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Selides S, Nallet C, Vouga M, Mottet N, Ramanah R. [Obstetrical and neonatal prognosis of patients with a history of female genital mutilation]. Gynecol Obstet Fertil Senol 2024; 52:343-347. [PMID: 38211770 DOI: 10.1016/j.gofs.2024.01.002] [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: 09/25/2023] [Revised: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 01/13/2024]
Abstract
OBJECTIVE Female genital mutilation (FGM) covers all procedures involving partial or total removal of the external genitalia for non-therapeutic purposes. The period of pregnancy and childbirth is probably more at risk of complications for these women. The main aim of this study was to compare obstetrical, maternal and neonatal outcomes in patients with a history of female genital mutilation with patients without such a history. METHODS All deliveries taking place between January 2005 and June 2022 at Besançon University Hospital in patients with a history of FGM were included. This group was compared with a randomly selected group of deliveries of patients with no history of FGM. A total of 87 deliveries with a history of FGM were included and compared with 696 deliveries with no history of FGM. RESULTS There were significantly more instrumental deliveries (27.6% vs. 17.5%, P=0.01), more caesarean sections (23% vs. 14.1%, P=0.01), more episiotomies (9.2% vs. 0.7%, P<0.01), more first-degree perineal tears (30.8% vs. 20.8%, P=0.02), second-degree (13.9% vs. 5.3%, P<0, 01), third-degree (3.1% vs. 0.2%, P=0.02), more anterior perineal tears (23.1% vs. 2.5%, P<0.01), increased duration of pushing efforts (13 min vs. 10 min, P=0.05) and greater blood loss (297 cc vs. 165 cc, P<0.01) in the group with a history of FGM. There was no statistically significant difference in neonatal outcome. CONCLUSION The obstetrical prognosis of patients with a history of FGM is significantly poorer. Neonatal prognosis remains unchanged.
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Affiliation(s)
- S Selides
- Service de gynécologie-obstétrique, CHU Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France.
| | - C Nallet
- Service de gynécologie-obstétrique, CHU Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - M Vouga
- Service de gynécologie-obstétrique, CHU Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - N Mottet
- Service de gynécologie-obstétrique, CHU Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - R Ramanah
- Service de gynécologie-obstétrique, CHU Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
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Armengaud C, Fauconnier A, Drioueche H, Campagne Loiseau S, De Tayrac R, Saussine C, Panel L, Cosson M, Deffieux X, Lucot JP, Pizzoferrato AC, Ferry P, Vidart A, Thubert T, Capon G, Debodinance P, Gauthier T, Koebele A, Salet-Lizee D, Hermieu JF, Game X, Ramanah R, Lamblin G, Lecornet E, Carlier-Guérin C, Chartier-Kastler E, Fritel X. Serious complications and recurrences after retropubic vs transobturator midurethral sling procedures for 2682 patients in the VIGI-MESH register. Am J Obstet Gynecol 2024; 230:428.e1-428.e13. [PMID: 38008151 DOI: 10.1016/j.ajog.2023.11.1241] [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: 08/11/2023] [Revised: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Midurethral slings are the gold standard for treating stress urinary incontinence, but their complications may raise concerns. Complications may differ by the approach used to place them. OBJECTIVE This study aimed to compare serious complications and reoperations for recurrence after midurethral sling procedures when using the retropubic vs the transobturator route for female stress urinary incontinence. STUDY DESIGN This analysis was of patients included in the French, multicenter VIGI-MESH register since February 2017 who received a midurethral sling for female stress urinary incontinence either by the retropubic or the transobturator route and excluded patients with single-incision slings. Follow-up continued until October 2021. Serious complications (Clavien-Dindo classification ≥ grade III) attributable to the midurethral sling and reoperations for recurrence were compared using Cox proportional hazard models including any associated surgery (hysterectomy or prolapse) and a frailty term to consider the center effect. Baseline differences were balanced by propensity score weighting. Analyses using the propensity score and Cox models were adjusted for baseline differences, center effect, and associated surgery. RESULTS A total of 1830 participants received a retropubic sling and 852 received a transobturator sling in 27 French centers that were placed by 167 surgeons. The cumulative 2-year estimate of serious complications was 5.8% (95% confidence interval, 4.8-7.0) in the retropubic group and 2.9% (95% confidence interval, 1.9-4.3) in the transobturator group, that is, after adjustment, half of the retropubic group was affected (adjusted hazard ratio, 0.41; 95% confidence interval, 0.3-0.6). The cumulative 2-year estimate of reoperation for recurrence of stress urinary incontinence was 2.7% (95% confidence interval, 2.0-3.6) in the retropubic group and 2.8% (95% confidence interval, 1.7-4.2) in the transobturator group with risk for revision for recurrence being higher in the transobturator group after adjustment (adjusted hazard ratio, 1.9; 95% confidence interval, 1.2-2.9); this surplus risk disappeared after exclusion of the patients with a previous surgery for stress urinary incontinence. CONCLUSION The transobturator route for midurethral sling placement is associated with a lower risk for serious complications but a higher risk for surgical reoperation for recurrence than the retropubic route. Despite the large number of surgeons involved, these risks were low. The data are therefore reassuring.
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Affiliation(s)
- Camille Armengaud
- Service de Gynécologie-Obstétrique, CHI Poissy-St-Germain, Poissy, France.
| | - Arnaud Fauconnier
- Université Paris-Saclay, UVSQ, Unité de recherche 7285 "Risques cliniques et sécurité en santé des femmes et en santé périnatale" (RISCQ), Montigny-le-Bretonneux, Service de Gynécologie-Obstétrique, CHI Poissy-Saint-Germain, Poissy, France
| | - Hocine Drioueche
- Service de Gynécologie-Obstétrique, CHI Poissy-St-Germain, Poissy, France
| | | | - Renaud De Tayrac
- Service de Gynécologie-Obstétrique, CHU Carémeau, Nîmes, Université de Montpellier, Montpellier, France
| | - Christian Saussine
- Service d'urologie, CHU de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Laure Panel
- Service de Gynécologie, Clinique Beau-Soleil, Montpellier, France
| | - Michel Cosson
- Service de Gynécologie-Obstétrique, CHU de Lille, Université de Lille, Lille, France
| | - Xavier Deffieux
- Service de Gynécologie-Obstétrique, APHP Antoine-Béclère, Université Paris-Sud, Clamart, France
| | - Jean Philippe Lucot
- Service de Gynécologie-Obstétrique, Hôpital Saint-Vincent-de-Paul, Lille, France; Groupe des hôpitaux de l'institut catholique de Lille (GHICL), Lille, France
| | - Anne Cécile Pizzoferrato
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, CHU de Poitiers, Poitiers, France; Faculté de Médecine et Pharmacie, Université de Poitiers, Inserm CIC, France
| | - Philippe Ferry
- Service de Gynécologie-Obstétrique, CH de La Rochelle, La Rochelle, France
| | | | - Thibault Thubert
- Service de Gynécologie, CHU de Nantes, Centre d'investigation clinique, CHU de Nantes, Laboratoire Motricité, Interactions, Performances (MIP) - UR 4334 - UFR STAPS - Nantes Université, Nantes, France
| | | | | | - Tristan Gauthier
- Service de Gynécologie-Obsétrique, Hôpital Mère-Enfant, CHU Limoges, Limoges, France
| | - Antoine Koebele
- Service de Gynécologie, Maternité régionale universitaire, Nancy, France
| | - Delphine Salet-Lizee
- Groupe Hospitalier Diaconesses-Croix-Saint-Simon, Service de gynécologie, Paris, France
| | | | - Xavier Game
- Service d'urologie, CHU Rangueil, Toulouse, France
| | | | - Gery Lamblin
- Service de Gynécologie-Obstétrique, Hôpital Femme-Mère-Enfant, Hospices civils de Lyon, Lyon, France
| | - Emilie Lecornet
- Service d'urologie, Polyclinique d'Hénin Beaumont, Groupe AHNAC, Henin-Beaumont, France
| | | | | | - Xavier Fritel
- Faculté de Médecine et Pharmacie, Université de Poitiers, Inserm CIC 1402, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, CHU de Poitiers, Poitiers, France
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Lallemant M, Shimojyo AA, Mayeur O, Ramanah R, Rubod C, Kerbage Y, Cosson M. Mobility analysis of a posterior sacrospinous fixation using a finite element model of the pelvic system. PLoS One 2024; 19:e0299012. [PMID: 38512958 PMCID: PMC10956756 DOI: 10.1371/journal.pone.0299012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/04/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION AND HYPOTHESIS In order to improve the knowledge POP physiopathology and POP repair, a generic biomechanical model of the female pelvic system has been developed. In the literature, no study has currently evaluated apical prolapse repair by posterior sacrospinous ligament fixation using a generic model nor a patient-specific model that personalize the management of POP and predict surgical outcomes based on the patient's pre-operative Magnetic Resonance Imaging. The aim of our study was to analyze the influence of a right and/or left sacrospinous ligament fixation and the distance between the anchorage area and the ischial spine on the pelvic organ mobility using a generic and a patient-specific Finite Element model (FEM) of the female pelvic system during posterior sacrospinous ligament fixation (SSF). METHODS Firstly, we used a generic 3D FEM of the female pelvic system previously made by our team that allowed us to simulate the mobility of the pelvic system. To create a patient-specific 3D FEM of the female pelvic system, we used a preoperative dynamic pelvic MRI of a 68 years old woman with a symptomatic stage III apical prolapse and cystocele. With these 2 models, a SSF was simulated. A right and/or left SSF and different distances between the anchorage area and the ischial spine (1 cm, 2 cm and 3 cm.) were compared. Outcomes measures were the pelvic organ displacement using the pubococcygeal line during maximal strain: Ba point for the most posterior and inferior aspect of the bladder base, C point the cervix's or the vaginal apex and Bp point for the anterior aspect of the anorectal junction. RESULTS Overall, pelvic organ mobility decreased regardless of surgical technique and model. According to the generic model, C point was displaced by 14.1 mm and 11.5 mm, Ba point by 12.7 mm, and 12 mm and Bp point by 10.6 mm and 9.9 mm after left and bilateral posterior SSF, respectively. C point was displaced by 15.4 mm and 11.6 mm and Ba point by 12.5 mm and 13.1mm when the suture on the sacrospinous ligament was performed at 1 cm and 3 cm from the ischial spine respectively (bilateral posterior SSF configuration). According to the patient-specific model, the displacement of Ba point could not be analyzed because of a significative and asymmetric organ displacement of the bladder. C point was displaced by 4.74 mm and 2.12 mm, and Bp point by 5.30 mm and 3.24 mm after left and bilateral posterior SSF respectively. C point was displaced by 4.80 mm and 4.85 mm and Bp point by 5.35 mm and 5.38 mm when the suture on the left sacrospinous ligament was performed at 1 cm and 3 cm from the ischial spine, respectively. CONCLUSION According to the generic model from our study, the apex appeared to be less mobile in bilateral SSF. The anchorage area on the sacrospinous ligament seems to have little effect on the pelvic organ mobilities. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04551859.
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Affiliation(s)
- Marine Lallemant
- Service de Gynécologie Obstétrique, Pôle Mère-Femme, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
| | - Andres Arteaga Shimojyo
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
| | - Olivier Mayeur
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
| | - Rajeev Ramanah
- Service de Gynécologie Obstétrique, Pôle Mère-Femme, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France
- Laboratoire de Nanomédecine, Imagerie et Thérapeutiques, INSERM E4 4662, Université de Franche-Comté, Besançon, France
| | - Chrystèle Rubod
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
- Faculté de médecine, Université Lille Nord de France, F-59000, Lille, France
| | - Yohan Kerbage
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
- Faculté de médecine, Université Lille Nord de France, F-59000, Lille, France
| | - Michel Cosson
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
- Faculté de médecine, Université Lille Nord de France, F-59000, Lille, France
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Boudry T, Maisonnette Escot Y, Pluvy I, Feuvrier D, Houvenaeghel G, Ramanah R. [RECOMA study: Evaluation of quality of life and satisfaction after immediate or delayed breast reconstruction]. Gynecol Obstet Fertil Senol 2024:S2468-7189(24)00089-8. [PMID: 38513889 DOI: 10.1016/j.gofs.2024.03.006] [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] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE Breast reconstruction after mastectomy, whether immediate or delayed, is an integral part of the overall management of breast cancer. However, up to 40 % of reconstructed patients are not satisfied with the aesthetic result. The primary objective of the study was to evaluate satisfaction and quality of life according to the reconstruction techniques used in our center. The secondary objectives were to identify the parameters that could influence satisfaction and quality of life after surgery, to list the main complications, and the number of operations required to consider the reconstruction process as completed. METHOD A retrospective monocentric study, RECOMA, was carried out at the CHRU Minjoz in Besançon. All patients who underwent immediate or delayed breast reconstruction between 2010 and 2021 were contacted by post or e-mail and asked to complete the standardized BREAST-Q postoperative module. RESULTS Of 508 patients contacted, 149 were included. Reconstructed patients reported satisfaction, but also "average" quality of physical and psychological sexual life. Only the surgeon's assessment was rated as "good". There was no significant difference in satisfaction and quality of life depending on the reconstruction method chosen. On the other hand, patients who underwent nipple areolar complex (NAC) reconstruction had a significantly higher psychic quality of life score (P=0.02). In addition, a significant decrease in physical satisfaction was observed over time(P=0.049). An average of 2.4 operations was required to consider breast reconstruction complete. CONCLUSION In our opinion, breast reconstruction is an essential procedure to be considered as soon as the indication for mastectomy is given, but it is a process that requires the patient to be prepared for a result that may be weaker than expected, may require several operations, and may be complicated.
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Affiliation(s)
- Thibaud Boudry
- Département de chirurgie gynécologie et obstétrique, centre hospitalier universitaire Jean-Minjoz, université de Franche-Comté, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France.
| | - Yolande Maisonnette Escot
- Département de chirurgie gynécologie et obstétrique, centre hospitalier universitaire Jean-Minjoz, université de Franche-Comté, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France
| | - Isabelle Pluvy
- Département de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, centre hospitalier universitaire Jean-Minjoz, université de Franche-Comté, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France; Unité de recherche Nanomedicine Lab, Imagery & Therapeutics EA4662, université de Bourgogne-Franche-Comté, 16, route de Gray, 25030 Besançon, France
| | - Damien Feuvrier
- Département de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, centre hospitalier universitaire Jean-Minjoz, université de Franche-Comté, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France
| | - Gilles Houvenaeghel
- Institut Paoli Calmettes & CRCM, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France; Faculté de médecine Timone, université Aix-Marseille, 27, boulevard Jean-Moulin, 13005 Marseille, France
| | - Rajeev Ramanah
- Département de chirurgie gynécologie et obstétrique, centre hospitalier universitaire Jean-Minjoz, université de Franche-Comté, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France; Unité de recherche Nanomedicine Lab, Imagery & Therapeutics EA4662, université de Bourgogne-Franche-Comté, 16, route de Gray, 25030 Besançon, France
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Tresch C, Lallemant M, Nallet C, Offringa Y, Ramanah R, Guerby P, Mottet N. Updating of pelvimetry standards in modern obstetrics. Sci Rep 2024; 14:3080. [PMID: 38321054 PMCID: PMC10847410 DOI: 10.1038/s41598-024-53603-1] [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: 11/09/2022] [Accepted: 02/02/2024] [Indexed: 02/08/2024] Open
Abstract
Clinical value of pelvimetry in modern obstetrics practices has never been established and normal values are set since the middle of the twentieth century. The aim of this study was to describe current dimensions of pelvis in a female French Caucasian population. A retrospective, bi-centric observational study was conducted from August 2013 to August 2019 in two French departments of Obstetrics. We included all Caucasian women who had a computed tomography pelvimetry during pregnancy. The primary outcome was the values of the obstetric transverse diameter, obstetric conjugate diameter and bispinous diameter. Five hundred and fifty-one CT pelvimetries were analyzed. The median Obstetric Transverse Diameter (OTD) was 12.41 cm and the 3rd percentile was 11 cm. The median Obstetric Conjugate Diameter (OCD) was 12.2 cm and the 3rd percentile was 10.5 cm. The median Bispinous Diameter (BSD) in our data collection was 10.9 cm and the 3rd percentile was 9.3 cm. A significant correlation coefficient between women's height and OTD, OCD and BSD was found. In our study, the OCD and the BSD have not evolved since the middle of the twentieth century. The obstetric transverse diameter was smaller than the standard currently used.
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Affiliation(s)
- Caroline Tresch
- Department of Obstetrics and Gynecology, Besancon University Medical Centre, University of Franche-Comté, Besancon, France.
| | - Marine Lallemant
- Department of Obstetrics and Gynecology, Besancon University Medical Centre, University of Franche-Comté, Besancon, France
| | - Camille Nallet
- Department of Obstetrics and Gynecology, Besancon University Medical Centre, University of Franche-Comté, Besancon, France
| | - Yvonne Offringa
- Department of Obstetrics and Gynecology, Paule de Viguier University Medical Centre, Toulouse III University, Toulouse, France
| | - Rajeev Ramanah
- Department of Obstetrics and Gynecology, Besancon University Medical Centre, University of Franche-Comté, Besancon, France
| | - Paul Guerby
- Department of Obstetrics and Gynecology, Paule de Viguier University Medical Centre, Toulouse III University, Toulouse, France
| | - Nicolas Mottet
- Department of Obstetrics and Gynecology, Besancon University Medical Centre, University of Franche-Comté, Besancon, France
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Chollet-Fictor J, Benelmir S, Ramanah R. [How do I… perform a laparoscopic ablation of uterine fibroids by radiofrequency? (with video)]. Gynecol Obstet Fertil Senol 2024; 52:116-118. [PMID: 38101772 DOI: 10.1016/j.gofs.2023.12.002] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Justine Chollet-Fictor
- Pôle Mère-Femme, Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire de Besançon, 3, boulevard Alexandre Fleming, 25000 Besançon, France
| | - Scharif Benelmir
- Pôle Mère-Femme, Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire de Besançon, 3, boulevard Alexandre Fleming, 25000 Besançon, France
| | - Rajeev Ramanah
- Pôle Mère-Femme, Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire de Besançon, 3, boulevard Alexandre Fleming, 25000 Besançon, France; Laboratoire de Nanomédecine, Imagerie et Thérapeutiques, INSERM EA 4662, Université de Franche-Comté, 19, Rue Ambroise Paré, 25000 Besançon, France.
