR 1099, Rennes F-35000, France.
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Le Lous M, Baxter J, Nyangoh Timoh K. Madame Angélique du Coudray: Pioneer of medical simulation and unsung hero. J Gynecol Obstet Hum Reprod 2023; 52:102529. [PMID: 36566930 DOI: 10.1016/j.jogoh.2022.102529] [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: 11/24/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Maela Le Lous
- University of Rennes 1, INSERM, LTSI - UMR 1099, F35000 Rennes, France; Department of Obstetrics and Gynecology, University Hospital of Rennes, France.
| | - John Baxter
- University of Rennes 1, INSERM, LTSI - UMR 1099, F35000 Rennes, France
| | - Krystel Nyangoh Timoh
- University of Rennes 1, INSERM, LTSI - UMR 1099, F35000 Rennes, France; Department of Obstetrics and Gynecology, University Hospital of Rennes, France
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11
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Boulmedais M, Monperrus M, Corbel E, Blanc-Petitjean P, Lassel L, Béranger R, Timoh KN, Enderle I, Le Lous M. Predictive value of head-perineum distance measured at the initiation of the active second stage of labor on the mode of delivery: A prospective cohort study. Eur J Obstet Gynecol Reprod Biol 2023; 280:132-137. [PMID: 36463788 DOI: 10.1016/j.ejogrb.2022.11.020] [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: 09/23/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective was to assess the predictive value of head-perineum distance measured at the initiation of the active second stage of labor on the mode of delivery. MATERIAL AND METHODS It was a prospective cohort study in an academic Hospital of Rennes, France, from July 1, 2020 to April 4, 2021 including 286 full-term parturients who gave birth to a newborn in cephalic presentation. A double-blind ultrasound measurement of the head-perineum distance was performed during the second phase of labor within five minutes after the onset of pushing efforts. The primary outcome was the mode of delivery (spontaneous vaginal delivery versus instrumental vaginal delivery or cesarean section). We performed a multivariate analysis to determine the predictive value of the head-perineum distance by adjusting on potential confounders. RESULTS Overall, 199 patients delivered by spontaneous vaginal delivery, 80 by instrumental vaginal delivery, and seven by cesarean section. The head-perineum distance measured at the beginning of pushing efforts was predictive of the mode of delivery with a threshold at 44 mm (crude: sensitivity = 56.8 % and specificity = 79.3 %; adjusted: sensitivity = 79.4 % and specificity = 87.4 %). The risk of medical intervention was higher when the head-perineum distance is>44 mm with an adjusted OR of 2.78 [1.38; 5.76]. CONCLUSION The head-perineum distance measured at the initiation of the active second stage of labor is predictive of the mode of delivery. Head-perineum distance below 44 mm predicts a vaginal delivery with the best diagnostic performance, and optimizes the time to start pushing efforts.
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Affiliation(s)
- Myriam Boulmedais
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France
| | - Marion Monperrus
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France; Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Sante, Environnement et Travail) - UMR_S 1085, F-35000 Rennes, France
| | - Elise Corbel
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France
| | | | - Linda Lassel
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France
| | - Rémi Béranger
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France; Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Sante, Environnement et Travail) - UMR_S 1085, F-35000 Rennes, France
| | - Krystel Nyangoh Timoh
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France; University of Rennes 1, INSERM, LTSI - UMR 1099, F35000 Rennes, France
| | - Isabelle Enderle
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France; Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Sante, Environnement et Travail) - UMR_S 1085, F-35000 Rennes, France
| | - Maela Le Lous
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France; University of Rennes 1, INSERM, LTSI - UMR 1099, F35000 Rennes, France.
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12
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Enderle I, Costet N, Cognez N, Zaros C, Caudeville J, Garlantezec R, Chevrier C, Nougadere A, De Lauzon-Guillain B, Le Lous M, Beranger R. Prenatal exposure to pesticides and risk of preeclampsia among pregnant women: Results from the ELFE cohort. Environ Res 2021; 197:111048. [PMID: 33766571 DOI: 10.1016/j.envres.2021.111048] [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] [Received: 11/01/2020] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Preeclampsia is a pregnancy-specific syndrome caused by abnormal placentation. Although environmental chemicals, including some pesticides, are suspected of impairing placentation and promoting preeclampsia, its relationship with preeclampsia has been insufficiently explored. OBJECTIVES We aimed to investigate the relation between non-occupational exposure to pesticides during pregnancy and the risk of preeclampsia. METHODS The study cohort comprised 195 women with and 17,181 without preeclampsia from the ELFE birth cohort. We used toxicogenomic approaches to select 41 pesticides of interest for their possible influence on preeclampsia. We assessed household pesticide use (self-reported data), environmental exposure to agricultural pesticides (geographic information systems), and dietary exposure (food-frequency questionnaire with data from monitoring pesticide residues in food and water). Dietary exposures to pesticides were grouped into clusters of similar exposures to resolve collinearity issues. For each exposure source, pesticides were mutually adjusted, and odds ratios estimated with logistic regression models. RESULTS The quantity of prochloraz applied within a kilometer of the women's homes was higher in women with than without preeclampsia (fourth quartile vs. others; adjusted odds ratio [aOR] = 1.54; 95%CI: 1.02, 2.35), especially when preeclampsia was diagnosed before 34 weeks of gestation (aOR = 2.25; 95%CI: 1.01, 5.06). The reverse was observed with nearby cypermethrin application (aOR = 0.59, 95%CI: 0.36, 0.96). In sensitivity analyses, women with preeclampsia receiving antihypertensive treatment had a significantly higher probability of using herbicides at home during pregnancy than women without preeclampsia (aOR = 2.20; 95%CI: 1.23, 3.93). No statistically significant association was found between dietary exposure to pesticide residues and preeclampsia. DISCUSSION While the most of the associations examined remained statistically non-significant, our results suggest the possible influence on preeclampsia of residential exposures to prochloraz and some herbicides. These estimations are supported by toxicological and mechanistic data.
