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Vigoureux S, Maurice P, Sibiude J, Garabedian C, Sananès N. [Prevention of Rh D Alloimmunization in the first trimester of the pregnancy: French College of Obstetricians and Gynecologists guidelines for clinical practice.]. Gynecol Obstet Fertil Senol 2024:S2468-7189(24)00081-3. [PMID: 38417789 DOI: 10.1016/j.gofs.2024.02.026] [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] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To provide recommendations for the prevention of Rh D alloimmunization in the first trimester of pregnancy. MATERIALS AND METHODS The quality of evidence of the literature was assessed following the GRADE methodology with questions formulated in the PICO format (Patients, Intervention, Comparison, Outcome) and outcomes defined a priori and classified according to their importance. An extensive bibliographic search was performed on Pubmed, Cochrane, EMBASE, and Google Scholar databases. The quality of evidence was assessed (high, moderate, low, very low) and a recommendation was formulated: (i) strong, (ii) weak, or (iii) no recommendation. The recommendations were reviewed in two rounds with reviewers from the scientific board of the French College of the OB/GYN (Delphi survey) to select the consensus recommendations. RESULTS The three recommendations from PICO questions reached agreement using the Delphi method. It is recommended not to administer Rh D immunoglobulin before 12 weeks of gestation to reduce the risk of alloimmunization in case of abortion or miscarriage, in RhD negative patients when the genitor is RhD positive or unknown (Weak recommendation. Very low-quality evidence). It is recommended not to administer Rh D immunoglobulin before 12 weeks of gestation to reduce the risk of alloimmunization in cases of bleeding in an ongoing intrauterine pregnancy (Weak recommendation. Very low-quality evidence). The literature data are insufficient in quality and quantity to determine if the injection of Rh D immunoglobulin reduces the risk of alloimmunization in the case of an ectopic pregnancy (No recommendation. Very low-quality evidence). CONCLUSION Even though the quality of evidence from the studies is very low, it is recommended not to administer Rh D immunoglobulin in case of abortion, miscarriage or bleeding before 12 weeks of amenorrhea. The quality of evidence was too low to issue a recommendation regarding ectopic pregnancy.
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Affiliation(s)
- Solène Vigoureux
- Service de gynécologie obstétrique, CHU de Nantes, Nantes, France
| | - Paul Maurice
- Centre National de Référence en Hémobiologie Périnatale, Hôpital Trousseau, AP-HP. Sorbonne Université, France
| | - Jeanne Sibiude
- Service de gynécologie obstétrique, Hôpital Trousseau, AP-HP, Paris, France
| | | | - Nicolas Sananès
- Service de gynécologie obstétrique, Hôpital Américain de Paris, Neuilly-sur-Seine, France.
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Dochez V, Chabernaud C, Schirr-Bonnans S, Riche VP, Thubert T, Winer N, Vigoureux S. Prevention of Rhesus-D Alloimmunization in the First Trimester of Pregnancy: Economic Analysis of Three Management Strategies. Transfus Med Rev 2024; 38:150778. [PMID: 37925226 DOI: 10.1016/j.tmrv.2023.150778] [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: 06/19/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 11/06/2023]
Abstract
Anti-D alloimmunization in the first trimester of pregnancy has long been the subject of prevention with anti-D immunoglobulins during events at risk of fetomaternal hemorrhage. Although the efficacy of preventing anti-D alloimmunization by an injection of immunoglobulin at 28 weeks of gestation (WG) is obvious, the literature provides little evidence of the effectiveness before 12+6 WG and several countries have modified their recommendations. In the presumed absence of a difference in alloimmunization risk between early and late prevention, our objective was to evaluate and compare the cost of treatment for 3 alloimmunization prevention strategies in France, the United Kingdom, and the Netherlands. This was a single-center retrospective study. Our target population included all women who received anti-D immunoglobulins (Rhophylac) in the first trimester of pregnancy before 12+6 WG at Nantes University Hospital in 2018 (N = 356). Within the target population, 2 other populations were constituted based on British (N = 145) and Dutch (N = 142) clinical practice guidelines (CPG). These 3 populations were analyzed for the comparative cost of treatment for prevention from a health system perspective. The average cost of Rhophylac alloimmunization prevention for 1 episode was €117.8 from a health system perspective. The total cost attributed to prevention in 2018 at Nantes University Hospital (N = 356) was €41,931.4 according to this perspective. If the UK CPG or Dutch CPG had been applied to the Nantes target population, a saving of around 60% would have been achieved. At the national level, the cost according to the health system perspective specifically attributable to induced abortion (N estimated = 26,916) could represent a total cost of €3,170,704. This study highlighted the high cost of the French prevention strategy in the first trimester of pregnancy compared with British or Dutch strategies. The modification of our practices would allow substantial financial savings to the French health system but would also avoid the nonrecommended exposure to a blood product at this term, would allow a faster medical management and a relief of the care system.