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Node J, Dor F, Puget L, Ramanah R, Cot S, Bibeau F, Di Domizio N, Prétet JL, Lepiller Q. Prevalence and significance of HPV DNA detection below the clinical threshold of the commercial kit Alinity m HR-HPV assay (Abbott). J Med Virol 2024; 96:e29465. [PMID: 38323725 DOI: 10.1002/jmv.29465] [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: 10/25/2023] [Revised: 01/11/2024] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
The positive clinical threshold of human papillomavirus (HPV) tests validated for primary cervical cancer screening (CCS) is designed to offer an optimal balance between clinical sensitivity and specificity. However, there may be a gap between the analytical sensitivity of the test and the positive clinical threshold, referred to here as the "gray-zone." This study aims to determine the prevalence and significance of HPV results obtained in the gray-zone in routine practice. Cervical samples obtained in our institution for CCS over a 22-month-period were tested with the Alinity m HR-HPV Assay (Abbott). Clinical and biological data, including cytological results and patients' HPV history were collected. Of the 6101 samples collected, 1.7% had an HPV result in the gray-zone (102 patients). The proportion of gray-zone results varied according to HPV genotype, reaching 11.8% of samples with detectable HPV DNA in the case of HPV31/33/52/58 genotypes. Reflex cytologies showed no abnormalities or Atypical Squamous Cells of Undetermined Significance results in 74.6% and 17.9% of cases, respectively. A previous or subsequent HPV-positive result with a (possibly) identical genotype was observed in 58% and 38% of cases, respectively. Two women with a history of persistent HPV detection had a CIN2+ lesion 1 year after the gray-zone result. In conclusion, the proportion of HPV results in the gray-zone varies according to genotype. No cytological abnormality is observed in the majority of cases, but a few rare patients with a history of persistent HPV infection should be closely monitored even if the HPV result is transiently located in the gray-zone.
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Affiliation(s)
- Juliette Node
- Laboratoire de virologie, CHU de Besançon, Besançon, France
- CNR Papillomavirus, CHU Besançon, Besancon, France
| | - Fanny Dor
- Laboratoire de biologie cellulaire, CHU Besançon, Besancon, France
| | - Line Puget
- Laboratoire de virologie, CHU de Besançon, Besançon, France
- CNR Papillomavirus, CHU Besançon, Besancon, France
| | - Rajeev Ramanah
- Service de Gynécologie-Obstétrique, CHU Besançon, Besancon, France
| | - Sophie Cot
- Service de Gynécologie-Obstétrique, CHU Besançon, Besancon, France
| | - Frédéric Bibeau
- Laboratoire d'anatomie Pathologique, CHU Besançon, Besancon, France
| | | | - Jean-Luc Prétet
- CNR Papillomavirus, CHU Besançon, Besancon, France
- Laboratoire de biologie cellulaire, CHU Besançon, Besancon, France
- EA3181, UBFC, LabEx LipSTIC ANR-11-LABX-0021, Besancon, France
| | - Quentin Lepiller
- Laboratoire de virologie, CHU de Besançon, Besançon, France
- CNR Papillomavirus, CHU Besançon, Besancon, France
- EA3181, UBFC, LabEx LipSTIC ANR-11-LABX-0021, Besancon, France
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Tresch C, Lallemant M, Ramanah R. Enhanced Recovery after Pelvic Organ Prolapse Surgery. J Clin Med 2023; 12:5911. [PMID: 37762852 PMCID: PMC10532386 DOI: 10.3390/jcm12185911] [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: 08/18/2023] [Revised: 09/03/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
The objective of this study was to review on the influence of enhanced rehabilitation in pelvic organ prolapse surgery outcomes, specifically focusing on length of hospital stay, hospital costs, pain, morbidity, and patient satisfaction. Following the PRISMA model and using PubMed as a source, eight articles pertaining to prolapse surgery and two articles concerning vaginal hysterectomies were selected, all published between 2014 and 2021. These studies revealed no significant difference in terms of operating time, intra- and post-operative complications, intra-operative blood loss and post-operative pain scores before and after the introduction of the ERAS program. Only one study noted a difference in readmission rates. There was, however, a noticeable decrease in intra-operative and post-operative intravenous intakes, opioid administration, length of stay, and overall hospital costs with the adoption of ERAS. Additionally, with ERAS, patients were able to mobilize more rapidly, and overall patient satisfaction significantly improved.
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Affiliation(s)
- Caroline Tresch
- Service de Gynécologie-Obstétrique, Université de Franche-Comté, CHU de Besançon, 25000 Besançon, France;
| | - Marine Lallemant
- Service de Gynécologie-Obstétrique, Université de Franche-Comté, CHU de Besançon, 25000 Besançon, France;
| | - Rajeev Ramanah
- Service de Gynécologie, Université de Franche-Comté, CHU de Besançon, 25000 Besançon, France;
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Lallemant M, D'Antona A, Vidal C, Bourtembourg A, Toubin C, Chehab M, Vilchez M, Boiteux G, Ramanah R, Pazart L, Riethmuller D, Mottet N. Conservative management versus systematic suture of isolated vaginal or first-degree perineal tears after delivery: A preliminary randomized efficacy trial. Birth 2023; 50:513-524. [PMID: 35960611 DOI: 10.1111/birt.12671] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The objective of this study was to assess the preliminary efficacy and safety of conservative management compared with systematic suture in isolated vaginal or first-degree perineal tears after birth. METHODS We conducted a preliminary efficacy, open-label, randomized, controlled, and prospective trial. This study implemented Simon's 2-step plan (interim analysis and final analysis) to test the success rate of the digital compression strategy group. Primiparous women aged ≥18 years with isolated vaginal or first-degree perineal tears after spontaneous vaginal birth of a cephalic presenting term (≥37 weeks) neonate were randomly allocated to the conservative management (CM) group (digital compression if bleeding followed by suture if persistent bleeding) or a systematic suture (SS) group. The primary outcome was the success of the intervention 10 days after delivery, defined by pain as evaluated using a visual analog scale < 3, satisfactory healing defined by a REEDA score ≤ 2, and no bleeding or infection. Sexual well-being was assessed at 2 and 6 months postpartum. RESULTS Among 861/2209 eligible women, 143 consenting women with a superficial perineal tear were randomized: 72 in the systematic suture group and 71 in the conservative management group. Success rate was 87.8% (90% CI [70.5-93.54]) (42/55) in the systematic suture group vs 90% (90% CI [78.3-93.8]) (53/61) in the conservative management group. The REEDA score was significantly higher in the systematic suture group (1.4 vs 0.9; P = 0.036). Perineal pain was significantly higher at day 1 in the systematic suture group (2.38 vs 1.69; P = 0.034). For the Female Sexual Functional Index score, no significant difference was found between the two groups at inclusion or at 2 and 6 months postpartum. CONCLUSIONS Conservative management of superficial perineal tears shows an efficacy rate ≥90%. Women in the conservative management group had less pain at the 1st day follow-up and lower REEDA scores at the 10th day follow-up.
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Affiliation(s)
- Marine Lallemant
- Department of Obstetrics and Gynecology, University Medical Center of Besancon, University of Franche-Comte, Besançon, France
- Applied Mechanics Department, FEMTO-ST Institute, University Bourgogne Franche-Comté, CNRS (UMR 6174), Besançon, France
| | - Aurélie D'Antona
- Department of Obstetrics and Gynecology, University Medical Center of Besancon, University of Franche-Comte, Besançon, France
| | - Chrystelle Vidal
- Centre d'investigation Clinique, INSERM CI 1431, University Medical Center of Besancon, Besançon, France
| | - Aude Bourtembourg
- Department of Obstetrics and Gynecology, University Medical Center of Besancon, University of Franche-Comte, Besançon, France
| | - Claire Toubin
- Department of Obstetrics and Gynecology, University Medical Center of Besancon, University of Franche-Comte, Besançon, France
| | - Malek Chehab
- Department of Obstetrics and Gynecology, University Medical Center of Besancon, University of Franche-Comte, Besançon, France
| | - Marie Vilchez
- Department of Obstetrics and Gynecology, University Medical Center of Besancon, University of Franche-Comte, Besançon, France
| | - Guillaume Boiteux
- Centre d'investigation Clinique, INSERM CI 1431, University Medical Center of Besancon, Besançon, France
| | - Rajeev Ramanah
- Department of Obstetrics and Gynecology, University Medical Center of Besancon, University of Franche-Comte, Besançon, France
- Nanomedecine Laboratory, INSERM EA4662, University of Franche-Comte, Besançon, France
| | - Lionel Pazart
- Centre d'investigation Clinique, INSERM CI 1431, University Medical Center of Besancon, Besançon, France
| | - Didier Riethmuller
- Department of Obstetrics and Gynecology, University Medical Center of Grenoble, Grenoble, France
| | - Nicolas Mottet
- Department of Obstetrics and Gynecology, University Medical Center of Besancon, University of Franche-Comte, Besançon, France
- Nanomedecine Laboratory, INSERM EA4662, University of Franche-Comte, Besançon, France
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Bulle C, Lallemant M, Rigori C, Ramanah R. YouTube as a source of information on ectopic pregnancy: A qualitative and quantitative analysis. PLoS One 2023; 18:e0287603. [PMID: 37437074 DOI: 10.1371/journal.pone.0287603] [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: 04/17/2023] [Accepted: 06/08/2023] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess the quality and reliability of YouTube videos on ectopic pregnancies for the public. METHOD We searched for the key terms "ectopic pregnancy", "ectopic birth" and "extra uterine pregnancy" on YouTube. Each video that met the inclusion criteria was analyzed by two independent raters. Quantitative and qualitative metrics were recorded, and the videos were scored using the DISCERN instrument. RESULTS A total of 37 videos met the inclusion criteria. The mean overall DISCERN score was 44.5 ± 15.6. Videos had significantly a higher DISCERN score if they contained explanations on anatomy (pvalue <0.01), physiopathology (p-value <0.01), diagnosis (p-value = <0.01), treatments (p-value <0.01), symptoms (p-value <0.01), clear information (p-value <0.01), animations (p-value <0.01) and if it was a physician speaking (p-value <0.01). CONCLUSION YouTube videos on ectopic pregnancy have been assessed to be only fairly reliable. We identified the five best ones using the validated DISCERN instrument. While ectopic pregnancy is not uncommon, YouTube videos should be improved to provide more accurate information for the public.
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Affiliation(s)
- Camille Bulle
- Department of Obstetrics and Gynecology, University Medical Center of Besancon, University of Franche-Comte, Besançon, France
| | - Marine Lallemant
- Department of Obstetrics and Gynecology, University Medical Center of Besancon, University of Franche-Comte, Besançon, France
- Department of Applied Mechanics, FEMTO-ST Institute, UMR 6174 CNRS, University of Franche-Comte, Besançon, France
| | - Clara Rigori
- Department of Obstetrics and Gynecology, University Medical Center of Besancon, University of Franche-Comte, Besançon, France
| | - Rajeev Ramanah
- Department of Obstetrics and Gynecology, University Medical Center of Besancon, University of Franche-Comte, Besançon, France
- Nanomedecine Laboratory, INSERM EA4662, University of Franche-Comte, Besancon, France
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11
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Boudry T, Lallemant M, Ramanah R, Mottet N. Influence of in utero fetal death on perineal tears in vaginal deliveries. Sci Rep 2023; 13:7484. [PMID: 37160998 PMCID: PMC10170066 DOI: 10.1038/s41598-023-34185-w] [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: 02/05/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023] Open
Abstract
The aim of this work was to evaluate and compare the incidence of perineal tears and Obstetrical anal sphincter injuries (OASIS) after vaginal delivery following a in utero fetal death (IUFD) compared with those with a live-birth. We conducted a single-center, retrospective cohort study using a database of all women who underwent a spontaneous vaginal delivery in the level III maternity ward. Exclusion criteria were breech presentation, cesarean section birth, instrumental delivery, multiple pregnancy, delivery before 24 + 6 weeks of gestation (WG) and termination of pregnancy for medical reasons. Women from the database were divided into two groups: an "in utero fetal death" (IUFD) group and a control group. Women were included in the IUFD group if they had a spontaneous vaginal delivery following a fetal demise after 24 + 6 WG in cephalic presentation between January 2006 and June 2020. Women in the "control" group were selected from the same database and were included if they underwent a spontaneous vaginal delivery of a live fetus in cephalic presentation, after 24 + 6 WG, during the same period. Each woman in the "IUFD" group was matched to two women (ratio 1:2) in the control group for parity, maternal age, body mass index, gestation and birth weight. The primary outcome was the presence of a sutured or unsutured perineal tear. During the study period, 31,208 patients delivered at a level III maternity hospital. Among them, 215 and 430 women were included in the IUFD group and the control group respectively. The two groups were comparable for all demographic and clinical characteristics except for an epidural analgesia (92% versus 70% in the control group, p < 0.01) and labor induction (86% versus 17% in the control group, p < 0.01). The incidence of any perineal tears was 13% (28/15) in the IUFD group versus 16% (70/430) in the control group. Relative risk of any perineal tears was non significative (RR = 0.8 IC95% [0.5-1.2]). The incidence of first-degree perineal tears was 10% in the IUFD group and 11% in the control group. The incidence of second-degree perineal tears was 18% in the IUFD group and 28% in the control group. Relative risk of first-degree perineal tears (RR = 0.88 95% CI [0.5-1.4]) and second-degree tears (RR = 0.51 95% CI [0.2-1.4]) were non significative. No obstetrical anal sphincter injury was found in either group. Vaginal delivery following a fetal demise did not appear to be either a risk factor or a protective factor for perineal tears. But there as a trend toward a lower incidence of second degree perineal tears in this context.
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Affiliation(s)
- Thibaud Boudry
- Department of Obstetrics and Gynecology, University Medical Center of Besancon, University of Franche-Comte, Alexander Fleming Boulevard, 25000, Besançon, France
| | - Marine Lallemant
- Department of Obstetrics and Gynecology, University Medical Center of Besancon, University of Franche-Comte, Alexander Fleming Boulevard, 25000, Besançon, France
- Université de Franche-Comté, FEMTO-ST Institute, UMR CNRS 6174, Department of Applied Mechanics, Besançon, France
| | - Rajeev Ramanah
- Department of Obstetrics and Gynecology, University Medical Center of Besancon, University of Franche-Comte, Alexander Fleming Boulevard, 25000, Besançon, France
- Nanomedicine Laboratory, INSERM EA4662, University of Franche-Comte, 25000, Besancon, France
| | - Nicolas Mottet
- Department of Obstetrics and Gynecology, University Medical Center of Besancon, University of Franche-Comte, Alexander Fleming Boulevard, 25000, Besançon, France.
- Nanomedicine Laboratory, INSERM EA4662, University of Franche-Comte, 25000, Besancon, France.
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12
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Nallet C, Ramirez Zegarra R, Mazellier S, Dall'asta A, Puyraveau M, Lallemant M, Ramanah R, Riethmuller D, Ghi T, Mottet N. Head-to-perineum distance measured transperineally as a predictor of failed midcavity vacuum-assisted delivery. Am J Obstet Gynecol MFM 2023; 5:100827. [PMID: 36464238 DOI: 10.1016/j.ajogmf.2022.100827] [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: 11/17/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND During the second stage of labor, in case of a need for a fetal extraction at midcavity, the choice of attempting the procedure between operative vaginal delivery and cesarean delivery is difficult. Moreover, guidelines on this subject are not clear. OBJECTIVE This study aimed to identify antenatal and intrapartum parameters associated with a failed midcavity vacuum-assisted delivery and its association with maternal and neonatal adverse outcomes. STUDY DESIGN This was a single-center, retrospective, cohort study conducted at a tertiary maternity hospital in France from January 2010 to December 2020. Women with singleton pregnancies under epidural analgesia with nonanomalous cephalic presenting fetuses and gestational ages at ≥37 weeks of gestation, who were submitted to midcavity vacuum-assisted delivery, were included. Following the American College of Obstetricians and Gynecologists definition, midcavity was defined as the presenting part of the fetus (ie, the fetal head) found at stations 0 and +1. For research purposes, all patients were submitted to transperineal ultrasound to evaluate the head-to-perineum distance, however, this measurement did not affect the decision to perform a midcavity vacuum-assisted delivery. The primary outcome of the study was failed midcavity vacuum-assisted delivery leading to cesarean delivery or the use of a different instrument to achieve vaginal delivery. RESULTS Overall, 951 cases of midcavity vacuum-assisted delivery were included in this study. Failed midcavity vacuum-assisted delivery occurred in 242 patients (25.4%). Factors independently associated with failed midcavity vacuum-assisted delivery included maternal height (adjusted odds ratio, 0.96; 95% confidence interval, 0.94-0.99; P=.002), duration of the active phase of the first stage of labor (adjusted odds ratio, 1.11; 95% confidence interval, 1.05-1.17; P<.001), nonocciput anterior fetal head position (adjusted odds ratio, 1.47; 95% confidence interval, 1.06-2.04; P=.02), z score of the head-to-perineum distance (adjusted odds ratio, 1.23; 95% confidence interval, 1.05-1.43; P=.01), and birthweight of >4000 g (adjusted odds ratio, 2.04; 95% confidence interval, 1.28-3.26; P=.003). Women submitted to a failed midcavity vacuum-assisted delivery were more likely to have a major postpartum hemorrhage (7.1% vs 2.0%; P<.001), whereas neonates were more likely to have an umbilical artery pH of <7.1 (30.5% vs 19.8%; P=.001), be admitted to the neonatal intensive care unit (9.6% vs 4.7%; P=.005), and have a severe caput succedaneum (14.9% vs 0.7%; P<.001). Subgroup analysis on all patients with a fetal head station of 0 found that the head-to-perineum distance was the only independent variable associated with failed midcavity vacuum-assisted delivery (adjusted odds ratio, 1.66; 95% confidence interval, 1.29-2.12; P<.001). The area under the receiving operating characteristic curve of the head-to-perineum distance in this subgroup population was 0.67 (95% confidence interval, 0.60-0.73; P<.001), and the optimal cutoff point of the head-to-perineum distance measurement discriminating between failed and successful midcavity vacuum-assisted deliveries was 55 mm. It was associated with a 0.90 (95% confidence interval, 0.83-0.95) sensitivity, 0.19 (95% confidence interval, 0.14-0.25) specificity, 0.36 (95% confidence interval, 0.30-0.42) positive predictive value, and 0.80 (95% confidence interval, 0.66-0.90) negative predictive value. CONCLUSION Study data showed that a high fetal head station, measured using the head-to-perineum distance, and a nonocciput anterior position of the fetal head are independently associated with failed midcavity vacuum-assisted delivery. The result supported the systematic assessment of the sonographic head station and position before performing a midcavity vacuum-assisted delivery.