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Affiliation(s)
- Isabelle Enderle
- CHU Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000, Rennes, France; Department of Obstetrics and Gynecology and Reproductive Medicine, Anne de Bretagne University Hospital, Rennes, France.
| | - Nathalie Costet
- Univ Rennes, Inserm, EHESP, Irset - UMR_S 1085, F-35000, Rennes, France
| | - Noriane Cognez
- Univ Rennes, Inserm, EHESP, Irset - UMR_S 1085, F-35000, Rennes, France
| | - Cécile Zaros
- French Institute for Demographic Studies (Ined), French Institute for Medical Research and Health (Inserm), French Blood Agency, ELFE Joint Unit, F-75020, Paris, France
| | - Julien Caudeville
- INERIS (French National Institute for Industrial Environment and Risks), 60550, Verneuil-en-Halatte, France
| | - Ronan Garlantezec
- CHU Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000, Rennes, France
| | - Cécile Chevrier
- Univ Rennes, Inserm, EHESP, Irset - UMR_S 1085, F-35000, Rennes, France
| | - Alexandre Nougadere
- ANSES, Risk Assessment Department, 14 Rue Pierre et Marie Curie, F-94701, Maisons-Alfort, France
| | | | - Maela Le Lous
- Department of Obstetrics and Gynecology and Reproductive Medicine, Anne de Bretagne University Hospital, Rennes, France
| | - Rémi Beranger
- CHU Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000, Rennes, France; Department of Obstetrics and Gynecology and Reproductive Medicine, Anne de Bretagne University Hospital, Rennes, France
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Le Lous M, Despinoy F, Klein M, Fustec E, Lavoue V, Jannin P. Impact of Physician Expertise on Probe Trajectory During Obstetric Ultrasound: A Quantitative Approach for Skill Assessment. Simul Healthc 2021; 16:67-72. [PMID: 32502122 DOI: 10.1097/sih.0000000000000465] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The objective of the study was to identify objective metrics to evaluate the significance of a sonographer's expertise on trajectories of ultrasound probe during obstetric ultrasound training procedures. METHODS This prospective observational study was conducted at Rennes University Hospital, Department of Obstetrics and Gynecology. We evaluated a panel of sonographers (expert, intermediate, and novice) in performing 3 tasks (brain, heart, and spine) with an obstetric ultrasound simulator (Scantrainer; Medaphor, Cardiff, UK). The trajectories of the probe were logged and recorded by a custom data acquisition software. We computed metrics on the trajectories (duration, path length, average velocity, average acceleration, jerk, working volume) to compare the 3 groups and identify discriminating metrics. RESULTS A total of 33 participants were enrolled: 5 experts, 12 intermediates, and 16 novices. Discriminatory metrics were observed among the 3 levels of expertise for duration, velocity, acceleration, and jerk for brain and spine tasks. Working volume was discriminatory for the brain and the heart task. Path length was discriminatory for the brain task. CONCLUSIONS Our results suggest a relationship between the sonographer's level of expertise and probe trajectory metrics. Such measurements could be used as an indicator of sonographer proficiency and contribute to automatic analysis of probe trajectory to evaluate the quality of sonography and the sonographer.
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Affiliation(s)
- Maela Le Lous
- From the Universty of Rennes 1 (M.L.L. F.D., P.J.), INSERM, LTSI - UMR 1099; Department of Obstetrics and Gynecology (M.L.L. M.K., E.F., V.L.), University Hospital of Rennes; and INSERM 1242 (V.L.), Chemistry, Oncogenesis, Stress and Signaling, Rennes, France
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Dion L, Le Lous M, Nyangoh Timoh K, Levêque J, Arnaud A, Henri-Malbert C, Foucher F, Boudjema K, Bendavid C, Vigneau C, Legembre P, Val-Laillet D, Lavoué V. Single bilateral ovarian venous return in uterine transplant: Validation in an orthotopic auto-transplant model in the Yucatan minipig. J Gynecol Obstet Hum Reprod 2021; 50:102059. [PMID: 33421624 DOI: 10.1016/j.jogoh.2021.102059] [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] [Received: 09/03/2020] [Revised: 12/12/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Uterine transplant (UT) represents an opportunity to treat absolute uterine infertility. However, the use of uterine veins for venous return, in addition to ovarian veins, significantly increases the risk of ureteral wounds in the living donor and UT time for the recipient. Our aim was to demonstrate that dual ovarian venous return is sufficient for graft viability and survival. METHODS Uterine orthotopic auto-transplant was performed under general anaesthesia in six Yucatan minipig sows. The uterus graft was implanted with termino-lateral anastomoses between the ovarian and external iliac veins, and between the uterine and external iliac arteries, respectively. RESULTS The macroscopic physical aspect of the graft was adequate in 83 % of the sows (5/6) 30 min after reperfusion with a surgical time of 439±54 min (mean anastomosis time: 153±49 min). Two sows died the day after surgery. In the four remaining sows, two uteri were necrotic and two were adequately vascularized on Day 7. CONCLUSIONS the learning curve was relatively fast, the sole use of bilateral ovarian venous return is possible and might reduce post-surgery morbidity in human living donors as well as UT time for the recipient.