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Affiliation(s)
- Camille Nallet
- Department of Obstetrics and Gynaecology, University Hospital of Besançon, University of Franche-Comté, Besançon, France (Drs Nallet, Mazellier, Lallemant, Ramanah, Riethmuller, and Mottet)
| | - Ruben Ramirez Zegarra
- Department of Obstetrics and Gynaecology, University Hospital of Parma, University of Parma, Parma, Italy (Drs Ramirez Zegarra, Dall'asta, and Ghi)
| | - Sylvia Mazellier
- Department of Obstetrics and Gynaecology, University Hospital of Besançon, University of Franche-Comté, Besançon, France (Drs Nallet, Mazellier, Lallemant, Ramanah, Riethmuller, and Mottet)
| | - Andrea Dall'asta
- Department of Obstetrics and Gynaecology, University Hospital of Parma, University of Parma, Parma, Italy (Drs Ramirez Zegarra, Dall'asta, and Ghi)
| | - Marc Puyraveau
- Clinical Methodology Center, University Hospital of Besançon, University of Franche-Comté, Besançon, France (Mr Puyraveau)
| | - Marine Lallemant
- Department of Obstetrics and Gynaecology, University Hospital of Besançon, University of Franche-Comté, Besançon, France (Drs Nallet, Mazellier, Lallemant, Ramanah, Riethmuller, and Mottet)
| | - Rajeev Ramanah
- Department of Obstetrics and Gynaecology, University Hospital of Besançon, University of Franche-Comté, Besançon, France (Drs Nallet, Mazellier, Lallemant, Ramanah, Riethmuller, and Mottet); Nanomedecine Laboratory, Imaging, and Therapeutics, INSERM EA 4662, University of Franche-Comté, Besançon, France (Drs Ramanah, and Mottet)
| | - Didier Riethmuller
- Department of Obstetrics and Gynaecology, University Hospital of Besançon, University of Franche-Comté, Besançon, France (Drs Nallet, Mazellier, Lallemant, Ramanah, Riethmuller, and Mottet); Department of Obstetrics and Gynaecology, University Hospital of Grenoble, University of Grenoble Alpes, Grenoble, France. (Dr Riethmuller)
| | - Tullio Ghi
- Department of Obstetrics and Gynaecology, University Hospital of Parma, University of Parma, Parma, Italy (Drs Ramirez Zegarra, Dall'asta, and Ghi).
| | - Nicolas Mottet
- Department of Obstetrics and Gynaecology, University Hospital of Besançon, University of Franche-Comté, Besançon, France (Drs Nallet, Mazellier, Lallemant, Ramanah, Riethmuller, and Mottet); Nanomedecine Laboratory, Imaging, and Therapeutics, INSERM EA 4662, University of Franche-Comté, Besançon, France (Drs Ramanah, and Mottet)
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Briet M, Barkatz J, Frontczak S, Ramanah R, Chabbert Buffet N, Cristofari S. [Modalities of gynecological follow-up of transgender patients - Literature review]. Gynecol Obstet Fertil Senol 2022; 50:788-796. [PMID: 36150648 DOI: 10.1016/j.gofs.2022.09.003] [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: 01/24/2022] [Revised: 08/09/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Transgender patients are at increased risk of cancer, sexually transmitted diseases, short- and long-term postoperative complications in patients with vaginoplasty, but also unwanted pregnancy in non-hysterectomized trans men. However, access to care is often difficult for these patients, who often do not benefit from appropriate gynecological monitoring, especially for fear of judgment or discrimination. In view of the health risks of these patients, it is essential to be able to offer them specific and adapted gynecological follow-up. To date, there are no clear recommendations regarding the gynecological follow-up of transgender patients. We relied on the recommendations of the World Professional Association of Transgender Health (W-PATH) and the Endocrine Society Guideline and performed a literature review. We carried out several searches via pubmed in order to explore one by one the different aspects of gynecological follow-up, in particular of non-hysterectomized transgender men and transgender women with a vaginoplasty. It emerges from this a lack of follow-up of transgender people, with a reluctance to consult a gynecologist, associated with the lack of knowledge and experience of health professionals. Due to the risks identical to those of the general population, added to those specific to transgender people, it is important to be able to offer these patients specialized and personalized gynecological follow-up, and to raise awareness and train health professionals on the importance of and the specificities of the gynecological follow-up of these patients.
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Affiliation(s)
- M Briet
- Centre d'assistance médicale à la procréation, pôle mère-femme, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France; Sorbonne université, 75005 Paris, France.
| | - J Barkatz
- Service d'urologie - Transplantation rénale- andrologie, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - S Frontczak
- Centre d'assistance médicale à la procréation, pôle mère-femme, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France; Service de biologie et médecine de la reproduction, cryobiologie, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France; Université de Franche-Comté, UFR Santé, 25000 Besançon, France
| | - R Ramanah
- Pôle mère-femme, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France; Université de Franche-Comté, UFR Santé, 25000 Besançon, France
| | - N Chabbert Buffet
- Service de gynécologie obstétrique médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Sorbonne université, 75005 Paris, France
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Caroff A, Ramanah R, Nallet C, Pretalli JB, Roux C. [Embryo stage impact on the risk of ectopic pregnancy after In Vitro Fecondation]. Gynecol Obstet Fertil Senol 2022; 50:721-728. [PMID: 36055463 DOI: 10.1016/j.gofs.2022.08.004] [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: 06/11/2022] [Revised: 07/31/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Ectopic pregnancies are still the first mortality cause of the first semestre of pregnancy. They are much more frequent in IVF (2-5%) than in the standard population (1-2%). The aim of this study was to compare the rate of ectopic pregnancies following a fresh embryo transfer done whether at an clived embryo stage (day 2 or 3 of the embryo development) or at a blastocyst stage (day 5 or 6 of the embryo development). METHODS This is a monocentric retrospective study including all 18 to 43 year-old patients getting pregnant (ßHCG>100 UI/L) after a fresh embryo transfer from In Vitro Fecondation with or without Intra-Cytoplasmic Sperm Injection, between January 1st 2014 and December 30th 2020 in the Hospital of Besançon (France). This population has been divided into 2 groups according to the embryo stage on the day of transfer. RESULTS Nine hundred and twenty two patients have been included. There were statistically more ectopic pregnancies after a blastocyst transfer (n=4; 5.4%) than after a clived embryo transfer (n=14; 1.7%). (P=0.049) CONCLUSION: In our population, there were more ectopic pregnancies from blastocyst(s) transfers than from clived embryo(es).
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Affiliation(s)
- A Caroff
- Service de gynécologie obstétrique, Centre Hospitalo-Universitaire Jean Minjoz, 3, boulevard Alexandre Flemming, 25000 Besançon, France.
| | - R Ramanah
- Service de gynécologie obstétrique, Centre Hospitalo-Universitaire Jean Minjoz, 3, boulevard Alexandre Flemming, 25000 Besançon, France
| | - C Nallet
- Service de gynécologie obstétrique, Centre Hospitalo-Universitaire Jean Minjoz, 3, boulevard Alexandre Flemming, 25000 Besançon, France
| | - J-B Pretalli
- Service de biologie de la reproduction, Centre Hospitalo-Universitaire Jean Minjoz, 3, boulevard Alexandre Flemming, 25000 Besançon, France
| | - C Roux
- Service de biologie de la reproduction, Centre Hospitalo-Universitaire Jean Minjoz, 3, boulevard Alexandre Flemming, 25000 Besançon, France
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Tresch C, Lallemant M, Mottet N, Ramanah R. Placental preservation after surgery of an advanced ovarian pregnancy. J Gynecol Obstet Hum Reprod 2022; 51:102469. [DOI: 10.1016/j.jogoh.2022.102469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/02/2022] [Indexed: 11/15/2022]
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Debernardi A, Valot B, Almarcha J, Guenat D, Hocquet D, Algros MP, Riethmuller D, Ramanah R, Mougin C, Prétet JL, Lepiller Q. Longitudinal follow-up of HPV16 sequence after cervical infection: Low intrahost variation and no correlation with clinical evolution. J Med Virol 2022; 94:5512-5518. [PMID: 35799409 DOI: 10.1002/jmv.27978] [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: 04/07/2022] [Revised: 06/12/2022] [Accepted: 07/05/2022] [Indexed: 12/15/2022]
Abstract
Human papillomavirus (HPV) 16 exhibits different variants that may differ in their carcinogenic risk. To identify some high-risk variants, we sequenced and compared HPV16 whole genomes obtained from a longitudinal cohort of 34 HPV16-infected women who had either spontaneously cleared their infection (clearance group or "C"), or developed cervical high-grade lesions following a viral persistence (group persistence or "P"). Phylogenetic analysis of paired samples obtained at the beginning (C0 or P0) and at the end (C2 or P2) of the follow-up (median intervals between C0-C2 and between P0-P2 were 16 and 36.5 months, respectively) revealed a low genetic variability within the host compared to the genetic interhost diversity. By comparing our HPV16 sequences to a reference sequence, we observed 301 different substitutions, more often transitions (60.9%) than transversions (39.1%), that occurred throughout the viral genome, but with a low frequency in E6 and E7 oncogenes (10 and 9 substitutions), suggesting a high conservation of these genes. Deletions and insertions were mostly observed in intergenic regions of the virus. The only significant substitution found between the subgroups C2 and P2 was observed in the L2 gene (L330F), with an unclear biological relevance. Our results suggest a low longitudinal intrahost evolution of HPV16 sequences and no correlation between genetic variations and clinical evolution.
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Affiliation(s)
- Alice Debernardi
- EA3181, LabEx LipSTIC ANR-11-LABX-0021, Université de Bourgogne-Franche-Comté, Besançon, France
| | - Benoit Valot
- Bioinformatique et Big Data au Service de la Santé, UFR Santé, Université de Bourgogne Franche-Comté, Besançon, France.,UMR CNRS 6249 Chrono-Environnement, Université de Bourgogne Franche-Comté, Besançon, France
| | - Julien Almarcha
- Bioinformatique et Big Data au Service de la Santé, UFR Santé, Université de Bourgogne Franche-Comté, Besançon, France
| | - David Guenat
- EA3181, LabEx LipSTIC ANR-11-LABX-0021, Université de Bourgogne-Franche-Comté, Besançon, France
| | - Didier Hocquet
- Bioinformatique et Big Data au Service de la Santé, UFR Santé, Université de Bourgogne Franche-Comté, Besançon, France.,UMR CNRS 6249 Chrono-Environnement, Université de Bourgogne Franche-Comté, Besançon, France
| | | | - Didier Riethmuller
- Department of Gynecology and Obstetrics, Hôpital Couple-Enfant, University Hospital Grenoble Alpes, La Tronche, France
| | - Rajeev Ramanah
- Gynecology Department, CHU de Besançon, Besançon, France
| | - Christiane Mougin
- Centre National de Référence Papillomavirus, CHU de Besançon, Besançon, France.,UMR U1098 RIGHT, Université de Bourgogne Franche-Comté, Besançon, France
| | - Jean-Luc Prétet
- EA3181, LabEx LipSTIC ANR-11-LABX-0021, Université de Bourgogne-Franche-Comté, Besançon, France.,Centre National de Référence Papillomavirus, CHU de Besançon, Besançon, France.,Laboratoire De Biologie Cellulaire, CHU de Besançon, Besançon, France
| | - Quentin Lepiller
- EA3181, LabEx LipSTIC ANR-11-LABX-0021, Université de Bourgogne-Franche-Comté, Besançon, France.,Centre National de Référence Papillomavirus, CHU de Besançon, Besançon, France.,Laboratoire De Virologie, CHU de Besançon, Besançon, France
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Nallet C, Puyraveau M, Lallemant M, Ramanah R, Simon A, Krausz M, Riethmuller D, Mottet N. 432 Mid-cavity vacuum-assisted delivery: Description of a large cohort of 1097 women, and development of a clinical risk score of failure. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Fritel X, de Tayrac R, de Keizer J, Campagne-Loiseau S, Cosson M, Ferry P, Deffieux X, Lucot JP, Wagner L, Debodinance P, Saussine C, Pizzoferrato AC, Carlier-Guérin C, Thubert T, Panel L, Bosset PO, Nkounkou E, Ramanah R, Boisramé T, Charles T, Raiffort C, Charvériat A, Ragot S, Fauconnier A. Serious complications and recurrences after pelvic organ prolapse surgery for 2309 women in the VIGI-MESH registry. BJOG 2021; 129:656-663. [PMID: 34541781 DOI: 10.1111/1471-0528.16892] [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] [Accepted: 07/28/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the incidence of serious complications and reoperations for recurrence after surgery for pelvic organ prolapse (POP) and compare the three most common types of repair. DESIGN Prospective cohort study using a registry. SETTING Nineteen French surgical centres. POPULATION A total of 2309 women participated between 2017 and 2019. METHODS A multivariate analysis including an inverse probability of treatment weighting approach was used to obtain three comparable groups. MAIN OUTCOME MEASURES Serious complications and subsequent reoperations for POP recurrence. RESULTS The median follow-up time was 17.6 months. Surgeries were native tissue vaginal repairs (n = 504), transvaginal mesh placements (n = 692) and laparoscopic sacropexies with mesh (n = 1113). Serious complications occurred among 52 women (2.3%), and reoperation for POP recurrence was required for 32 women (1.4%). At 1 year the cumulative weighted incidence of serious complications was 1.8% for native tissue vaginal repair, 3.9% for transvaginal mesh and 2.2% for sacropexy, and the rates for reoperation for recurrence of POP were 1.5, 0.7 and 1.1%, respectively. Compared with native tissue vaginal repair, the risk of serious complications was higher in the transvaginal mesh group (weighted hazard ratio, wHR 3.84, 95% CI 2.43-6.08) and the sacropexy group (wHR 2.48, 95% CI 1.45-4.23), whereas the risk of reoperation for prolapse recurrence was lower in both the transvaginal mesh (wHR 0.22, 95% CI 0.13-0.39) and sacropexy (wHR 0.29, 95% CI 0.18-0.47) groups. CONCLUSIONS Our results suggest that native tissue vaginal repairs have the lowest risk of serious complications but the highest risk of reoperation for recurrence. These results are useful for informing women and for shared decision making. TWEETABLE ABSTRACT Laparoscopic sacropexy had fewer serious complications than transvaginal mesh and fewer reoperations for recurrence than vaginal repair.