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Affiliation(s)
- Ludivine Dion
- Rennes University Hospital, Department of Gynecology, Hôpital Sud, France; INSERM, U1242, COS, Rennes, France.
| | - Maela Le Lous
- Rennes University Hospital, Department of Gynecology, Hôpital Sud, France
| | | | - Jean Levêque
- Rennes University Hospital, Department of Gynecology, Hôpital Sud, France; INSERM, U1242, COS, Rennes, France
| | - Alexis Arnaud
- Rennes University Hospital, Department of Paediatrics, Hôpital Sud, France; INRA, INSERM, Univ Rennes, Nutrition Metabolisms and Cancer (NuMeCan), Rennes, St Gilles, France
| | | | - Fabrice Foucher
- Rennes University Hospital, Department of Gynecology, Hôpital Sud, France
| | - Karim Boudjema
- Rennes University Hospital, Departement of Hepatobile Surgery and Liver Transplantation, Pontchaillou, France
| | - Claude Bendavid
- Rennes University Hospital, Departement of Biochemistry, Pontchaillou, France
| | - Cécile Vigneau
- Rennes University Hospital, Departement of Nephrology, Pontchaillou, France
| | | | - David Val-Laillet
- INRA, INSERM, Univ Rennes, Nutrition Metabolisms and Cancer (NuMeCan), Rennes, St Gilles, France
| | - Vincent Lavoué
- Rennes University Hospital, Department of Gynecology, Hôpital Sud, France; INSERM, U1242, COS, Rennes, France
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Le Lous M, Klein M, Tesson C, Berthelemy J, Lavoue V, Jannin P. Metrics used to evaluate obstetric ultrasound skills on simulators: A systematic review. Eur J Obstet Gynecol Reprod Biol 2020; 258:16-22. [PMID: 33387982 DOI: 10.1016/j.ejogrb.2020.12.034] [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] [Received: 10/03/2020] [Revised: 12/08/2020] [Accepted: 12/19/2020] [Indexed: 11/25/2022]
Abstract
Obstetric ultrasound simulators are now used for training and evaluating OB/GYN students but there is a lack of literature about evaluation metrics in this setting. In this literature review, we searched MEDLINE and the COCHRANE database using the keywords: (Obstetric OR Fetal) AND (Sonography OR Ultrasound) AND Simulation. Of a total of 263 studies screened, we selected nine articles from the title and the abstract in PubMed, in the past 5 years. Two more article were added from bibliographies. A total of 11 articles were therefore included. from which nine articles were selected from the title and the abstract in PubMed. Two more articles were added from the bibliographies For each study, data about the type of simulation, and the metrics (qualitative or quantitative) used for assessment were collected. The selection of studies shows that evaluation criteria for ultrasound training were qualitative metrics (binary success/fail exercise ; dexterity quoted by an external observer ; Objective Structured Assessment of Ultrasound Skills (OSAUS) Score ; quality of images according to Salomon's score) or quantitative criteria (Accuracy of Biometry - Simulator generated metrics). Most studies used a combination of both. To date, simulator metrics used to discriminate ultrasound skills are performance score quoted by external observers and image quality scoring. Whether probe trajectory metrics can be used to discriminate skills is unknown.
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Affiliation(s)
- Maela Le Lous
- Univ Rennes, INSERM, LTSI - UMR 1099, F35000, Rennes, France; Department of Obstetrics and Gynecology, University Hospital of Rennes, France; CIC Inserm 1414, University Hospital of Rennes, University of Rennes 1, Rennes, France.
| | - Margaux Klein
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France
| | - Caroline Tesson
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France
| | | | - Vincent Lavoue
- Department of Obstetrics and Gynecology, University Hospital of Rennes, France; CIC Inserm 1414, University Hospital of Rennes, University of Rennes 1, Rennes, France
| | - Pierre Jannin
- Univ Rennes, INSERM, LTSI - UMR 1099, F35000, Rennes, France
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Adam MJ, Enderle I, Le Bouar G, Cabaret-Dufour AS, Tardif C, Contin L, Arnaud A, Proisy M, Jaillard S, Pasquier L, Le Lous M. Performance of diagnostic ultrasound to identify causes of hydramnios. Prenat Diagn 2020; 41:111-122. [PMID: 32920845 DOI: 10.1002/pd.5825] [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: 06/18/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 11/06/2022]
Abstract
INTRODUCTION We aimed to assess the diagnostic yield of ultrasonography in the identification of the etiology of hydramnios, and the added value of MRI or amniocentesis. METHODS We conducted a single-center retrospective study including pregnancies with confirmed hydramnios (defined as deepest pocket ≥8 cm) between January 2013 and May 2017. Twin pregnancies, secondary hydramnios discovered after the diagnosis of a causal pathology, and pregnancies of unknown outcome were excluded. All pregnancies underwent a targeted scan, and selected cases underwent MRI or amniocentesis. RESULTS A total of 158 patients with confirmed hydramnios were included. Hydramnios was associated with a fetal pathology in 37 cases (23.4%), with diabetes in 39 (24.6%), isolated macrosomia in 16 (10.1%), and considered idiopathic in 66 (41.7%). Ultrasonography established a diagnosis of the underlying pathology in 73% of cases. Amniocentesis was done in 31 cases (20%) and it allowed diagnosis of chromosome anomalies, esophageal atresia, myotonic dystrophy congenital type, Prader-Willi syndrome, and Bartter syndrome. MRI was done in 15 cases (10%) and it allowed one additional diagnosis of esophageal atresia. The diagnostic yields of MRI and amniocentesis were 91.7% and 95.2%, respectively. There were five false positive diagnoses at ultrasonography, and one false positive diagnosis at MRI. CONCLUSION Hydramnios can be associated with a wide variety of underlying pathologies. Diagnostic ultrasound can attain a diagnosis in the majority of cases. Amniocentesis offers a valuable complementary assessment.