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Affiliation(s)
- X Fritel
- Service de Gynécologie, CHU de Poitiers, Poitiers, France.,Université de Poitiers, INSERM CIC 1402, Poitiers, France
| | - R de Tayrac
- Service de Gynécologie, CHU Carémeau, Nîmes, France
| | - J de Keizer
- Université de Poitiers, INSERM CIC 1402, Poitiers, France
| | | | - M Cosson
- Service de Gynécologie, CHU de Lille, Lille, France
| | - P Ferry
- Service de Gynécologie, CH de La Rochelle, La Rochelle, France
| | - X Deffieux
- Service de Gynécologie, APHP Antoine-Béclère, Clamart, France
| | - J-P Lucot
- Service de Gynécologie, Hôpital Saint-Vincent-de-Paul, Lille, France
| | - L Wagner
- Service d'Urologie, CHU Carémeau, Nîmes, France
| | - P Debodinance
- Service de Gynécologie, CH de Dunkerque, Dunkerque, France
| | - C Saussine
- Service d'Urologie, CHU de Strasbourg, Strasbourg, France
| | | | - C Carlier-Guérin
- Service de Gynécologie, CH de Châtellerault, Châtellerault, France
| | - T Thubert
- Service de Gynécologie, CHU de Nantes, Nantes, France
| | - L Panel
- Service de Gynécologie, Clinique Beau-Soleil, Montpellier, France
| | - P-O Bosset
- Service d'Urologie, Hôpital Foch, Suresnes, France
| | - E Nkounkou
- Service de Gynécologie, CH de Béthune, Béthune, France
| | - R Ramanah
- Université de Franche-Comté, CHU de Besançon, Besançon, France
| | - T Boisramé
- Service de Gynécologie, CHU de Strasbourg, Strasbourg, France
| | - T Charles
- Service d'Urologie, CHU de Poitiers, Poitiers, France
| | - C Raiffort
- Service de Gynécologie, Groupe Hospitalier Diaconesses-Croix-Saint-Simon, Paris, France
| | - A Charvériat
- Service de Gynécologie, CHU de Poitiers, Poitiers, France
| | - S Ragot
- Université de Poitiers, INSERM CIC 1402, Poitiers, France
| | - A Fauconnier
- Service de Gynécologie, CHI Poissy-Saint-Germain, Poissy, France
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Baumann A, Henriques J, Selmani Z, Meurisse A, Lepiller Q, Vernerey D, Valmary-Degano S, Paget-Bailly S, Riethmuller D, Ramanah R, Mougin C, Prétet JL. HPV16 Load Is a Potential Biomarker to Predict Risk of High-Grade Cervical Lesions in High-Risk HPV-Infected Women: A Large Longitudinal French Hospital-Based Cohort Study. Cancers (Basel) 2021; 13:cancers13164149. [PMID: 34439304 PMCID: PMC8394477 DOI: 10.3390/cancers13164149] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/27/2021] [Accepted: 08/04/2021] [Indexed: 11/30/2022] Open
Abstract
Simple Summary This study aimed at assessing HPV16 and HPV18 viral loads to predict the development of cervical high-grade lesion. Among 885 women positive for hrHPV and presenting no or mild cytological abnormalities, HPV16 and HPV18 prevalence was 25.9% and 8.4%, respectively. Of those women, 135 developed a high-grade lesion during the follow-up. Considering an HPV16 viral load cut-off set at 3.2 log10 GE/103 cells a subgroup of women at high risk of developing high-grade cervical lesion (HR = 2.67; 95% CI 1.80–3.97 p ≤ 0.0001) has been identified. Moreover, a composite score based on HPV16 load, cytology and hrHPV detection allowed for CIN2+ risk stratification. To conclude, HPV16 load is a relevant biomarker to identify women at high risk for developing precancerous lesions of the cervix. Abstract High-risk HPV (hrHPV) testing has been implemented as a primary screening tool for cervical cancer in numerous countries. However, there is still a need for relevant triage strategies to manage hrHPV positive women to avoid excessive referral to colposcopy. The objective of this study was to assess, in women infected by hrHPV and presenting no or mild cytological abnormalities, HPV16 and HPV18 viral loads to predict the development of cervical high-grade lesion. Among 2102 women positive for hrHPV, 885 had no lesion or mild cytological abnormalities at baseline and had at least one follow-up (FU) visit. HPV16 and HPV18 prevalence was 25.9% and 8.4%, respectively. Of those women, 15% developed a high-grade lesion during the FU. An HPV16 viral load cut-off set at 3.2 log10GE/103 cells permitted to identify a subgroup of women at high risk of developing high-grade cervical lesion (HR = 2.67; 95% CI 1.80–3.97; p ≤ 0.0001). No specific HPV18 viral load threshold could have been defined in regard to the present study. In multivariate analysis, HPV16 load (absence/log10GE/103 cells < 3.2 vs. ≥3.2), RLU/PC 239 (1–100 pg/mL vs. >100 pg/mL) and cytology (normal vs abnormal) were independently associated with a significant increased risk of high-grade lesion development and were used to construct the prognostic score. In conclusion, HPV16 load is a relevant biomarker to identify women at high risk for developing cervical precancerous lesions.
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Affiliation(s)
- Antoine Baumann
- Papillomavirus National Reference Centre, CHU de Besançon, 25000 Besançon, France; (A.B.); (Z.S.); (Q.L.); (D.R.); (C.M.)
- Pathology Department, CHU de Besançon, 25000 Besançon, France;
| | - Julie Henriques
- Methodology and Quality of Life Unit in Oncology, CHU de Besançon, 25000 Besançon, France; (J.H.); (A.M.); (D.V.); (S.P.-B.)
- UMR1098, Host-Graft-Tumor Interactions and Cell and Tissue Engineering, University Bourgogne Franche-Comté, INSERM, 25000 Besançon, France
- La Fédération Hospitalo-Universitaire Integrated Center for Research in Inflammatory Diseases (FHU Increase), ANR-11-LABX-0021, LabEx LipSTIC, University Bourgogne Franche-Comté, 25000 Besançon, France
| | - Zohair Selmani
- Papillomavirus National Reference Centre, CHU de Besançon, 25000 Besançon, France; (A.B.); (Z.S.); (Q.L.); (D.R.); (C.M.)
- UMR1098, Host-Graft-Tumor Interactions and Cell and Tissue Engineering, University Bourgogne Franche-Comté, INSERM, 25000 Besançon, France
- La Fédération Hospitalo-Universitaire Integrated Center for Research in Inflammatory Diseases (FHU Increase), ANR-11-LABX-0021, LabEx LipSTIC, University Bourgogne Franche-Comté, 25000 Besançon, France
| | - Aurélia Meurisse
- Methodology and Quality of Life Unit in Oncology, CHU de Besançon, 25000 Besançon, France; (J.H.); (A.M.); (D.V.); (S.P.-B.)
- UMR1098, Host-Graft-Tumor Interactions and Cell and Tissue Engineering, University Bourgogne Franche-Comté, INSERM, 25000 Besançon, France
- La Fédération Hospitalo-Universitaire Integrated Center for Research in Inflammatory Diseases (FHU Increase), ANR-11-LABX-0021, LabEx LipSTIC, University Bourgogne Franche-Comté, 25000 Besançon, France
| | - Quentin Lepiller
- Papillomavirus National Reference Centre, CHU de Besançon, 25000 Besançon, France; (A.B.); (Z.S.); (Q.L.); (D.R.); (C.M.)
- EA3181, University Bourgogne Franche-Comté, 25000 Besançon, France
| | - Dewi Vernerey
- Methodology and Quality of Life Unit in Oncology, CHU de Besançon, 25000 Besançon, France; (J.H.); (A.M.); (D.V.); (S.P.-B.)
- UMR1098, Host-Graft-Tumor Interactions and Cell and Tissue Engineering, University Bourgogne Franche-Comté, INSERM, 25000 Besançon, France
- La Fédération Hospitalo-Universitaire Integrated Center for Research in Inflammatory Diseases (FHU Increase), ANR-11-LABX-0021, LabEx LipSTIC, University Bourgogne Franche-Comté, 25000 Besançon, France
| | - Séverine Valmary-Degano
- Pathology Department, CHU de Besançon, 25000 Besançon, France;
- EA3181, University Bourgogne Franche-Comté, 25000 Besançon, France
| | - Sophie Paget-Bailly
- Methodology and Quality of Life Unit in Oncology, CHU de Besançon, 25000 Besançon, France; (J.H.); (A.M.); (D.V.); (S.P.-B.)
- UMR1098, Host-Graft-Tumor Interactions and Cell and Tissue Engineering, University Bourgogne Franche-Comté, INSERM, 25000 Besançon, France
- La Fédération Hospitalo-Universitaire Integrated Center for Research in Inflammatory Diseases (FHU Increase), ANR-11-LABX-0021, LabEx LipSTIC, University Bourgogne Franche-Comté, 25000 Besançon, France
| | - Didier Riethmuller
- Papillomavirus National Reference Centre, CHU de Besançon, 25000 Besançon, France; (A.B.); (Z.S.); (Q.L.); (D.R.); (C.M.)
- EA3181, University Bourgogne Franche-Comté, 25000 Besançon, France
- Gynecology Department, CHU de Besançon, 25000 Besançon, France;
| | - Rajeev Ramanah
- Gynecology Department, CHU de Besançon, 25000 Besançon, France;
| | - Christiane Mougin
- Papillomavirus National Reference Centre, CHU de Besançon, 25000 Besançon, France; (A.B.); (Z.S.); (Q.L.); (D.R.); (C.M.)
- UMR1098, Host-Graft-Tumor Interactions and Cell and Tissue Engineering, University Bourgogne Franche-Comté, INSERM, 25000 Besançon, France
- La Fédération Hospitalo-Universitaire Integrated Center for Research in Inflammatory Diseases (FHU Increase), ANR-11-LABX-0021, LabEx LipSTIC, University Bourgogne Franche-Comté, 25000 Besançon, France
| | - Jean-Luc Prétet
- Papillomavirus National Reference Centre, CHU de Besançon, 25000 Besançon, France; (A.B.); (Z.S.); (Q.L.); (D.R.); (C.M.)
- EA3181, University Bourgogne Franche-Comté, 25000 Besançon, France
- Correspondence: ; Tel.: +33-(03)-70-63-20-49
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Charles T, De Tayrac R, Campagne-Loiseau S, Cosson M, Ferry P, Deffieux X, Lucot JP, Wagner L, Debodinance P, Saussine C, Pizzoferrato AC, Carlier-Guérin C, Thubert T, Panel L, Bosset PO, Nkounkou E, Ramanah R, Boisramé T, Raiffort C, Chavériat A, Fauconnier A, Fritel X. Serious complications and recurrences after pelvic organ prolapse surgery for 2,309 women in the VIGI-MESH registry. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00763-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Charles T, Wagner L, Campagne-Loiseau S, Ferry P, Saussine C, Cosson M, Deffieux X, Hummel M, Panel L, Lucot JP, Debodinance P, Carlier-Guérin C, Pizzoferrato AC, Vidart A, Thubert T, Ramanah R, Nkounkou E, Fauconnier A, Fritel X. Complications, revision and perceived health after surgery for stress urinary incontinence by mid urethra sling inthe VIGI-MESH register: Description and medium-term incidence for 1814 women. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00491-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Joulaud P, Pithois A, Ramanah R. Vaginal bleeding from an unidentified suspicious uterine tumor in a young woman. Am J Obstet Gynecol 2021; 224:400-401. [PMID: 33065134 DOI: 10.1016/j.ajog.2020.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/24/2020] [Accepted: 10/08/2020] [Indexed: 11/24/2022]
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Goh J, Romanzi L, Elneil S, Haylen B, Chen G, Ghoniem G, Ijaiya M, Kwon S, Lee J, Mourad S, Ramanah R, Regmi M, Mohsin Rivzi R, Rogers R, Sharp J, Sung V. An International Continence Society (ICS) report on the terminology for female pelvic floor fistulas. Neurourol Urodyn 2021; 39:2040-2071. [PMID: 33068487 DOI: 10.1002/nau.24508] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The terminology for female pelvic floor fistulas (PFF) needs to be defined and organized in a clinically based consensus Report. METHODS This Report combines the input of members of the International Continence Society (ICS) assisted at intervals by external referees. Appropriate core clinical categories and a sub-classification were developed to give a coding to definitions. An extensive process of 19 rounds of internal and external review was involved to examine each definition, with decision-making by collective opinion (consensus). RESULTS A terminology report for female PFF, encompassing 416 (188 NEW) separate definitions, has been developed. It is clinically based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in different specialty groups involved in female pelvic floor dysfunction and PFF. Female-specific imaging (ultrasound, radiology, and magnetic resonance imaging) and conservative and surgical PFF managements as well as appropriate figures have been included to supplement and clarify the text. Interval (5-10 years) review is anticipated to keep the document updated and as widely acceptable as possible. CONCLUSION A consensus-based terminology report for female PFF has been produced to aid clinical practice and research.
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Affiliation(s)
- Judith Goh
- Department of Gynecology, Griffith University, Gold Coast, Queensland, Australia
| | - Lauri Romanzi
- Department of Global Health and Global Medicine, Harvard Medical School, New York, New York, USA
| | - Sohier Elneil
- Department of Urogynecology, University College, London Hospitals, London, UK
| | - Bernard Haylen
- Department of Gynecology, University of New South Wales, Sydney, New South Wales, Australia
| | - Grace Chen
- Department of Gynecology, John Hopkins University, Baltimore, Maryland, USA
| | - Gamal Ghoniem
- Division of Female Urology, UC Irvine Health, Irvine, California, USA
| | - Munir'deen Ijaiya
- Department of Obstetrics and Gynecology, University of IIorin, IIorin, Kwara, Nigeria
| | - Soo Kwon
- Department of Gynecology, Zucker School of Medicine, New York, New York, USA
| | - Joseph Lee
- Department of Gynecology, University of New South Wales, Sydney, New South Wales, Australia
| | - Sherif Mourad
- Department of Gynecology, Ain Shams University, Cairo, Egypt
| | | | - Mohan Regmi
- Department of Obstetrics and Gynecology, BP Koirala Institute, Dharan, Nepal
| | | | - Rebecca Rogers
- Department of Obstetrics and Gynecology, University of Texas, Austin, Texas, USA
| | - Jonothan Sharp
- Department of Women's Health, Fenwek Hospital, Bomet, Kenya
| | - Vivian Sung
- Division of Urogynecology, Woman & Infants Hospital, Providence, Rhode Island, USA
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Benelmir S, Lallemant M, Manfredelli S, Ramanah R. [How do I perform … a laparoscopic diaphragmatic endometriosis resection]. ACTA ACUST UNITED AC 2021; 49:792-794. [PMID: 33516937 DOI: 10.1016/j.gofs.2021.01.018] [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: 07/19/2020] [Indexed: 11/28/2022]
Affiliation(s)
- S Benelmir
- Pôle mère-femme, service de gynécologie-obstétrique, centre hospitalier universitaire Besançon, 3 Boulevard Alexandre Fleming, 25000Besançon, France
| | - M Lallemant
- Pôle mère-femme, service de gynécologie-obstétrique, centre hospitalier universitaire Besançon, 3 Boulevard Alexandre Fleming, 25000Besançon, France; Laboratoire de nanomédecine, imagerie et thérapeutiques, INSERM EA 4662, Université de Franche-Comté, 19, rue Ambroise Paré, 25000 Besançon, France
| | - S Manfredelli
- Service de chirurgie digestive, centre hospitalier universitaire Besançon, 3, boulevard Alexandre Fleming, 25000 Besançon, France
| | - R Ramanah
- Pôle mère-femme, service de gynécologie-obstétrique, centre hospitalier universitaire Besançon, 3 Boulevard Alexandre Fleming, 25000Besançon, France; Laboratoire de nanomédecine, imagerie et thérapeutiques, INSERM EA 4662, Université de Franche-Comté, 19, rue Ambroise Paré, 25000 Besançon, France.
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Lenoir P, Lallemant M, Vilchez M, Ramanah R. V-Y advancement flap to correct a perineal defect after an episiotomy dehiscence. Int Urogynecol J 2021; 32:1935-1937. [PMID: 33449126 DOI: 10.1007/s00192-020-04658-x] [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: 09/05/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Episiotomy scar may be the site of complications and result in wound dehiscence in the long term. The aim of this video article was to describe the surgical steps required to repair a right perineal defect after episiotomy using a V-Y advancement flap. METHOD Our patient had an episiotomy dehiscence that had already benefited from an end-to-end repair, but the perineal defect recurred. A V-Y advancement flap was performed. The first step of this surgery was to remove the episiotomy scar. A V-shaped flap was then created to fill the perineal defect. Upon advancement, the V flap was transformed in a Y shape and secured using tension-free absorbable sutures. CONCLUSION There was no flap necrosis, and the esthetic result was satisfactory.
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Affiliation(s)
- Philomène Lenoir
- Department of Gynecologic Surgery, Besancon University Medical Centre, 3 Alexander Fleming Boulevard, 25000, Besançon, France.
| | - Marine Lallemant
- Department of Gynecologic Surgery, Besancon University Medical Centre, 3 Alexander Fleming Boulevard, 25000, Besançon, France.,Nanomedicine Imaging and Therapeutics Laboratory, INSERM EA 4662, University of Franche-Comte, Besançon, France
| | - Marie Vilchez
- Department of Gynecologic Surgery, Besancon University Medical Centre, 3 Alexander Fleming Boulevard, 25000, Besançon, France
| | - Rajeev Ramanah
- Department of Gynecologic Surgery, Besancon University Medical Centre, 3 Alexander Fleming Boulevard, 25000, Besançon, France.,Nanomedicine Imaging and Therapeutics Laboratory, INSERM EA 4662, University of Franche-Comte, Besançon, France
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Lallemant M, Tresch C, Puyraveau M, Delplanque S, Cosson M, Ramanah R. Evaluating the morbidity and long-term efficacy of laparoscopic sacrocolpopexy with and without robotic assistance for pelvic organ prolapse. J Robot Surg 2020; 15:785-792. [PMID: 33247428 DOI: 10.1007/s11701-020-01177-1] [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: 09/05/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of our study was to compare the morbidity and long-term efficacy after laparoscopic sacrocolpopexy with and without robotic assistance. METHODS We conducted a retrospective chart review of all laparoscopic or robotic sacrocolpopexies for POP-Q stage 2-4 vaginal prolapse performed between September 2015 and October 2018 in 2 Gynecologic Surgery Departments of France. Patients were separated into two groups: a laparoscopic sacrocolpopexy group (LS) and a robotic-assisted sacrocolpopexy group (RAS). The primary outcome measure was reoperation procedures for recurrent pelvic organ prolapse (POP). RESULTS Two hundred and fourteen patients were included, 160 patients (75%) in the LS group and 54 patients (25%) in the RAS group. After a mean follow-up of 32.8 months, reoperation rate for recurrent POP and the recurrent POP rate were greater in the RAS group (9.2% versus 1.2%, p = 0.01 and 25.9% versus 7.5%, p = 0.0003, respectively). No significant difference was found in terms of immediate intraoperative (3.1% versus 1.8%, p = 1) and postoperative complications (1.9% versus 1.8%, p = 1). On comparing the 2 groups by bivariate analysis, RAS significantly increased the odds of reoperation for POP recurrence (OR = 7.8 CI 95% [1.5-41.6], p = 0.02) and the odds of global reoperation (OR = 3.8 CI 95% [1.4-10.4], p = 0.0095). Similarly, multivariate logistic analysis showed that RAS increased the risks of global reoperation (OR = 3.8 CI 95% [1.3-10.6], p = 0.01) after controlling high-grade prolapse. CONCLUSION Robotic sacrocolpopexy does not appear to give long-term clinical benefits. Recurrent POP and reoperation procedures seem to be more frequent in case of robotic-assisted surgery.
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Affiliation(s)
- M Lallemant
- Department of Gynecologic Surgery, Besancon University Medical Centre, 3 Alexander Fleming Boulevard, 25000, Besançon, France. .,Nanomedicine Imaging and Therapeutics Laboratory, INSERM EA 4662, University of Franche-Comte, Besançon, France.
| | - C Tresch
- Department of Gynecologic Surgery, Besancon University Medical Centre, 3 Alexander Fleming Boulevard, 25000, Besançon, France
| | - M Puyraveau
- Methodology department, uMETh, Inserm CIC 1431, Besancon University Medical Centre, Besançon, France
| | - S Delplanque
- Department of Gynecologic Surgery, Jeanne de Flandre, University Medical Centre, Lille, France
| | - M Cosson
- Department of Gynecologic Surgery, Jeanne de Flandre, University Medical Centre, Lille, France
| | - R Ramanah
- Department of Gynecologic Surgery, Besancon University Medical Centre, 3 Alexander Fleming Boulevard, 25000, Besançon, France.,Nanomedicine Imaging and Therapeutics Laboratory, INSERM EA 4662, University of Franche-Comte, Besançon, France
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Bourdel N, Huchon C, Abdel Wahab C, Azaïs H, Bendifallah S, Bolze PA, Brun JL, Canlorbe G, Chauvet P, Chereau E, Courbiere B, De La Motte Rouge T, Devouassoux-Shisheboran M, Eymerit-Morin C, Fauvet R, Gauroy E, Gauthier T, Grynberg M, Koskas M, Larouzee E, Lecointre L, Levêque J, Margueritte F, Mathieu D'argent E, Nyangoh-Timoh K, Ouldamer L, Raad J, Raimond E, Ramanah R, Rolland L, Rousset P, Rousset-Jablonski C, Thomassin-Naggara I, Uzan C, Zilliox M, Daraï E. Borderline ovarian tumors: Guidelines from the French national college of obstetricians and gynecologists (CNGOF). Eur J Obstet Gynecol Reprod Biol 2020; 256:492-501. [PMID: 33262005 DOI: 10.1016/j.ejogrb.2020.11.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 10/28/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 11/28/2022]
Abstract
It is recommended to classify Borderline Ovarian Tumors (BOTs) according to the WHO classification. Transvaginal and suprapubic ultrasonography are recommended for the analysis of an ovarian mass (Grade A). In case of an undetermined ovarian lesion on ultrasonography, it is recommended to perform a pelvic MRI (Grade A) with a score for malignancy (ADNEX MR/O-RADS) (Grade C) included in the report and to formulate a histological hypothesis (Grade C). Pelvic MRI is recommended to characterize a tumor suspected of being BOT (Grade C). It is recommended to evaluate serum levels of HE4 and CA125 and to use the ROMA score for the diagnosis of indeterminate ovarian mass on imaging (grade A). If there is a suspicion of a mucinous BOT on imaging, serum levels of CA 19-9 may be proposed (Grade C). For Early Stages (ES) of BOT, if surgery without risk of tumor rupture is possible, laparoscopy with protected extraction is recommended over laparotomy (Grade C). For treatment of a bilateral serous ES BOT with a strategy to preserve fertility and/or endocrine function, bilateral cystectomy is recommended where possible (Grade B). For mucinous BOTs with a treatment strategy of fertility and/or endocrine function preservation, unilateral salpingo-oophorectomy is recommended (grade C). For mucinous BOTs treated by initial cystectomy, unilateral salpingo-oophorectomy is recommended (grade C). For serous or mucinous ES BOTs, routine hysterectomy is not recommended (Grade C). For ES BOTs, lymphadenectomy is not recommended (Grade C). For ES BOTs, appendectomy is recommended only in case of a macroscopically pathological appendix (Grade C). Restaging surgery is recommended in cases of serous BOTs with micropapillary architecture and an incomplete abdominal cavity inspection during initial surgery (Grade C). Restaging surgery is recommended for mucinous BOTs after initial cystectomy or in cases where the appendix was not examined (Grade C). If restaging surgery is decided for ES BOTs, the following procedures should be performed: peritoneal washing (grade C), omentectomy (grade B), complete exploration of the abdominal cavity with peritoneal biopsies (grade C), visualization of the appendix and appendectomy in case of a pathological macroscopic appearance (grade C) as well as unilateral salpingo-oophorectomy in case of a mucinous BOT initially treated by cystectomy (grade C). In advanced stages (AS) of BOT, it is not recommended to perform a lymphadenectomy as a routine procedure (Grade C). For AS BOT in a patient with a desire to fall pregnant, conservative treatment involving preservation of the uterus and all or part of the ovary may be proposed (Grade C). Restaging surgery aimed at removing all lesions, not performed initially, is recommended for AS BOTs (Grade C). After treatment, follow-up for a duration greater than 5 years is recommended due to the median recurrence time of BOTs (Grade B). It is recommended that a systematic clinical examination be carried out during follow-up of a treated BOT (Grade B). If the determination of tumor markers is normal preoperatively, the routine dosage of tumor markers in BOT follow-up is not recommended (Grade C). In case of an initial elevation in serum CA 125 levels, it is recommended to monitor CA 125 during follow up (Grade B). In case of conservative treatment, it is recommended to use transvaginal and transabdominal ultrasound during follow up of a treated BOT (Grade B). In the event of a BOT recurrence in a woman of childbearing age, a second conservative treatment may be proposed (Grade C). A consultation with a physician specialized in Assisted Reproductive Technique (ART) should be offered in the case of BOTs in women of childbearing age (Grade C). When possible, a conservative surgical strategy is recommended to preserve fertility in women of childbearing age (Grade C). In the case of optimally treated BOT, there is no evidence to contraindicate the use of ART. The use of hormonal contraception after serous or mucinous BOT is not contraindicated (Grade C). After management of mucinous BOT, for women under 45 years, given the benefit of Hormonal Replacement Therapy (HRT) on cardiovascular and bone risks, and the lack of hormone sensitivity of mucinous BOTs, it is recommended to offer HRT (Grade C). Over 45 years of age, HRT can be prescribed in case of a climacteric syndrome after individual benefit to risk assessment (Grade C).
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Affiliation(s)
- N Bourdel
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003 Clermont Ferrand, France
| | - C Huchon
- Service de Gynécologie & Obstétrique, Hopital Lariboisière, 2 rue Ambroise Paré, 75010 Paris, France; Université de Paris, Paris, France.
| | - C Abdel Wahab
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France; Faculté De Médecine UPMC, Sorbonne Université, France
| | - H Azaïs
- AP-HP, Hôpital Pitié-Salpêtrière, Service De Chirurgie Et Oncologie Gynécologique Et Mammaire, 75013 Paris, France; Faculté de Médecine UPMC, Sorbonne Université, France
| | - S Bendifallah
- Service De Gynécologie-Obstétrique Et Médecine De La Reproduction, Hôpital Tenon, Assistance Publique Des Hôpitaux De Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, France
| | - P A Bolze
- Service De Chirurgie Gynécologique Et Oncologique, Obstétrique, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre Bénite, France; Université Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France
| | - J L Brun
- Service De Chirurgie Gynécologique, Centre Aliénor d'Aquitaine, Hôpital Pellegrin, 33076 Bordeaux, Société Française De Gynéco Pathologie, 81 Rue Verte, 76000 Rouen, France
| | - G Canlorbe
- AP-HP, Hôpital Pitié-Salpêtrière, Service De Chirurgie Et Oncologie Gynécologique Et Mammaire, 75013 Paris, France; Faculté de Médecine UPMC, Sorbonne Université, France
| | - P Chauvet
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003 Clermont Ferrand, France
| | - E Chereau
- Service De Gynécologie Obstétrique, Hopital Saint Joseph, Marseille, France
| | - B Courbiere
- Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005 Marseille, France
| | | | - M Devouassoux-Shisheboran
- Institut De Pathologie Multi-Sites Des HOSPICES CIVILS De LYON, Centre Hospitalier Lyon Sud, Centre De Biologie Et Pathologie Sud, 165 Chemin Du Grand Revoyet, 69495 Pierre Bénite. Société Française de Gynéco Pathologie, 81 Rue Verte, 76000 Rouen, France
| | - C Eymerit-Morin
- Service d'Anatomie Et Cytologie Pathologiques, Hôpital Tenon, HUEP, UPMC Paris VI, Sorbonne Universities, 4 rue de la Chine, 75020 Paris, France; Institut de Pathologie de Paris, 35 boulevard Stalingrad, 92240 Malakoff, France
| | - R Fauvet
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire de Caen, Caen, France
| | - E Gauroy
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - T Gauthier
- Service De Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 Av Dominique Larrey 87042 Limoges, France
| | - M Grynberg
- Service De Médecine De La Reproduction, Hôpital Antoine Béclère, 157 Rue De La Porte De Trivaux, 92140 Clamart, France
| | - M Koskas
- Service De Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - E Larouzee
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - L Lecointre
- Centre Hospitalier Universitaire Hautepierre, Hôpital de Hautepierre, CHRU Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France
| | - J Levêque
- Département De Gynécologie Obstétrique Et Reproduction Humaine, 16, Boulevard De Bulgarie, 35000 CHU Anne De Bretagne, UFR Médecine Université de Rennes 1, Rennes, Bretagne, France
| | - F Margueritte
- Service De Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 Av Dominique Larrey, 87042 Limoges, France
| | - E Mathieu D'argent
- Service de Gynécologie-Obstétrique Et Médecine De La Reproduction, Hôpital Tenon, Assistance Publique Des Hôpitaux De Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, France
| | - K Nyangoh-Timoh
- Département De Gynécologie Obstétrique Et Reproduction Humaine, 16, Boulevard De Bulgarie, 35000 CHU Anne De Bretagne, UFR Médecine Université de Rennes 1, Rennes, Bretagne, France
| | - L Ouldamer
- Département De Gynécologie, Centre Hospitalier Universitaire De Tours, Hôpital Bretonneau, 2 Boulevard Tonnellé, 37000, Tours, France
| | - J Raad
- Service De Médecine De La Reproduction, Hôpital Antoine Béclère, 157 Rue De La Porte De Trivaux, 92140 Clamart, France
| | - E Raimond
- Département de Gynécologie Obstétrique, Institut Alix De Champagne, CHU Reims, Reims, France
| | - R Ramanah
- Pôle Mère-Femme, CHU Besançon, 3 Boulevard Fleming, 25000 Besançon, France
| | - L Rolland
- Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005 Marseille, France
| | - P Rousset
- Service de Radiologie, Centre Hospitalier Lyon Sud, HCL, EMR 3738, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre-Bénite, France; Université Lyon 1, 43 Boulevard Du 11 Novembre 1918, 69100, Villeurbanne, France
| | - C Rousset-Jablonski
- Centre Léon Bérard, 28 Rue Laënnec, 69008, Lyon, France; Centre Hospitalier Lyon Sud, Pierre-Bénite, France; Université Claude Bernard Lyon 1, EA 7425 Hesper, Health Service and Performance Research, Domaine Rockefeller, 8 Avenue Rockefeller, 69373, Lyon Cedex 8, France
| | - I Thomassin-Naggara
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France; Faculté de Médecine UPMC, Sorbonne Université, France
| | - C Uzan
- AP-HP, Hôpital Pitié-Salpêtrière, Service De Chirurgie Et Oncologie Gynécologique Et Mammaire, 75013 Paris, France; Faculté de Médecine UPMC, Sorbonne Université, France
| | - M Zilliox
- Centre Hospitalier Universitaire Hautepierre, Hôpital De Hautepierre, CHRU Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France
| | - E Daraï
- Service de Gynécologie-Obstétrique Et Médecine De La Reproduction, Hôpital Tenon, Assistance Publique Des Hôpitaux De Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, France
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Huchon C, Bourdel N, Abdel Wahab C, Azaïs H, Bendifallah S, Bolze PA, Brun JL, Canlorbe G, Chauvet P, Chereau E, Courbiere B, De La Motte Rouge T, Devouassoux-Shisheboran M, Eymerit-Morin C, Fauvet R, Gauroy E, Gauthier T, Grynberg M, Koskas M, Larouzee E, Lecointre L, Levêque J, Margueritte F, Mathieu D'argent E, Nyangoh-Timoh K, Ouldamer L, Raad J, Raimond E, Ramanah R, Rolland L, Rousset P, Rousset-Jablonski C, Thomassin-Naggara I, Uzan C, Zilliox M, Daraï E. Borderline ovarian tumors: French guidelines from the CNGOF. Part 1. Epidemiology, biopathology, imaging and biomarkers. J Gynecol Obstet Hum Reprod 2020; 50:101965. [PMID: 33160106 DOI: 10.1016/j.jogoh.2020.101965] [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] [Indexed: 11/17/2022]
Abstract
The incidence (rate per 100 000) of borderline ovarian tumors (BOTs) increases progressively with age, starting at 15-19 years and peaking at around 4.5 cases per 100 000 at an age of 55-59 years (LE3) with a median age of 46 years. The five year survival for FIGO stages I, II, III and IV is 99.7 % (95 % CI: 96.2-100 %), 99.6 % (95 % CI: 92.6-100 %), 95.3 % (95 % CI: 91.8-97.4 %) and 77.1 % (95 % CI: 58.0-88.3 %), respectively (LE3). An epidemiological association exists between the individual risk of BOT and family history of BOT and certain other cancers (pancreatic, lung, bone, leukemia) (LE3), a personal history of benign ovarian cyst (LE2), a personal history of tubo-ovarian infection (LE3), the use of a levonorgestrel intrauterine device (LE3), oral contraceptive use (LE3), multiparity (LE3), Hormonal replacement therapy (LE3), high consumption of Coumestrol (LE4), medical treatment for infertility with progesterone (LE3) and non-steroidal anti-inflammatory drug use (LE3). Screening for BOTs is not recommended for patients (Grade C). The overall risk of recurrence of BOTs varies between 2% and 24 %, with an overall survival greater than 94 % at 10 years, and the risk of an invasive recurrence of a BOT ranges from 0.5 % to 3.8 %. The use of scores and nomograms can be useful in assessing the risk of recurrence, and providing patients with information (Grade C). The WHO classification is recommended for classifying BOTs. It is recommended that the presence of a microinvasive focus (<5 mm) and microinvasive carcinoma (<5 mm with an atypical nuclei and a desmoplastic stroma reaction) within a BOT be reported. In cases of serous BOT, it is recommended to specify the classic histological subtype or micropapillary / cribriform type (Grade C). When confronted with a BOT, it is recommended that the invasive or non-invasive nature of peritoneal implants can be investigated based solely on the invasion and destruction of underlying adipose or peritoneal tissue which has a desmoplastic stromal reaction where in contact with the invasive clusters (Grade B). For bilateral mucinous BOTs and / or in cases with peritoneal implants or peritoneal pseudomyxoma, it is recommended to also look for a primitive digestive or pancreato-biliary cancer (Grade C). It is recommended to sample ovarian tumors suspected of being BOTs by focusing samples on vegetations and solid components, with at least 1 sample per cm in tumors with a size less than 10 cm and 2 samples per cm in tumors with a size greater than 10 cm (Grade C). In cases of BOTs and in the absence of macroscopic omental involvement after careful macroscopic examination, it is recommended to perform at least 4-6 systematic sampling blocks and to include all peritoneal implants (Grade C). It is recommended to consult an expert pathologist in gynecology when a BOT suspicion requires intraoperative extemporaneous histology (grade C). Endo-vaginal and suprapubic ultrasonography are recommended for the analysis of an ovarian mass (Grade A). In case of an undetermined ovarian lesion on ultrasonography, it is recommended that a pelvic MRI be performed (Grade A). To analyze an adnexal mass with MRI, it is recommended to use an MRI protocol with T2, T1, T1 Fat Sat, dynamic and diffusion sequences as well as gadolinium injection (Grade B). To characterize an adnexal mass with MRI, it is recommended to include a score system for malignancy (ADNEX MR/O-RADS) (Grade C) in the report and to formulate a histological hypothesis (Grade C). Pelvic MRI is recommended to characterize a tumor suspected of being a BOT (Grade C). Macroscopic MRI features should be analyzed to differentiate BOT subtypes (Grade C). Pelvic ultrasound is the first-line examination for the detection and characterization of adnexal masses during pregnancy (Grade C). Pelvic MRI is recommended from 12 weeks of gestation in case of an indeterminate adnexal mass and should provide a diagnostic score (Grade C). Gadolinium injection must be minimized as fetal impairment has been proven (Grade C). It is recommended that serum levels of HE4 and CA125 be evaluated and that the ROMA score for the diagnosis of an indeterminate ovarian mass on imaging be used (grade A). In case of suspicion of a mucinous BOT on imaging, dosage of serum levels of CA 19-9 can be considered (Grade C). If the determination of tumor markers is normal preoperatively, routine dosage of tumor markers in BOT follow-up is not recommended (Grade C). In case of preoperative elevation in tumor markers, the determination of serum CA 125 levels is recommended in the follow-up of BOT (Grade B). When conservative treatment of a BOT has been adopted, the use of endovaginal and transabdominal ultrasonography is recommended during follow-up (Grade B).