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Affiliation(s)
- Marie-José Adam
- Department of Obstetrics and Gynecology, University Hospital of Rennes, Rennes, France
| | - Isabelle Enderle
- Department of Obstetrics and Gynecology, University Hospital of Rennes, Rennes, France.,CIC Inserm 1414, University Hospital of Rennes, University of Rennes, Rennes, France
| | - Gwenaëlle Le Bouar
- Department of Obstetrics and Gynecology, University Hospital of Rennes, Rennes, France
| | | | - Cécile Tardif
- Department of Obstetrics and Gynecology, University Hospital of Rennes, Rennes, France
| | - Laurence Contin
- Department of Obstetrics and Gynecology, University Hospital of Rennes, Rennes, France
| | - Alexis Arnaud
- Department of Pediatric Surgery, University Hospital of Rennes, Rennes, France
| | - Maïa Proisy
- Department of Radiology, University Hospital of Rennes, Rennes, France
| | - Sylvie Jaillard
- Department of Cytogenetics, University Hospital of Rennes, Rennes, France
| | - Laurent Pasquier
- Department of Genetics, University Hospital of Rennes, Rennes, France
| | - Maela Le Lous
- Department of Obstetrics and Gynecology, University Hospital of Rennes, Rennes, France.,CIC Inserm 1414, University Hospital of Rennes, University of Rennes, Rennes, France
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Marguillier E, Beranger R, Garlantezec R, Levêque J, Lassel L, Rousseau C, Lavoue V, Le Lous M. Endocrine disruptors and pregnancy: Knowledge, attitudes and practice of perinatal health professionals. A French multicentre survey. Eur J Obstet Gynecol Reprod Biol 2020; 252:233-238. [PMID: 32623255 DOI: 10.1016/j.ejogrb.2020.06.032] [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] [Received: 03/20/2020] [Revised: 06/08/2020] [Accepted: 06/15/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Endocrine disruptors (ED) such as phthalates or bisphenol A are ubiquitous and pregnant women and children are particularly vulnerable. Perinatal health professionals are well-placed to inform pregnant women about the risks. We set out to evaluate perinatal health professionals' knowledge of ED and the information they give during pregnancy. MATERIAL AND METHODS We invited midwives, obstetrician-gynecologists (OB/GYN), general practitioners (GP), and general medicine and OB/GYN residents to respond to a short Google survey between August and November 2018 by email using perinatal network. RESULTS Out of 4100 questionnaires sent, 1650 completed questionnaires were returned and analyzed. The participation rate was 41 % with the following distribution: midwives (n = 1215, 74 %), OB/GYN residents (n = 102, 6 %), OB/GYNs (n = 129, 8 %), GPs and residents in general medicine (n = 204, 12 %), in private and public hospitals in France. Only 181 of the respondents thought they were well-informed about ED including 160 midwives (11 %). Most of the responding professionals reported not to give any information during pregnancy (n = 946, 57.3 %). Midwives (n = 452, 37.2 %), people >50 years (n = 104, 41.6 %) and people working in private structures (n = 451, 34.9 %) were the most likely to give information, mainly orally. Overall, 346 (74.2 %) of the respondents considered that information about health risks of endocrine disruptors was important and most of them wished they were better informed (n = 1532, 92.9 %). CONCLUSION Our study suggests that perinatal health professionals do not have enough medical information, training or tools to communicate about the risks associated with ED to pregnant women and consequently cannot educate them. Research is needed to further explore the risks and support prevention of environmental exposure for pregnant women.
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Affiliation(s)
- Elodie Marguillier
- University Hospital of Rennes, 16 boulevard de Bulgarie, Rennes, 35 000, France
| | - Remi Beranger
- University Hospital of Rennes, 16 boulevard de Bulgarie, Rennes, 35 000, France
| | - Ronan Garlantezec
- University Hospital of Rennes, 16 boulevard de Bulgarie, Rennes, 35 000, France
| | - Jean Levêque
- University Hospital of Rennes, 16 boulevard de Bulgarie, Rennes, 35 000, France
| | - Linda Lassel
- University Hospital of Rennes, 16 boulevard de Bulgarie, Rennes, 35 000, France
| | - Chloe Rousseau
- University Hospital of Rennes, 16 boulevard de Bulgarie, Rennes, 35 000, France
| | - Vincent Lavoue
- University Hospital of Rennes, 16 boulevard de Bulgarie, Rennes, 35 000, France
| | - Maela Le Lous
- University Hospital of Rennes, 16 boulevard de Bulgarie, Rennes, 35 000, France.
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Delplanque S, Le Lous M, Flévin M, Bauville E, Moquet PY, Dion L, Fauconnier A, Guérin S, Leveque J, Lavoué V, Nyangoh Timoh K. Effectiveness of conservative medical treatment for non-tubal ectopic pregnancies: a multicenter study. J Gynecol Obstet Hum Reprod 2020; 49:101762. [PMID: 32325266 DOI: 10.1016/j.jogoh.2020.101762] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/04/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the effectiveness of conservative treatment for the management of non-tubal ectopic pregnancies (NTEP) METHODS: Retrospective cohort study in three centers (two referral centers) of patients managed for NTEP diagnosed by 2D or 3D ultrasonograhy. Patients underwent one of the following: expectant management, systemic methotrexate (MTX) injection, local MTX injection, combined MTX injection (local and systemic), local injection of hyperosmolar glucose, or misoprostol administration. The primary endpoint was final success defined by resolution of hCG level without need for emergency surgical treatment. Sixty-four patients diagnosed with NTEP were included: 37 (57%) had an interstitial pregnancy, 23 (35.9%) a cesarean scar pregnancy, two (3.1%) a cervical pregnancy and two (3.1%) an ovarian pregnancy. RESULTS Six patients (9.4%) underwent expectant management, 24 (37.5%) a systemic MTX injection, 28 (43.8%) a local injection of MTX, three (4.7%) a combined MTX injection, one (1.6%) a local injection of hyperosmolar glucose (1.6%), and two (3.1%) were administered misoprostol. The median age was 32 years (22-45) and mean follow-up was 41 months. The final success rate overall was 92.2%: 100% for expectant management, 87.5% for systemic MTX, 96.4% for local MTX, 100% for combined injection of MTX, 100% for local injection of hyperosmolar glucose, and 50% for misoprostol. No patient required a hysterectomy. Nine (14.1%) patients required surgery, including five (7.8% (5/64)) following a rupture of the NTEP. CONCLUSIONS Our results suggest that conservative medical management of NTEP is effective and safe and should be the first-line treatment for pauci-symptomatic patients with an NTEP.
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Affiliation(s)
- Sophie Delplanque
- Department of Obstetrics and Gynecology, CHU Rennes Hospital, 35000 Rennes, France; Université de Rennes 1 : 2 avenue de Professeur Léon Bernard, 35000, Rennes, France
| | - Maela Le Lous
- Department of Obstetrics and Gynecology, CHU Rennes Hospital, 35000 Rennes, France; Université de Rennes 1 : 2 avenue de Professeur Léon Bernard, 35000, Rennes, France; SAFE CIC 1414 Thematic Team, University Hospital Rennes, Rennes, France; INSERM, UMR 1099, Rennes, F-35000, France; Université de Rennes 1, LTSI, Rennes, F-35000, France
| | - Marie Flévin
- Department of Obstetrics and Gynecology, CHU Rennes Hospital, 35000 Rennes, France
| | - Estelle Bauville
- Department of Obstetrics and Gynecology, CHU Rennes Hospital, 35000 Rennes, France; Department of Gynecology and Obstetrics, CHI Poissy-St-Germain, 78300 Poissy, France; SAFE CIC 1414 Thematic Team, University Hospital Rennes, Rennes, France
| | - Pierre Yves Moquet
- Department of Gynecology and Obstetrics, Clinique mutualiste La sagesse, 35 000 Rennes, France
| | - Ludivine Dion
- Department of Obstetrics and Gynecology, CHU Rennes Hospital, 35000 Rennes, France; Université de Rennes 1 : 2 avenue de Professeur Léon Bernard, 35000, Rennes, France; SAFE CIC 1414 Thematic Team, University Hospital Rennes, Rennes, France
| | - Arnaud Fauconnier
- Department of Gynecology and Obstetrics, Clinique mutualiste La sagesse, 35 000 Rennes, France
| | - Sonia Guérin
- Department of Obstetrics and Gynecology, CHU Rennes Hospital, 35000 Rennes, France; Université de Rennes 1 : 2 avenue de Professeur Léon Bernard, 35000, Rennes, France
| | - Jean Leveque
- Department of Obstetrics and Gynecology, CHU Rennes Hospital, 35000 Rennes, France; Université de Rennes 1 : 2 avenue de Professeur Léon Bernard, 35000, Rennes, France; SAFE CIC 1414 Thematic Team, University Hospital Rennes, Rennes, France
| | - Vincent Lavoué
- Department of Obstetrics and Gynecology, CHU Rennes Hospital, 35000 Rennes, France; Université de Rennes 1 : 2 avenue de Professeur Léon Bernard, 35000, Rennes, France; SAFE CIC 1414 Thematic Team, University Hospital Rennes, Rennes, France
| | - Krystel Nyangoh Timoh
- Department of Obstetrics and Gynecology, CHU Rennes Hospital, 35000 Rennes, France; Université de Rennes 1 : 2 avenue de Professeur Léon Bernard, 35000, Rennes, France; SAFE CIC 1414 Thematic Team, University Hospital Rennes, Rennes, France; INSERM, UMR 1099, Rennes, F-35000, France; Université de Rennes 1, LTSI, Rennes, F-35000, France
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Enderle I, Dion L, Bauville E, Moquet PY, Leveque J, Lavoue V, Lous ML, Nyangoh-Timoh K. Surgical management of isthmocele symptom relief and fertility. Eur J Obstet Gynecol Reprod Biol 2020; 247:232-237. [DOI: 10.1016/j.ejogrb.2020.01.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 01/18/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
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Le Lous M, Coulais C, Boyer L, Denoel S, Leveque J, Nyangoh Timoh K, Lavoue V. Who are the minors seeking an abortion for an unplanned pregnancy? A French observational study. J Gynecol Obstet Hum Reprod 2019; 48:643-647. [DOI: 10.1016/j.jogoh.2019.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/05/2019] [Accepted: 04/09/2019] [Indexed: 11/25/2022]