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Affiliation(s)
- Cyrille Huchon
- APHP. Service de gynécologie & obstétrique, GH Saint-Louis Lariboisière-Fernand Widal, Hôpital Lariboisière, Université de Paris, 2, rue Ambroise Paré, 75010 Paris, France.
| | - Nicolas Bourdel
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003 Clermont Ferrand, France
| | - Cendos Abdel Wahab
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
| | - Henri Azaïs
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
| | - Sofiane Bendifallah
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
| | - Pierre-Adrien Bolze
- Service de chirurgie gynécologique et oncologique, obstétrique, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre Bénite, France; Université Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France
| | - Jean-Luc Brun
- Service de Chirurgie Gynécologique, Centre Aliénor d'Aquitaine, Hôpital Pellegrin, 33076 Bordeaux, France; Société Française de Gynéco Pathologie, 81 rue verte, 76000 Rouen, France
| | - Geoffroy Canlorbe
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
| | - Pauline Chauvet
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003 Clermont Ferrand, France
| | - Elisabeth Chereau
- Service de gynécologie obstétrique, Hopital Saint Joseph, 13005 Marseille, France
| | - Blandine Courbiere
- Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005 Marseille, France
| | | | - Mojgan Devouassoux-Shisheboran
- Institut de Pathologie multi-sites des HOSPICES CIVILS de LYON, Centre Hospitalier Lyon Sud, Centre de biologie et pathologie Sud, 165 Chemin du Grand revoyet, 69495 Pierre Bénite, France; Société Française de Gynéco Pathologie, 81 rue verte, 76000 Rouen, France
| | - Caroline Eymerit-Morin
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Tenon, HUEP, 4 rue de la Chine, 75020 Paris, France; UPMC Paris VI, Sorbonne Universities, France; Institut de Pathologie de Paris, 35 boulevard Stalingrad, 92240 Malakoff, France
| | - Raffaele Fauvet
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire de Caen, 14000 Caen, France
| | - Elodie Gauroy
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, Université de Paris, 75018 Paris, France
| | - Tristan Gauthier
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 av Dominique Larrey, 87042 Limoges, France
| | - Michael Grynberg
- Service de Médecine de la Reproduction, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140 Clamart, France
| | - Martin Koskas
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, Université de Paris, 75018 Paris, France
| | - Elise Larouzee
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, Université de Paris, 75018 Paris, France
| | - Lise Lecointre
- Centre Hospitalier Universitaire Hautepierre, Hôpital de Hautepierre, CHRU Strasbourg, 1 avenue Molière, 67000 Strasbourg, France
| | - Jean Levêque
- Département de Gynécologie Obstétrique et Reproduction Humaine, 16, boulevard de Bulgarie, 35000 Rennes, France; CHU Anne de Bretagne, UFR Médecine Université de Rennes 1, 35000 Rennes, Bretagne, France
| | - Francois Margueritte
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 av Dominique Larrey, 87042 Limoges, France
| | - Emmanuelle Mathieu D'argent
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
| | - Krystel Nyangoh-Timoh
- Département de Gynécologie Obstétrique et Reproduction Humaine, 16, boulevard de Bulgarie, 35000 Rennes, France; CHU Anne de Bretagne, UFR Médecine Université de Rennes 1, 35000 Rennes, Bretagne, France
| | - Lobna Ouldamer
- Département de Gynécologie, Centre hospitalier universitaire de Tours, Hôpital Bretonneau, 2 Boulevard Tonnellé, 37000, Tours, France
| | - Jade Raad
- Service de Médecine de la Reproduction, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140 Clamart, France
| | - Emilie Raimond
- Département de Gynécologie Obstétrique, Institut Alix de Champagne, CHU Reims, 51000 Reims, France
| | - Rajeev Ramanah
- Pôle Mère-Femme, CHU Besançon, 3 boulevard Fleming, 25000 Besançon, France
| | - Lucie Rolland
- Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005 Marseille, France
| | - Pascal Rousset
- Service de Radiologie, Centre Hospitalier Lyon Sud, HCL, EMR 3738, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre-Bénite, France; Université Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France
| | - Christine Rousset-Jablonski
- Centre Léon Bérard, 28 Rue Laënnec, 69008, Lyon, France; Centre Hospitalier Lyon Sud, Pierre-Bénite, France; Université Claude Bernard Lyon 1, EA 7425 Hesper, Health Service and Performance Research, Domaine Rockefeller, 8 Avenue Rockefeller, 69373, Lyon Cedex 8, France
| | - Isabelle Thomassin-Naggara
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
| | - Catherine Uzan
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
| | - Marie Zilliox
- Centre Hospitalier Universitaire Hautepierre, Hôpital de Hautepierre, CHRU Strasbourg, 1 avenue Molière, 67000 Strasbourg, France
| | - Emile Daraï
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, 75013 Paris, France
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Bourdel N, Huchon C, Abdel Wahab C, Azaïs H, Bendifallah S, Bolze PA, Brun JL, Canlorbe G, Chauvet P, Chereau E, Courbiere B, De La Motte Rouge T, Devouassoux-Shisheboran M, Eymerit-Morin C, Fauvet R, Gauroy E, Gauthier T, Grynberg M, Koskas M, Larouzee E, Lecointre L, Levêque J, Margueritte F, D'argent Mathieu E, Nyangoh-Timoh K, Ouldamer L, Raad J, Raimond E, Ramanah R, Rolland L, Rousset P, Rousset-Jablonski C, Thomassin-Naggara I, Uzan C, Zilliox M, Daraï E. Borderline ovarian tumors: French guidelines from the CNGOF. Part 2. Surgical management, follow-up, hormone replacement therapy, fertility management and preservation. J Gynecol Obstet Hum Reprod 2020; 50:101966. [PMID: 33144266 DOI: 10.1016/j.jogoh.2020.101966] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In the Early Stages (ES) of Borderline Ovarian Tumor (BOT), if surgery without risk of tumor rupture is possible, then laparoscopy with protected extraction is recommended over laparotomy (Grade C). In case of bilateral serous ES BOT treatment with a strategy to preserve fertility and/or endocrine function, bilateral cystectomy is recommended if possible (Grade B). In case of mucinous BOT treatment with a strategy to preserve fertility and/or endocrine function, unilateral adnexectomy is recommended (grade C). In the case of a mucinous BOT in a patient who has had an initial cystectomy, unilateral adnexectomy is recommended (grade C). In the case of treatment of a serous ES BOT in a patient who has had an initial cystectomy, with a strategy to preserve fertility and/or endocrine function, restaging surgery for adnexectomy is not recommended in the absence of suspicious residual lesions at the time of surgery and/or postoperative imaging (reference ultrasonography or pelvic MRI) (grade C). For serous or mucinous ES BOTs, routine hysterectomy is not recommended (Grade C). In cases of ES BOTs, lymphadenectomy is not recommended (Grade C). For ES BOTs, appendectomy is recommended only if there is a macroscopically pathological aspect to the appendix (Grade C). Restaging surgery is recommended in case of a serous BOT with a micropapillary aspect and an unsatisfactory inspection of the abdominal cavity during initial surgery (Grade C). Restaging surgery is recommended in cases of mucinous BOT if only a cystectomy has been performed or if the appendix has not been evaluated (Grade C). If restaging surgery is decided for an ES BOT, the following procedures should be performed: peritoneal cytology (grade C), omentectomy (there is no data in literature to recommend which type of omentectomy should be performed) (grade B), complete exploration of the abdominal cavity with peritoneal biopsies (grade C), visualization of the appendix +/- appendectomy in case of pathological macroscopic appearance (grade C) and unilateral adnexectomy in case of a mucinous BOT (grade C). In advanced stages of BOT it is not recommended to perform a lymphadenectomy as a routine procedure (Grade C). In cases of an advanced stage BOT, in a patient with a desire to fall pregnant, conservative treatment involving preservation of the uterus and all or part of the ovary may be proposed after a multidisciplinary meeting (Grade C). Second surgery aimed at removing all lesions, if not performed initially, is recommended in cases of advanced stage BOT (Grade C). It is not recommended to perform completion surgery after conservative treatment (preservation of the ovaries and the uterus) and after the achievement of fertility desire for a serous BOT (Grade B). After treatment for a BOT, follow-up beyond 5 years is recommended due to the median time to recurrence (Grade B). It is recommended that a systematic clinical examination be carried out during follow-up of a treated BOT (Grade B). In the particular case of an initial elevation of CA 125 levels, it is recommended to monitor CA 125 during follow up (Grade B). In cases treated conservatively (ovarian and uterine conservation), it is recommended to use endovaginal and transabdominal ultrasonography during the follow up period (Grade B). In the event of a recurrence of a BOT, in a woman of childbearing age, a conservative treatment strategy can again be proposed (Grade C). In the presence of non-invasive BOT implants, conservative treatment may be considered after a first non-invasive recurrence in women who wish to preserve their fertility (Grade C). Pelvic MRI is recommended after 12 weeks of amenorrhea in case of an undetermined adnexal mass and should be concluded with a diagnostic score (Grade C). The injection of gadolinium, in case of pregnancy, should be discussed on a case-by-case basis due to the proven risks for the foetus (Grade C). If feasible, a laparoscopic approach should be preferred during pregnancy (Grade C). A consultation with a specialist reproductive physician should be offered to patients with a BOT and of childbearing age (Grade C). It is recommended that patients be provided with full information on the risk of decreased ovarian reserve following to surgical treatment. It is recommended that the ovarian reserve be evaluated prior to surgical management of a suspected BOT (Grade C). When possible, a conservative surgical strategy is recommended to preserve fertility in women of childbearing age (Grade C). There is no specific data on the management of infertility following to conservative treatment of BOT. In case of durable infertility following to conservative treatment of BOT, a consultation with a specialist reproductive physician is required (Grade C). In the case of optimally treated BOT, there is no evidence in literature to contraindicate the use of Assisted Reproductive Techniques (ART). The use of hormonal contraception after serous or mucinous BOT is not contraindicated (Grade C). After treatment of a mucinous BOT, for women aged under 45 years, given the benefit of hormonal replacement therapy (HRT) on cardiovascular and bone risks, and the lack of hormone-sensitivity of mucinous BOTs, it is recommended to offer HRT (Grade C). After treatment of a mucinous BOT, for women over 45 years of age, there is no argument to contraindicate the use of HRT. HRT can be prescribed in case of a climacteric syndrome, as part of an individual benefit to risk assessment (Grade C).
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Affiliation(s)
- Nicolas Bourdel
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003, Clermont Ferrand, France
| | - Cyrille Huchon
- Service de gynécologie & obstétrique, GH Saint-Louis Lariboisière-Fernand Widal, Hôpital Lariboisière, Université de Paris, 2, rue Ambroise Paré, 75010, Paris, France.
| | - Cendos Abdel Wahab
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
| | - Henri Azaïs
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, Faculté de Médecine UPMC, Sorbonne Université, 75013, Paris, France
| | - Sofiane Bendifallah
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
| | - Pierre-Adrien Bolze
- Service de chirurgie gynécologique et oncologique, obstétrique, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre Bénite, France; Université Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France
| | - Jean-Luc Brun
- Service de Chirurgie Gynécologique, Centre Aliénor d'Aquitaine, Hôpital Pellegrin, 33076 Bordeaux, Société Française de Gynéco Pathologie, 81 rue verte, 76000, Rouen, France
| | - Geoffroy Canlorbe
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, Faculté de Médecine UPMC, Sorbonne Université, 75013, Paris, France
| | - Pauline Chauvet
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003, Clermont Ferrand, France
| | - Elizabeth Chereau
- Service de gynécologie obstétrique, Hopital Saint Joseph, 13005, Marseille, France
| | - Blandine Courbiere
- Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005, Marseille, France
| | | | - Mojgan Devouassoux-Shisheboran
- Institut de Pathologie multi-sites des HOSPICES CIVILS de LYON, Centre Hospitalier Lyon Sud, Centre de biologie et pathologie Sud, 165 Chemin du Grand revoyet, 69495 Pierre Bénite, Société Française de Gynéco Pathologie, 81 rue verte, 76000, Rouen, France
| | - Caroline Eymerit-Morin
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Tenon, HUEP, 4 rue de la Chine, 75020, Paris, UPMC Paris VI, Sorbonne Universities, France; Institut de Pathologie de Paris, 35 boulevard Stalingrad, 92240, Malakoff, France
| | - Raffaele Fauvet
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire de Caen, 14000, Caen, France
| | - Elodie Gauroy
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, Université de Paris, 75018, Paris, France
| | - Tristan Gauthier
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 av Dominique Larrey, 87042, Limoges, France
| | - Michael Grynberg
- Service de Médecine de la Reproduction, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140, Clamart, France
| | - Martin Koskas
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, Université de Paris, 75018, Paris, France
| | - Elise Larouzee
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, Université de Paris, 75018, Paris, France
| | - Lise Lecointre
- Département de Gynécologie Obstétrique et Reproduction Humaine, 16, boulevard de Bulgarie, CHU Anne de Bretagne, UFR Médecine Université de Rennes 1, 35000, Rennes, France
| | - Jean Levêque
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003, Clermont Ferrand, France; Service de gynécologie obstétrique, Hopital Saint Joseph, 13005, Marseille, France
| | - Francois Margueritte
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 av Dominique Larrey, 87042, Limoges, France
| | - Emmanuelle D'argent Mathieu
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
| | - Krystel Nyangoh-Timoh
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003, Clermont Ferrand, France; Service de gynécologie obstétrique, Hopital Saint Joseph, 13005, Marseille, France
| | - Lobna Ouldamer
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003, Clermont Ferrand, France; Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005, Marseille, France
| | - Jade Raad
- Service de Médecine de la Reproduction, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140, Clamart, France
| | - Emilie Raimond
- Département de Gynécologie Obstétrique, Institut Alix de Champagne, CHU Reims, 51100, Reims, France
| | - Rajeev Ramanah
- Département de Gynécologie, Centre hospitalier universitaire de Tours, Hôpital Bretonneau, 2 Boulevard Tonnellé, 37000, Tours, France
| | - Lucie Rolland
- Service de gynécologie obstétrique, Hopital Saint Joseph, 13005, Marseille, France
| | - Pascal Rousset
- Service de Radiologie, Centre Hospitalier Lyon Sud, HCL, EMR 3738, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre-Bénite, France; Université Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France
| | - Christine Rousset-Jablonski
- Pôle Mère-Femme, CHU Besançon, 3 boulevard Fleming, 25000, Besançon, France; Centre Hospitalier Lyon Sud, Pierre-Bénite, France; Université Claude Bernard Lyon 1, EA 7425 Hesper, Health Service and Performance Research, Domaine Rockefeller, 8 Avenue Rockefeller, 69373, Lyon Cedex 8, France
| | - Isabelle Thomassin-Naggara
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
| | - Catherine Uzan
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, Faculté de Médecine UPMC, Sorbonne Université, 75013, Paris, France
| | - Marie Zilliox
- Centre Hospitalier Universitaire Hautepierre, Hôpital de Hautepierre, CHRU Strasbourg, 1 avenue Molière, 67000, Strasbourg, France
| | - Emile Daraï
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, 75020, Paris, France
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Charles T, Wagner L, Campagne-Loiseau S, Ferry P, Saussine C, Cosson M, Deffieux X, Hummel M, Panel L, Lucot J, Debodinance P, Carlier C, Pizzoferrato A, Vidart A, Hubert T, Ramanah R, Nkounkou E, Fauconnier A, De Tayrac R, Fritel X. Complications, révisions et qualité de vie à moyen terme après 1814 chirurgies de l’incontinence urinaire d’effort par bandelette sous-urétrale : données du registre VIGI-MESH. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wagner L, Campagne-Loiseau S, De Tayrac R, Ferry P, Deffieux X, Lucot J, Fauconnier A, De Bodinance P, Saussine C, Pizzoferrato A, Carlier C, Thubert T, Panel L, Bosset P, Nkounkou E, Ramanah R, Charles T, Bressler L, Cosson M, Fritel X. Taux de complications et de récidives après chirurgie des prolapsus des organes pelviens : résultats à moyen terme d’une étude prospective chez 2341 patientes (Registre VIGI-MESH). Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dole C, Metz JP, Formet J, Riethmuller D, Ramanah R, Mottet N. Intra pelvic spontaneous rotation of persistent occiput posterior position in case of operative vaginal delivery with spatulas. J Gynecol Obstet Hum Reprod 2020; 50:101943. [PMID: 33069912 DOI: 10.1016/j.jogoh.2020.101943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES In 5 % of vaginal deliveries in case of cephalic presentation there is a persistent occipital posterior position known to be associated with a higher maternal and neonatal morbidity. In these situations, vacuum extractor seems to be the best choice for assisted delivery but it also has limits and contraindications, for example an important caput succadenum or premature birth. The aim of our study was to evaluate the rate of intra-pelvic rotation of persistent occipital posterior position without instrumental rotation in case of operative delivery with spatulas. METHODS This is a retrospective, monocentric and descriptive study evaluating the rate of spontaneous intra-pelvic rotation of persistent occipital posterior position in case of assisted delivery with spatulas among all live births at the Besançon University Medical Center between 2010 and 2017. RESULTS There were 20 205 births during the study and 81(0,4 %) operative deliveries by spatulas in case of persistent occipital posterior position. Delivery in occiput anterior (OA) position was obtained in 36 cases (44.4 %). There was no significant difference in maternal or neonatal morbidity between both groups and perineum injuries were less severe in case of OA delivery. CONCLUSION Operative deliveries by spatulas without instrumental rotation in case of persistent occipital-posterior position seem to be a relevant alternative to vacuum extractor, especially in case of premature birth or important caput succedaneum without altering the maternal or neonatal prognostic.