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Bastin A, Scanff A, Fraize S, Hild JC, Lous ML, Lavoue V, Ruelle Y, Chaaban S. Direct vs. standard method of insertion of an intrauterine contraceptive device: insertion pain and outcomes at 6 months. EUR J CONTRACEP REPR 2019; 24:399-406. [DOI: 10.1080/13625187.2019.1659951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Alexandre Scanff
- Department of Epidemiology and Public Health, Rennes University Hospital, Rennes, France
| | | | | | - Maela Le Lous
- Department of Gynaecology, Rennes University Hospital, Rennes, France
| | - Vincent Lavoue
- Department of Gynaecology, Rennes University Hospital, Rennes, France
- School of Medicine, University of Rennes 1, Rennes, France
- Inserm U1242, Rennes, France
| | - Yannick Ruelle
- Department of General Practice, UFR SMBH, University of Paris 13, Bobigny, France
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Abstract
OBJECTIVES The main aim of the study was to establish a threshold for serum human chorionic gonadotropin (hCG) level that ruled out ongoing pregnancy after induced medical abortion (MA). The secondary aim was to discover risk factors for the need for uterine aspiration. METHODS This prospective study included women who underwent MA with mifepristone-misoprostol at ≤9 weeks of gestation between 2012 and 2014. Serum hCG levels were measured 14-21 days after MA. The main outcome measure, ongoing pregnancy, was defined as the presence of an embryo with cardiac activity on transvaginal ultrasonography after MA. The receiver operating characteristic curve was plotted to determine the optimal serum hCG threshold. Risk factors for the need for uterine aspiration were calculated using multivariate logistic regression and expressed as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS The study included 814 women. Mean gestational age was 46.5 ± 7.4 days for ongoing pregnancies and 44.2 ± 4.8 days for MA success (p = .43). The ongoing pregnancy rate after MA was 0.9%. A serum hCG threshold ≥900 IU/l to diagnose ongoing pregnancy gave 100% sensitivity and 81.5% specificity, compared with 85.7% sensitivity and 83.5% specificity using a threshold ≥1000 IU/l. Independent risk factors for uterine aspiration requirement were: gravidity (OR 3.8; 95% CI 1.1, 13.2; p = .001), gestational age >6 weeks (OR 6.0; 95% CI 1.8, 6.0; p = .006) and previous surgical abortion (OR 2.4; 95% CI 1.1, 5.2; p < .001). CONCLUSION Serum hCG measurement <900 IU/l, 14-21 days after MA, is an efficient strategy for excluding ongoing pregnancy after first trimester MA.
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Affiliation(s)
- Maela Le Lous
- a Département de Gynécologie, Obstétrique et Médecine de la Reproduction, CHU de Rennes, Hôpital Sud , Rennes , France.,b Faculté de Médecine , Université de Rennes 1 , Rennes , France
| | - Anne-Claire Gallinand
- a Département de Gynécologie, Obstétrique et Médecine de la Reproduction, CHU de Rennes, Hôpital Sud , Rennes , France.,b Faculté de Médecine , Université de Rennes 1 , Rennes , France
| | - Bruno Laviolle
- b Faculté de Médecine , Université de Rennes 1 , Rennes , France.,c Service de Pharmacologie, CIC Inserm , CHU de Rennes, Pontchaillou , Rennes , France
| | - Lucas Peltier
- b Faculté de Médecine , Université de Rennes 1 , Rennes , France.,d Service de Biochimie , CHU de Rennes, Pontchaillou , Rennes , France
| | - Krystel Nyangoh Timoh
- a Département de Gynécologie, Obstétrique et Médecine de la Reproduction, CHU de Rennes, Hôpital Sud , Rennes , France.,b Faculté de Médecine , Université de Rennes 1 , Rennes , France
| | - Vincent Lavoué
- a Département de Gynécologie, Obstétrique et Médecine de la Reproduction, CHU de Rennes, Hôpital Sud , Rennes , France.,b Faculté de Médecine , Université de Rennes 1 , Rennes , France
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Delplanque S, Le Lous M, Proisy M, Joueidi Y, Bauville E, Rozel C, Beraud E, Bruneau B, Levêque J, Lavoué V, Nyangoh Timoh K. Fertility, Pregnancy, and Clinical Outcomes after Uterine Arteriovenous Malformation Management. J Minim Invasive Gynecol 2019; 26:153-161. [DOI: 10.1016/j.jmig.2018.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/14/2018] [Accepted: 05/02/2018] [Indexed: 02/07/2023]
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Cadoret F, Parinaud J, Bettiol C, Pienkowski C, Letur H, Ohl J, Sentilhes L, Papaxanthos A, Winer N, Mathieu d'Argent E, Catteau-Jonard S, Chauleur C, Biquard F, Hieronimus S, Pimentel C, Le Lous M, Fontaine N, Chevreau J, Parant O. Pregnancy outcome in Turner syndrome: A French multi-center study after the 2009 guidelines. Eur J Obstet Gynecol Reprod Biol 2018; 229:20-25. [PMID: 30096465 DOI: 10.1016/j.ejogrb.2018.08.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE This study aimed to assess the application of the French guidelines for pregnancies in Turner syndrome (TS) and their impact on perinatal prognosis. STUDY DESIGN We performed a French multi-center retrospective study (14 centers), including TS pregnant patients (spontaneously or by Assisted Reproductive Technology (ART)) between January 2006 and July 2017. Only clinical pregnancies were analyzed. The adjustment of medical follow-up modalities to French guidelines was evaluated for all pregnancies after 2009. Pregnancies from oocyte donation (OD) after 2009 were compared to those of a cohort of TS pregnancies obtained by OD before 2009, which were reported by the French Study Group for Oocyte Donation. RESULTS One hundred seventy pregnancies in 103 patients were included: 35 spontaneous, 5 by means of intra-conjugal ART, and 130 with OD. No serious maternal complications were observed. We reported two stillbirths and one intra uterine fetal death. The French guidelines were partially respected. The preconceptional assessment was carried out in 74% of cases. Cardiology follow-up during pregnancy was performed in accordance with guidelines in 74% of patients. Postpartum cardiac ultrasonography was performed in 45% of pregnancies but only in 11% within 8 days post-partum. When compared to the 2009 historical cohort, the rates of high blood pressure (19% vs. 38%; p < 0.005) pre-eclampsia (8% vs. 21%; p < 0.005) and prematurity <35 weeks (15% vs 38%; p < 0.0001) were lower. CONCLUSIONS The implementation of guidelines has allowed the standardization of TS pregnancy care and improved perinatal indicators for both mothers and children. However, an effort must be done, in a postpartum survey.
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Affiliation(s)
- Florence Cadoret
- Department of Obstetrics, Gynecology and Reproductive Medicine, Toulouse University Hospital, Toulouse, France
| | - Jean Parinaud
- Department of Obstetrics, Gynecology and Reproductive Medicine, Toulouse University Hospital, Toulouse, France; EA 3694 Human Fertility Research Group, University of Toulouse III, France.
| | - Celia Bettiol
- Department of Obstetrics, Gynecology and Reproductive Medicine, Toulouse University Hospital, Toulouse, France
| | - Catherine Pienkowski
- Reference Center for Rare Gynecological Pathologies, Children's Hospital, Toulouse University Hospital, Toulouse, France
| | - Helene Letur
- Fertility Center, Institut Mutualiste Montsouris, Paris, France
| | - Jeanine Ohl
- Department of Obstetrics, Gynecology and Reproductive Medicine, Strasbourg University Hospital, Strasbourg, France
| | - Loïc Sentilhes
- Department of Obstetrics, Gynecology and Reproductive Medicine, Bordeaux University Hospital, Bordeaux, France
| | - Aline Papaxanthos
- Department of Obstetrics, Gynecology and Reproductive Medicine, Bordeaux University Hospital, Bordeaux, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, Nantes University Hospital, and UMR 1280 Physiologie des Adaptations Nutritionnelles, Nantes University, Nantes, France
| | | | | | - Celine Chauleur
- Department of Gynecology and Obstetrics, Saint-Etienne University Hospital, and INSERM U1059, Saint-Etienne, France
| | - Florence Biquard
- Department of Gynecology and Obstetrics, Angers University Hospital, Angers, France
| | - Sylvie Hieronimus
- Department of Endocrinology, Diabetology and Reproductive Medicine, Nice University Hospital, Nice, France
| | - Celine Pimentel
- Department of Obstetrics and Gynecology and Reproductive Medicine, Anne de Bretagne University Hospital, Rennes, France
| | - Maela Le Lous
- Department of Obstetrics and Gynecology and Reproductive Medicine, Anne de Bretagne University Hospital, Rennes, France
| | - Nathalie Fontaine
- Department of Gynecology, La Reunion University Hospital, La Reunion, France
| | - Julien Chevreau
- Department of Obstetrics and Obstetrics and Gynecology, Amiens University Hospital, Amiens, France
| | - Olivier Parant
- Department of Obstetrics, Gynecology and Reproductive Medicine, Toulouse University Hospital, Toulouse, France; UMR1027, University of Toulouse III, France
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Le Lous M, Mediouni I, Chalouhi G, Salomon LJ, Bussières L, Carrier A, Bernard JP, Ville Y. Impact of laser therapy for twin-to-twin transfusion syndrome on subsequent pregnancy. Prenat Diagn 2018; 38:293-297. [PMID: 29417606 DOI: 10.1002/pd.5227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/19/2018] [Accepted: 01/20/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The objective of our study was to determine the impact of laser therapy for twin-to-twin transfusion syndrome (TTTs) on subsequent pregnancies. METHODS This was a monocentric retrospective observational study. Women treated by laser fetoscopy for TTTs were asked to answer a postal questionnaire about subsequent pregnancies. The primary outcome was fecundity (number of pregnancies and time to pregnancy). We also assessed pregnancy complications, birth weight, and gestational age at delivery. Pregnancy complications included the following: threatened preterm labor, preeclampsia, placenta accreta, postpartum hemorrhage, and psychological disorders. Our study population was compared with an external control group made up of mothers of monochorionic twins without TTTs. RESULTS We included 122 cases managed at the Necker Hospital between 2008 and 2012 and 39 controls. The median conception time was longer in the TTTs group (6.4 ± 11.1 versus 2 ± 1.6 months, P = .03). The numbers of live childbirths at the end of those pregnancies were equivalent (77.6% versus 66.7%, P = .56). Birth weight (3317 ± 726 versus 3240 ± 382 g, P = .81) and gestational age at delivery (38.2 ± 6.8 WG versus 39.5 ± 1.2 WG, P = .64) were similar, with no increase of obstetrical complications compared with the control group. DISCUSSION Twin-to-twin transfusion syndrome and its treatment do not seem to impact subsequent pregnancies.