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Affiliation(s)
- Chloé Dole
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000, Besançon, France.
| | - Jean Patrick Metz
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000, Besançon, France
| | - Justine Formet
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000, Besançon, France
| | - Didier Riethmuller
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000, Besançon, France
| | - Rajeev Ramanah
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000, Besançon, France
| | - Nicolas Mottet
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000, Besançon, France
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Forey PL, Lallemant M, Bourtembourg-Matras A, Eckman-Lacroix A, Ramanah R, Riethmuller D, Mottet N. Impact of a selective use of episiotomy combined with Couder's maneuver for the perineal protection. Arch Gynecol Obstet 2020; 302:77-83. [PMID: 32388778 DOI: 10.1007/s00404-020-05572-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 04/25/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the impact of a selective use of episiotomy combined with Couder's maneuver on the incidence of perineal tears in spontaneous term deliveries. METHODS A comparative, retrospective, mono-centric study in a university maternity unit was designed and included all primiparous women who delivered spontaneously after 37 weeks of gestation in cephalic presentation. Two cohorts were studied, before and after the practice of Couder's maneuver. In the first cohort, the ''OSE cohort'' only selective episiotomies were performed from January 2009 to December 2010. In the second cohort, from January 2016 to December 2017, the ''SEC cohort'' selective episiotomies combined with Couder's maneuver were performed by midwives and obstetricians. The primary outcome was the type of perineal tears, according to the Royal College of Obstetricians and Gynaecologists (RCOG) classification. RESULTS A total of 2081 patients were included: 909 patients in the OSE cohort and 1172 patients in the SEC cohort. Couder's maneuver was performed in 59% of the SEC cohort. In the SEC cohort, there were an increase in the number of intact perinea (55% versus 63%, p < 0.001), a decrease in second-degree perineal tears (18% versus 11%, p < 0.001) and a decrease in labia minora tears (48% versus 37%, p < 0.001). The rate of obstetrical anal sphincter injuries was less than 1% in both cohorts (0.3% versus 0.5%, p = 0.7). CONCLUSION A selective use of episiotomy combined with Couder's maneuver could reduce the incidence of perineal tears, particularly second-degree perineal tears, without increasing the rate of obstetrical anal sphincter injuries.
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Affiliation(s)
- Pierre-Louis Forey
- Department of Obstetrics and Gynecology, University Hospital Jean Minjoz, University of Franche-Comté, 25000, Besançon, France
| | - Marine Lallemant
- Department of Obstetrics and Gynecology, University Hospital Jean Minjoz, University of Franche-Comté, 25000, Besançon, France
| | - Aude Bourtembourg-Matras
- Department of Obstetrics and Gynecology, University Hospital Jean Minjoz, University of Franche-Comté, 25000, Besançon, France
| | - Astrid Eckman-Lacroix
- Department of Obstetrics and Gynecology, University Hospital Jean Minjoz, University of Franche-Comté, 25000, Besançon, France
| | - Rajeev Ramanah
- Department of Obstetrics and Gynecology, University Hospital Jean Minjoz, University of Franche-Comté, 25000, Besançon, France
- Nanomedecine Laboratory, Imagery and Therapeutics, INSERM EA 4662, University of Franche-Comté, 25000, Besançon, France
| | - Didier Riethmuller
- Department of Obstetrics and Gynecology, University Hospital Jean Minjoz, University of Franche-Comté, 25000, Besançon, France
| | - Nicolas Mottet
- Department of Obstetrics and Gynecology, University Hospital Jean Minjoz, University of Franche-Comté, 25000, Besançon, France.
- Nanomedecine Laboratory, Imagery and Therapeutics, INSERM EA 4662, University of Franche-Comté, 25000, Besançon, France.
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Mottet N, Bourtembourg A, Eckman-Lacroix A, Forner O, Mougey C, Metz JP, Ramanah R, Riethmuller D. [Focus on the Odon Device™: Technical improvements, mechanical principles and progress of the clinical research program]. ACTA ACUST UNITED AC 2020; 48:814-819. [PMID: 32184177 DOI: 10.1016/j.gofs.2020.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Indexed: 12/01/2022]
Abstract
The Odon Device™ has been described in the literature since 2013 and the World Health Organization supports its development through the Human Reproduction Program. This innovative device could be easier to use than usual instruments and could be an alternative to caesarean section during the second stage of labor, especially in countries where access to obstetric care is limited. The aim of the Odon Device™ is to position an air cuff over the fetal head, past its widest point (around the level of the fetal mouth anteriorly and the nape of the fetal neck posteriorly). Three mechanical principles favor the progression of the fetal head with the Odon Device™: partial propulsion, limited flexion and traction. Preliminary clinical studies on animals and simulators are reassuring and show that an appropriate use is no more at risk than the vaccum or forceps. A phase 1 study was conducted in Argentina and South Africa between 2011 and 2017. The reported failure rate was 29%, of which 77% was secondary to a mechanical failure of one of the components of the device. Improvements concerning the applicator, the handles and the inflatable air cuff have been made to the device. Phase II of the clinical research program began in 2018 and includes two studies in two different centers: The ASSIST Study in Bristol, England, and The BESANCON ASSIST Study, Besançon, France.
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Affiliation(s)
- N Mottet
- Service de gynécologie-obstétrique, centre hospitalo-universitaire de Besançon, université de Franche-Comté, 25000 Besançon, France.
| | - A Bourtembourg
- Service de gynécologie-obstétrique, centre hospitalo-universitaire de Besançon, université de Franche-Comté, 25000 Besançon, France
| | - A Eckman-Lacroix
- Service de gynécologie-obstétrique, centre hospitalo-universitaire de Besançon, université de Franche-Comté, 25000 Besançon, France
| | - O Forner
- Service de gynécologie-obstétrique, centre hospitalo-universitaire de Besançon, université de Franche-Comté, 25000 Besançon, France; Nanomedicine Lab, Imagery and Therapeutics, EA4662, University of Franche-Comte, 25000 Besançon, France
| | - C Mougey
- Service de pédiatrie et de réanimation pédiatrique, centre hospitalo-universitaire de Besançon, université de Franche-Comté, 25000 Besançon, France
| | - J P Metz
- Service de gynécologie-obstétrique, centre hospitalo-universitaire de Besançon, université de Franche-Comté, 25000 Besançon, France
| | - R Ramanah
- Service de gynécologie-obstétrique, centre hospitalo-universitaire de Besançon, université de Franche-Comté, 25000 Besançon, France
| | - D Riethmuller
- Service de gynécologie-obstétrique, centre hospitalo-universitaire de Besançon, université de Franche-Comté, 25000 Besançon, France; Service de gynécologie-obstétrique, centre hospitalo-universitaire de Grenoble, 38000 Grenoble, France
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Mazellier S, Lallemant M, Tholozan AS, Terzibachian JJ, Ramanah R. [Buttock abscess: A late complication of prosthetic surgery for stress urinary incontinence]. ACTA ACUST UNITED AC 2020; 48:466-468. [PMID: 32092490 DOI: 10.1016/j.gofs.2020.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Indexed: 10/25/2022]
Affiliation(s)
- S Mazellier
- Service de gynécologie-obstétrique, centre hospitalier de Trevenans hôpital Nord Franche-Comté, 100, route de Moval, 90400 Trevenans France.
| | - M Lallemant
- Service de gynécologie-obstétrique, pôle mère-femme, centre hospitalier universitaire de Besançon, 3, boulevard Alexandre-Fleming 25000 Besançon France
| | - A-S Tholozan
- Service de gynécologie-obstétrique, pôle mère-femme, centre hospitalier universitaire de Besançon, 3, boulevard Alexandre-Fleming 25000 Besançon France
| | - J-J Terzibachian
- Service de gynécologie-obstétrique, centre hospitalier de Trevenans hôpital Nord Franche-Comté, 100, route de Moval, 90400 Trevenans France
| | - R Ramanah
- Service de gynécologie-obstétrique, pôle mère-femme, centre hospitalier universitaire de Besançon, 3, boulevard Alexandre-Fleming 25000 Besançon France
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Marguier Blanchard I, Metz JP, Eckman Lacroix A, Ramanah R, Riethmuller D, Mottet N. [Manual rotation in occiput posterior position: A systematic review in 2019]. ACTA ACUST UNITED AC 2019; 47:672-679. [PMID: 31200108 DOI: 10.1016/j.gofs.2019.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of our study was to evaluate the safety and the benefits of manual rotation in the management of Occiput-posterior positions in 2019. METHODS A systematic review of literature was performed using the MEDLINE and COCHRANE LIBRARY databases, in order to identify articles concerning maternal and neonatal outcomes after a manual rotation, through January 2019. Information on study characteristics (review, author, year of publication), population, objectives and main neonatal and maternal outcomes were extracted. RESULTS A total of 51 articles were identified and 12 articles were selected for the systematic review. The rate of successful manual rotation were about 47 to 90%. There were more success if systematic manual rotation, multiparity, engagement, spontaneous labour and maternal age<35. The 2nd stage of labour was shorter after an attempt of manual rotation. The randomised controlled trials did not find any statistical difference concerning operative deliveries or neonatal and maternal outcomes. CONCLUSION The manual rotation is an obstetrical manoeuvre which must be regulated and only practiced by trained operators. Currently, the state of science is not sufficient to recommend the manual rotation as a systematic practice in 2019.
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Affiliation(s)
- I Marguier Blanchard
- Department of obstetrics and gynaecology, Besançon university medical center, Alexander-Fleming boulevard, 25000 Besançon, France.
| | - J-P Metz
- Department of obstetrics and gynaecology, Besançon university medical center, Alexander-Fleming boulevard, 25000 Besançon, France
| | - A Eckman Lacroix
- Department of obstetrics and gynaecology, Besançon university medical center, Alexander-Fleming boulevard, 25000 Besançon, France
| | - R Ramanah
- Department of obstetrics and gynaecology, Besançon university medical center, Alexander-Fleming boulevard, 25000 Besançon, France
| | - D Riethmuller
- Department of obstetrics and gynaecology, Besançon university medical center, Alexander-Fleming boulevard, 25000 Besançon, France
| | - N Mottet
- Department of obstetrics and gynaecology, Besançon university medical center, Alexander-Fleming boulevard, 25000 Besançon, France.
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Metz JP, Chaussy Y, Lenoir M, Riethmuller D, Ramanah R, Mottet N. Exploration of foetal lung lesions by 2D-ultrasound shear wave elastography: How should stiffness variation be interpreted in two different malformations? Eur J Obstet Gynecol Reprod Biol 2019. [DOI: 10.1016/j.ejogrb.2018.08.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hulot G, Ramanah R, Riethmuller D, Mottet N. The impact of active delivery of the anterior arm during vacuum-assisted vaginal delivery on perineal tears: a clinical practice evaluation. J Matern Fetal Neonatal Med 2019; 33:3308-3312. [PMID: 30714443 DOI: 10.1080/14767058.2019.1571573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective: Our purpose was to evaluate the impact of active delivery of the anterior arm with Couder's Maneuver (CM) during vacuum-assisted vaginal delivery (VAVD) on perineal tears. This maneuver can be beneficial because it has the advantage of reducing fetal biacromial diameter.Methods: This monocentric retrospective study compared two non-concurrent cohorts of nulliparous women before and after implementation of a systematic CM during VAVD: Cohort 1 from 1 January to 31 December 2006 without CM and Cohort 2 from 1 January to 31 December 2016 with systematic CM. This study reviewed all births during these two periods. All live-born singleton pregnancies where VAVD occurred after 37 weeks of gestation were included. The principal endpoint was the type of perineal tear.Results: In total, there were 179 VAVD in the Cohort 1 and 267 VAVD in the Cohort 2. In the Cohort 2, 233 VAVD (87.3%) were performed with systematic CM. No episiotomy was performed in both cohorts. There was a significant decrease in the rate of second-degree perineal tears between the two cohorts (42.4 versus 15%, p < .001) and a significant increase in the rate of intact perineum (34.1 versus 54.7%, p < .001). There was no influence of CM on the rate of obstetrical anal sphincter injury (3.9 versus 2.6%, p = .44).Conclusions: Practicing this maneuver could improve the perineal prognosis during VAVD in nulliparous women.
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Affiliation(s)
- Ghislain Hulot
- Department of Obstetrics and Gynecology, Besançon University Medical Center, Besançon, France
| | - Rajeev Ramanah
- Department of Obstetrics and Gynecology, Besançon University Medical Center, Besançon, France
| | - Didier Riethmuller
- Department of Obstetrics and Gynecology, Besançon University Medical Center, Besançon, France
| | - Nicolas Mottet
- Department of Obstetrics and Gynecology, Besançon University Medical Center, Besançon, France
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Lallemant M, Prévost S, Nobili F, Riethmuller D, Ramanah R, Seronde MF, Mottet N. Prenatal hypocalvaria after prolonged intrauterine exposure to angiotensin II receptor antagonists. J Renin Angiotensin Aldosterone Syst 2019; 19:1470320318810940. [PMID: 30394825 PMCID: PMC6243420 DOI: 10.1177/1470320318810940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We report a case of prenatal exposure to angiotensin II receptor antagonists (ARA
II) from the beginning of pregnancy in a patient with a hypokinetic dilated
cardiomyopathy. This case report emphasizes the fetal renal impact of prolonged
intrauterine exposure to renin-angiotensin system (RAS) blockers, and highlights
that this exposure can cause severe prenatal hypocalvaria. This delayed
ossification can be reversible after birth, but the presence of anhydramnios
indicates an early and irreversible block of RAS blockers in the fetus that is
responsible for fetal kidney development abnormalities. This association carries
a high risk of neonatal death. Prolonged exposure to ARA II or other RAS
blockers remains prohibited throughout pregnancy.
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Affiliation(s)
- Marine Lallemant
- 1 Obstetrics and Gynaecology Department, Besançon University Medical Centre, Franche-Comté University, France
| | - Sarah Prévost
- 1 Obstetrics and Gynaecology Department, Besançon University Medical Centre, Franche-Comté University, France
| | - François Nobili
- 2 Paediatric Nephrology Department, Besançon University Medical Centre, Franche-Comté University, France
| | - Didier Riethmuller
- 1 Obstetrics and Gynaecology Department, Besançon University Medical Centre, Franche-Comté University, France
| | - Rajeev Ramanah
- 1 Obstetrics and Gynaecology Department, Besançon University Medical Centre, Franche-Comté University, France
| | - Marie-France Seronde
- 3 Cardiology Department, Besançon University Medical Centre, Franche-Comté University, France
| | - Nicolas Mottet
- 1 Obstetrics and Gynaecology Department, Besançon University Medical Centre, Franche-Comté University, France
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Pascalet M, Fourel M, Bourtembourg A, Toubin C, Coppola C, Becher P, Ramanah R, Riethmuller D, Mottet N. Mode of delivery of twin pregnancies with the first twin in breech position after the introduction of a policy of planned caesarean delivery for nulliparous women. Eur J Obstet Gynecol Reprod Biol 2019; 234:58-62. [PMID: 30660038 DOI: 10.1016/j.ejogrb.2018.11.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 09/09/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION To evaluate the impact of the mode of delivery of twin pregnancies with the first twin in breech position for all parities combined after introduction of a policy of planned caesarean section in 38 weeks' gestation in nulliparas. MATERIAL AND METHODS A retrospective study of the mode of delivery of twin pregnancies with the first twin in breech position was conducted from January 2007 to December 2015 after the implementation of a planned caesarean section in 38 weeks' gestation in nulliparas. Maternal and neonatal outcomes were compared according to the decision of attempted vaginal or planned caesarean delivery. RESULTS Among the 134 women included, an attempted vaginal delivery was decided for 30.6% women (n = 41), with 95% (n = 39) who delivered vaginally and 5% (n = 2) by caesarean section during labour. Among the 69.4% women (n = 93) with a planned caesarean section, 64.5% (n = 60) and 11.8% (n = 11) delivered by caesarean before labour and during labour, respectively, and 23.7% (n = 22) delivered vaginally. The overall vaginal delivery rate was 45.5%, and the overall rate of caesarean section was 54.5% for all parities combined. In nulliparous women, the rate of caesarean section during labour was 33%. There were no significant differences in maternal mortality or morbidity between the two groups. CONCLUSION A selective policy of attempted vaginal delivery based on parity for twin pregnancies with the first twin in breech position can lead to a reduction in the overall rate of caesarean section in this population.
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Affiliation(s)
- Marion Pascalet
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000 Besançon, France.
| | - Marianne Fourel
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000 Besançon, France
| | - Aude Bourtembourg
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000 Besançon, France
| | - Claire Toubin
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000 Besançon, France
| | - Camille Coppola
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000 Besançon, France
| | - Patrick Becher
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000 Besançon, France
| | - Rajeev Ramanah
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000 Besançon, France
| | - Didier Riethmuller
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000 Besançon, France
| | - Nicolas Mottet
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000 Besançon, France.