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Affiliation(s)
- Maela Le Lous
- Department of Obstetrics and Gynecology, University Hospital of Rennes, Rennes, France
| | - Imen Mediouni
- Department of Obstetrics and Fetal Therapy, AP-HP, Necker-Enfants Malades Hospital, Paris, France
| | - Gihad Chalouhi
- Department of Obstetrics and Fetal Therapy, AP-HP, Necker-Enfants Malades Hospital, Paris, France.,Sorbonne Paris-Cité, Paris Descartes University, Paris, France
| | - Laurent J Salomon
- Department of Obstetrics and Fetal Therapy, AP-HP, Necker-Enfants Malades Hospital, Paris, France.,Sorbonne Paris-Cité, Paris Descartes University, Paris, France
| | - Laurence Bussières
- Department of Obstetrics and Fetal Therapy, AP-HP, Necker-Enfants Malades Hospital, Paris, France
| | - Aude Carrier
- Department of Obstetrics and Fetal Therapy, AP-HP, Necker-Enfants Malades Hospital, Paris, France
| | - Jean-Pierre Bernard
- Department of Obstetrics and Fetal Therapy, AP-HP, Necker-Enfants Malades Hospital, Paris, France
| | - Yves Ville
- Department of Obstetrics and Fetal Therapy, AP-HP, Necker-Enfants Malades Hospital, Paris, France.,Sorbonne Paris-Cité, Paris Descartes University, Paris, France
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Puget C, Joueidi Y, Bauville E, Laviolle B, Bendavid C, Lavoué V, Le Lous M. Serial hCG and progesterone levels to predict early pregnancy outcomes in pregnancies of uncertain viability: A prospective study. Eur J Obstet Gynecol Reprod Biol 2018; 220:100-105. [DOI: 10.1016/j.ejogrb.2017.11.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 11/21/2017] [Accepted: 11/26/2017] [Indexed: 12/17/2022]
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Le Lous M, Bouhanna P, Colmant C, Rozenberg P, Quibel T. The performance of an intermediate 16th-week ultrasound scan for the follow-up of euploid fetuses with increased nuchal translucency. Prenat Diagn 2015; 36:148-53. [DOI: 10.1002/pd.4756] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 11/18/2015] [Accepted: 11/27/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Maela Le Lous
- Department of Obstetrics and Gynecology; Poissy-Saint Germain Hospital, Versailles-Saint Quentin University; Versailles France
| | - Philippe Bouhanna
- Department of Obstetrics and Gynecology; Poissy-Saint Germain Hospital, Versailles-Saint Quentin University; Versailles France
| | - Claire Colmant
- Department of Obstetrics and Gynecology, AP-HP; Kremlin-Bicêtre Hospital, University of Paris-Sud; Orsay France
| | - Patrick Rozenberg
- Department of Obstetrics and Gynecology; Poissy-Saint Germain Hospital, Versailles-Saint Quentin University; Versailles France
| | - Thibaud Quibel
- Department of Obstetrics and Gynecology; Poissy-Saint Germain Hospital, Versailles-Saint Quentin University; Versailles France
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Nicoletis C, Bazin S, Lous ML. Clinical and biochemical features of normal, defective, and pathologic scars. Clin Plast Surg 1977; 4:347-59. [PMID: 884926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Lous ML, Piat G, Laget P. [Study of the cortical field potentials produced by weak light stimulation in adult rabbits]. C R Acad Hebd Seances Acad Sci D 1977; 284:1317-20. [PMID: 405144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
On a chronic preparation of an adult Rabbit, the cortical visual evoked response, produced by a weak luminous stimulation activating only the scotopic system is characterized by the suppression of the early surface-positive phase and by a lengthening of the latencies of the following deflection. The profile of the fields of potential corresponding to the various defletions in relation to the depth, has been investigated.
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