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Riethmuller D, Ramanah R, Mottet N. [Fetal expulsion: Which interventions for perineal prevention? CNGOF Perineal Prevention and Protection in Obstetrics Guidelines]. ACTA ACUST UNITED AC 2018; 46:937-947. [PMID: 30377094 DOI: 10.1016/j.gofs.2018.10.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The objective for all obstetricians and midwifes who intervene during the release of the fetal presentation is to prevent at best the perineal lesions. This work consisted in analyzing the literature, researching and evaluating interventions that reduce this perineal risk during the release. METHODS A keyword search for each medical intervention during the expulsion phase was conducted by selecting studies assessing perineal risk. Interventions during pregnancy and during delivery before the expulsion phase were specifically addressed in other sections of the recommendations. RESULTS Firstly, the degree of perineal stretching during the second stage of labour does not appear to be a risk factor for OASIS, postpartum incontinence, or sexual disorders (LE3) and that a substantial stretching of the perineum is not an indication of episiotomy (Professional consensus). Then, manual control of the expulsion of the fetus at the end of the second stage of labour and support of the posterior perineum during this time appear to reduce the rate of OASIS (LE3). The crowning of the baby's head should be manually controlled and the posterior perineum manually supported manually to reduce the risk of OASIS (GradeC). There is no recognised benefit to episiotomy in normal deliveries (LE1); the liberal practice of episiotomy results in fewer intact perineums than its restrictive practice, and the latter does not result in increasing the number of cases of OASIS. No evidence indicates that an episiotomy for women with a breech presentation, twin pregnancy, or posterior position prevents OASIS (LE3). Indication for episiotomy during delivery depends on individual risk factors and obstetric conditions (Professional consensus). It is recommended that the indication for episiotomy be explained and the woman's consent received before its performance. The performance of an episiotomy during normal deliveries is not recommended to reduce the risk of OASIS (Grade A). The liberal practice of episiotomy to prevent OASIS is not recommended for women with a breech presentation, twin pregnancy, or posterior position (GradeC). Episiotomy during an instrumental delivery appears to be associated with a reduction of the risk of OASIS (LE3). The vacuum extractor appears to induce fewer cases of OASIS than other instruments (LE3). Episiotomy may be indicated in instrumental deliveries to avoid OASIS (GradeC). Training in perineal protection in obstetrics is recommended (Grade B). In operative vaginal deliveries when several instruments can be used, a vacuum extractor is preferentially recommended to reduce the risk of OASIS (GradeC). When forceps or spatulas are used, it is preferable that they be withdrawn just before cephalic deflexion so that the fetal head is not "capped" with these instruments at birth (Professional consensus). Couder's maneuver, which consists of lowering the forearm during the release of the fetal shoulders, appears to decrease the rate of second-degree perineal tears and increase the rate of intact perineum (LE3). CONCLUSION Manual control of the expulsion and perineal support reduce the risk of perineal injury. There is no benefit to episiotomy in normal delivery, nor in special cases such the breech presentation for example. On the other hand, in case of instrumental delivery, an episiotomy may be indicated to avoid OASIS (GradeC), and it is recommended if it is possible to use the ventouse preferentially. The Couder's maneuver seems to reduce the rate of 2nd degree perineal lesions (LE3). Finally, training in perineal obstetric protection is recommended (Grade B).
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Affiliation(s)
- D Riethmuller
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France.
| | - R Ramanah
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - N Mottet
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France
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Bourgon N, Mottet N, Bourtembourg A, Pugin A, Ramanah R, Riethmuller D. [Obstetrical anal sphincter injuries and vacuum-assisted delivery at term in primiparas]. ACTA ACUST UNITED AC 2018; 46:686-691. [PMID: 30293947 DOI: 10.1016/j.gofs.2018.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Operative Vaginal Delivery (OVD) is subject to a risk of perineal tears especially of Obstetrical Anal Sphincter Injuries (OASIS) that are associated with more complications and impaired quality of life. The main objective of this study was to compare the rate of OASIS in primipara at term with fetus in cephalic presentation depending on the type of delivery: OVD using vacuum extractor and spontaneous delivery. METHODS This is a single-center retrospective study between 01/01/2010 and 12/31/2014 including all primipara who delivered vaginally at term, a single and living fetus in cephalic presentation. Perineal lesions were classified according to the WHO classification. The primary endpoint was the proportion of OASIS. RESULTS 3552 patients were included: 2496 spontaneous deliveries (SD) and 1056 OVD (29.72 %). There were twenty sphincter tears (0.56 %): 7 in SD group (0.28 %) and 13 in OVD (1.23 %), P<0.0001, OR=5.10 [2.00; 12.99]. Other risk factors associated with OASIS in univariable analysis were: maternal age (≥30 years), duration of expulsive efforts (≥20min) and a birth weight≥4000g. CONCLUSION In these patients, the risk of OASIS in case of AI increases by a factor of 5;10. The high rate of AI in these patients exposes them to a real risk of OASIS. However, the proportion of OASIS in this group remains lower than those reported in the literature and is barely higher than the national overall rate, despite a very restrictive policy of the use of episiotomy.
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Affiliation(s)
- N Bourgon
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - N Mottet
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - A Bourtembourg
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - A Pugin
- Centre d'investigation clinique, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - R Ramanah
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - D Riethmuller
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France.
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Mottet N, Ramanah R. Comment on "Shear wave elastography safety in fetus: A quantitative health risk assessment". Diagn Interv Imaging 2018; 99:577-578. [PMID: 30177448 DOI: 10.1016/j.diii.2018.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 07/03/2018] [Accepted: 07/04/2018] [Indexed: 02/09/2023]
Affiliation(s)
- N Mottet
- Department of Obstetrics and Gynecology, Hopital Jean Minjoz, Université de Franche Comté, 25000 Besançon, France; Inserm EA4662, Nanomedecine laboratory, University of Franche-Comte, 25000 Besançon, France.
| | - R Ramanah
- Department of Obstetrics and Gynecology, Hopital Jean Minjoz, Université de Franche Comté, 25000 Besançon, France; Inserm EA4662, Nanomedecine laboratory, University of Franche-Comte, 25000 Besançon, France
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Ramanah R, Omar S, Guillien A, Pugin A, Martin A, Riethmuller D, Mottet N. Predicting umbilical artery pH during labour: Development and validation of a nomogram using fetal heart rate patterns. Eur J Obstet Gynecol Reprod Biol 2018; 225:166-171. [PMID: 29727787 DOI: 10.1016/j.ejogrb.2018.04.008] [Citation(s) in RCA: 4] [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: 01/08/2018] [Revised: 04/07/2018] [Accepted: 04/08/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Nomograms are statistical models that combine variables to obtain the most accurate and reliable prediction for a particular risk. Fetal heart rate (FHR) interpretation alone has been found to be poorly predictive for fetal acidosis while other clinical risk factors exist. The aim of this study was to create and validate a nomogram based on FHR patterns and relevant clinical parameters to provide a non-invasive individualized prediction of umbilical artery pH during labour. STUDY DESIGN A retrospective observational study was conducted on 4071 patients in labour presenting singleton pregnancies at >34 gestational weeks and delivering vaginally. Clinical characteristics, FHR patterns and umbilical cord gas of 1913 patients were used to construct a nomogram predicting an umbilical artery (Ua) pH <7.18 (10th centile of the study population) after an univariate and multivariate stepwise logistic regression analysis. External validation was obtained from an independent cohort of 2158 patients. Area under the receiver operating characteristics (ROC) curve, sensitivity, specificity, positive and negative predictive values of the nomogram were determined. RESULTS Upon multivariate analysis, parity (p < 0.01), induction of labour (p = 0.01), a prior uterine scar (p = 0.02), maternal fever (p = 0.02) and the type of FHR (p < 0.01) were significantly associated with an Ua pH <7.18 (p < 0.05). Apgar score at 1, 5 and 10 min were significantly lower in the group with an Ua pH <7.18 (p < 0.01). The nomogram constructed had a Concordance Index of 0.75 (area under the curve) with a sensitivity of 57%, a specificity of 91%, a negative predictive value of 5% and a positive predictive value of 99%. Calibration found no difference between the predicted probabilities and the observed rate of Ua pH <7.18 (p = 0.63). The validation set had a Concordance Index of 0.72 and calibration with a p < 0.77. CONCLUSION We successfully developed and validated a nomogram to predict Ua pH by combining easily available clinical variables and FHR. Discrimination and calibration of the model were statistically good. This mathematical tool can help clinicians in the management of labour by predicting umbilical artery pH based on FHR tracings.
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Affiliation(s)
- Rajeev Ramanah
- Obstetrics and Gynecology Department, Besancon University Medical Centre, 3 Alexander Fleming Boulevard, 25000 Besancon, France.
| | - Sikiyah Omar
- Obstetrics and Gynecology Department, Besancon University Medical Centre, 3 Alexander Fleming Boulevard, 25000 Besancon, France.
| | - Alicia Guillien
- Biostatistics Department, Besancon University Medical Centre, 3 Alexander Fleming Boulevard, 25000 Besancon, France.
| | - Aurore Pugin
- Biostatistics Department, Besancon University Medical Centre, 3 Alexander Fleming Boulevard, 25000 Besancon, France.
| | - Alain Martin
- Obstetrics and Gynecology Department, Besancon University Medical Centre, 3 Alexander Fleming Boulevard, 25000 Besancon, France.
| | - Didier Riethmuller
- Obstetrics and Gynecology Department, Besancon University Medical Centre, 3 Alexander Fleming Boulevard, 25000 Besancon, France.
| | - Nicolas Mottet
- Obstetrics and Gynecology Department, Besancon University Medical Centre, 3 Alexander Fleming Boulevard, 25000 Besancon, France.
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Mottet N, Aubry S, Vidal C, Boiteux G, Metz JP, Riethmuller D, Pazart L, Ramanah R. Feasibility of 2-D ultrasound shear wave elastography of fetal lungs in case of threatened preterm labour: a study protocol. BMJ Open 2017; 7:e018130. [PMID: 29282263 PMCID: PMC5770838 DOI: 10.1136/bmjopen-2017-018130] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION 2-D ultrasound shear wave elastography (SWE) could be considered as a new noninvasive tool for monitoring fetal lung development based on evaluation of mechanical properties during pregnancy. Interesting results are available concerning the use of SWE on developing organs, especially on premature infants and animal models. The main objective in this study is to evaluate the feasibility of 2-D SWE in human fetal lungs between 24 and 34 weeks of gestation (WG). The secondary objective is to modellise fetal lung-to-liver elastography ratio (LLE ratio) and to assess variations between normal lung and lung surfactant-enriched after a corticosteroids course indicated for a threatened preterm labour (TPL). METHODS/DESIGN A prospective case-control study will be performed between 24 and 34 WG. Fetal lungs and liver will be explored by SWE into two groups: fetuses of women with an uncomplicated pregnancy (control group) and fetuses of women with a TPL requiring administration of corticosteroids (cases group). LLE ratio will be defined as the value of the lung elasticity divided by the value of the liver elasticity.Primary judgement criterion is the value of elasticity modulus expressed in kilopascal. Lungs and liver will be explored through three measurements to define the most reproducible regions with the lowest intra- and inter-observer variability. Feasibility will be evaluated by assessing the number of examinations performed and the number of examinations with interpretable results. Intra- and inter-observer reproducibility will be evaluated by means of the intra-class correlation coefficient. ETHICS AND DISSEMINATION Approval of the study protocol was obtained from the human ethical research committee (Comité de Protection des Personnes EST II, process number 15/494) and the French National Agency for Medicines and Health Products Safety (process number 2015-A01575-44). All participants will sign a statement of informed consent. TRIAL REGISTRATION NUMBER NCT02870608; Recruiting.
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Affiliation(s)
- Nicolas Mottet
- Department of Obstetrics and Gynaecology, Pôle Mère-Femme, University Hospital of Besancon, University of Franche-Comte, Besançon, France
- Nanomedecine Laboratory, INSERM EA4662, University of Franche-Comte, Besancon, France
| | - Sébastien Aubry
- Nanomedecine Laboratory, INSERM EA4662, University of Franche-Comte, Besancon, France
- Department of Musculoskeletal Imaging, University Hospital of Besancon, Besancon, France
| | - Chrystelle Vidal
- Centre d’investigation Clinique-Innovation Technologique, INSERM, University Hospital of Besançon, Besançon, France
| | - Guillaume Boiteux
- Centre d’investigation Clinique-Innovation Technologique, INSERM, University Hospital of Besançon, Besançon, France
| | - Jean-Patrick Metz
- Department of Obstetrics and Gynaecology, Pôle Mère-Femme, University Hospital of Besancon, University of Franche-Comte, Besançon, France
| | - Didier Riethmuller
- Department of Obstetrics and Gynaecology, Pôle Mère-Femme, University Hospital of Besancon, University of Franche-Comte, Besançon, France
| | - Lionel Pazart
- Centre d’investigation Clinique-Innovation Technologique, INSERM, University Hospital of Besançon, Besançon, France
| | - Rajeev Ramanah
- Department of Obstetrics and Gynaecology, Pôle Mère-Femme, University Hospital of Besancon, University of Franche-Comte, Besançon, France
- Nanomedecine Laboratory, INSERM EA4662, University of Franche-Comte, Besancon, France
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Mottet N, Bonneaud M, Eckman-Lacroix A, Ramanah R, Riethmuller D. Active delivery of the anterior arm and incidence of second-degree perineal tears: a clinical practice evaluation. BMC Pregnancy Childbirth 2017; 17:141. [PMID: 28499362 PMCID: PMC5429558 DOI: 10.1186/s12884-017-1322-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evaluate the feasibility of active delivery of the anterior arm during spontaneous delivery. This maneuver could decrease incidence of second-degree perineal tears because it reduces fetal biacromial diameter. METHODS An observational comparative prospective study was conducted at our teaching maternity from July 2012 to March 2013. The study included 199 nulliparous women ≥18 years, who met the following criteria: singleton pregnancy, vaginal delivery with occiput anterior presentation, on epidural analgesia, from 37 weeks of gestation onward. The distribution of rate and type of perineal tears were compared between two groups: a non-exposed group and a group exposed to the maneuver. RESULTS A total of 101 patients were exposed to Couder's maneuver (CM) and 98 patients were not exposed. In the intervention group, 3 failures of the maneuver were reported. The maneuver was considered easy in 80% of cases, moderately easy in 12% and difficult in 8% of cases. There was a significant difference (p = 0.03) in the distribution of perineal tears between the two groups. There was a significant reduction (p < 0.001) in the number of second-degree perineal tears in the patients exposed to CM. There was no significant difference in the rate of anterior perineal trauma between the exposed and non-exposed arms. CONCLUSIONS CM in primiparous women at term is feasible with a low failure rate and influences the distribution of perineal tears by lowering second-degree perineal tears in a highly significant manner (p <0.01).
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Affiliation(s)
- Nicolas Mottet
- Department of Obstetrics and Gynecology- Besancon University Medical Center, CHRU Jean Minjoz, Alexander Fleming Boulevard, 25000 Besancon, France
| | - Marine Bonneaud
- Department of Obstetrics and Gynecology- Besancon University Medical Center, CHRU Jean Minjoz, Alexander Fleming Boulevard, 25000 Besancon, France
| | - Astrid Eckman-Lacroix
- Department of Obstetrics and Gynecology- Besancon University Medical Center, CHRU Jean Minjoz, Alexander Fleming Boulevard, 25000 Besancon, France
| | - Rajeev Ramanah
- Department of Obstetrics and Gynecology- Besancon University Medical Center, CHRU Jean Minjoz, Alexander Fleming Boulevard, 25000 Besancon, France
| | - Didier Riethmuller
- Department of Obstetrics and Gynecology- Besancon University Medical Center, CHRU Jean Minjoz, Alexander Fleming Boulevard, 25000 Besancon, France
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Mendel A, Terzibachian JJ, Aubin F, Malicenco L, Ramanah R, Riethmuller D. Ovarian metastasis of a malignant melanoma: A case report. J Gynecol Obstet Hum Reprod 2017; 46:461-462. [PMID: 28428125 DOI: 10.1016/j.jogoh.2017.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 08/20/2016] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 11/16/2022]
Abstract
Malignant melanoma represents 3% of cancers at the woman. The metastatic gynecological localization are rare and ovary is an exceptional site. Prognosis of metastatic ovary malignant melanoma is pejorative (5% 5 years survival). We report a case observed in a 65-year-old patient, who developed 2 melanomas of the left leg and presented a right ovarian tumor during a supervision tomodensitometric 7 years after diagnostic initial. The immunohistochemical assays after annexectomy confirmed the diagnostic of ovarian metastasis. To evoke an ovarian metastasis localization of a malignant melanoma in front of the increasing incidence is a decisive for prognosis.
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Affiliation(s)
- A Mendel
- Pôle Mère-Femme, CHRU Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France
| | - J J Terzibachian
- Service de gynécologie, hôpital Nord Franche-Comté, 25200 Montbéliard, France
| | - F Aubin
- Service de dermatologie, CHU de Besançon - université de Franche-Comté, 25000 Besançon, France
| | - L Malicenco
- Service de gynécologie, hôpital Nord Franche-Comté, 25200 Montbéliard, France
| | - R Ramanah
- Pôle Mère-Femme, CHRU Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France
| | - D Riethmuller
- Pôle Mère-Femme, CHRU Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France.
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Paget-Bailly S, Kalbacher E, Ramanah R, Meurisse A, Es Saad I, Bonnetain F. Qualité de vie des patientes atteintes de cancers gynécologiques pelviens – étude de faisabilité d’une cohorte où la qualité de vie est recueillie électroniquement. Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2016.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Laroche J, Mottet N, Ramanah R, Riethmuller D. Delivery outcomes after prior obstetric anal sphincter injury. Eur J Obstet Gynecol Reprod Biol 2016. [DOI: 10.1016/j.ejogrb.2016.07.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bourgon N, Bourtembourg A, Ramanah R, Riethmuller D. Does vacuum extraction increase the rate of obstetric anal sphincter injuries in primiparous women at term? Eur J Obstet Gynecol Reprod Biol 2016. [DOI: 10.1016/j.ejogrb.2016.07.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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