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Affiliation(s)
- Vincent Dochez
- Nantes Université, CHU Nantes, Service de Gynécologie-Obstétrique, INSERM, CIC 1413, F-44000 Nantes, France; Nantes Université, CHU Nantes, Movement - Interactions - Performance, MIP, EA 4334, F-44000 Nantes, France.
| | - Camille Chabernaud
- Nantes Université, CHU Nantes, Service de Gynécologie-Obstétrique, INSERM, CIC 1413, F-44000 Nantes, France
| | - Solène Schirr-Bonnans
- Nantes Université, CHU Nantes, Cellule Innovation Département Partenariat et Innovation, F-44000 Nantes, France
| | - Valéry-Pierre Riche
- Nantes Université, CHU Nantes, Cellule Innovation Département Partenariat et Innovation, F-44000 Nantes, France
| | - Thibault Thubert
- Nantes Université, CHU Nantes, Service de Gynécologie-Obstétrique, INSERM, CIC 1413, F-44000 Nantes, France; Nantes Université, CHU Nantes, Movement - Interactions - Performance, MIP, EA 4334, F-44000 Nantes, France
| | - Norbert Winer
- Nantes Université, CHU Nantes, Service de Gynécologie-Obstétrique, INSERM, CIC 1413, F-44000 Nantes, France; Nantes Université, CHU Nantes, INRAE, UMR 1280, PhAN, F-44000 Nantes, France
| | - Solène Vigoureux
- Nantes Université, CHU Nantes, Service de Gynécologie-Obstétrique, INSERM, CIC 1413, F-44000 Nantes, France; CESP (Centre for Research in Epidemiology and Population Health), Inserm U1018, Université Paris-Saclay, UVSQ, Villejuif, France
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Haab E, Werschuren C, Parquet C, Sauvegrain P, Blanc J, Crenn-Hebert C, Fresson J, Gelly M, Gillard P, Gonnaud F, Vigoureux S, Ibanez G, Ngo C, Regnault N, Deneux-Tharaux C, Azria E. [Screening and healthcare for pregnant women with psycho-social vulnerability : A French national study]. Gynecol Obstet Fertil Senol 2022; 50:666-674. [PMID: 35820588 DOI: 10.1016/j.gofs.2022.07.002] [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: 04/08/2022] [Revised: 06/26/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Psycho-social vulnerabilities are a medical risk factor for both fetus and mother. Association between socioeconomic status and prenatal follow-up has been well established and inadequate follow-up is associated with higher morbidity and mortality in women in unfavorable situations. OBJECTIVE The objective is to identify screening strategies and to describe existing systems for pregnant women in psycho-social vulnerability in French maternity hospitals. MATERIAL AND METHODES This is a national survey conducted by questionnaire in all French maternities. RESULTS Screening by means of targeted questions is carried out by 96.7% of maternity units. Early prenatal interviews are offered systematically by 64% of maternity units and access to them is still difficult for women in vulnerable situations. In order to organize care pathways, 28.7% of maternities have a structured unit within their establishment and 81% state that they have mobilizable caregivers. Multidisciplinary meetings for the coordination of the various stakeholders are held by 85.8% of maternity units. Collaboration with networks and associations is emphasized. CONCLUSION A large proportion of maternities seek to identify women in situation of psycho-social vulnerabilities and to organize care paths. However, the resources implemented still appear insufficient for many maternity units. Each maternity hospital has resources and is developing initiatives to deal with the difficulties of care.
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Affiliation(s)
- E Haab
- Maternité Notre-Dame-de-Bon-Secours, Groupe Hospitalier Paris-Saint- Joseph, 185, rue Raymond-Losserand, 75876 Paris cedex 14, France.
| | - C Werschuren
- Maternité Notre-Dame-de-Bon-Secours, Groupe Hospitalier Paris-Saint- Joseph, 185, rue Raymond-Losserand, 75876 Paris cedex 14, France.
| | - C Parquet
- Maternité Notre-Dame-de-Bon-Secours, Groupe Hospitalier Paris-Saint- Joseph, 185, rue Raymond-Losserand, 75876 Paris cedex 14, France.
| | - P Sauvegrain
- Université de Paris, CRESS, Équipe de recherche en épidémiologie obstétricale périnatale et pédiatrique, EPOPé, INSERM U1153, INRA, Paris, France.
| | - J Blanc
- Service de gynécologie-obstétrique, Hôpital Nord, pôle Femmes-Parents-Enfants, hôpitaux universitaire de Marseille, AP-HM, chemin des Bourrely, 13015 Marseille, France; Aix-Marseille université, faculté de médecine, campus La-Timone, EA 3279, CEReSS, centre d'études et de recherches sur les services de santé et qualité de vie, Marseille, France.
| | - C Crenn-Hebert
- Service de gynécologie-obstétrique, hôpital Louis-Mourier, Assistance Publique-Hôpitaux de Paris, HUPNVS, Colombes, France.
| | - J Fresson
- Département d'information médicale, maternité du CHRU de Nancy, Nancy, France.
| | - M Gelly
- Centre de recherches sociologiques et politiques de Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, hôpitaux universitaires Paris-Seine-Saint-Denis, Paris, France.
| | - P Gillard
- Service de gynécologie obstétrique, Centre Hospitalier Universitaire d'Angers, Angers, France.
| | - F Gonnaud
- Service de pédopsychiatre, hospices civiles de Lyon, Lyon, France; Maternité et unité néonatale de la Croix-Rousse, Lyon, France.
| | - S Vigoureux
- Service de gynécologie, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France.
| | - G Ibanez
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Équipe de recherche en épidémiologie sociale (ERES), 75012 Paris, France.
| | - C Ngo
- Sorbonne université, Inserm, institut Pierre-Louis d'épidémiologie et de santé publique, 75012 Paris, France; Hôpital privé des Peupliers, Ramsay santé, Paris, France.
| | - N Regnault
- Centre de recherche des Cordeliers, Sorbonne université, Inserm, université de Paris, équipe ETRES, 75006 Paris, France
| | - C Deneux-Tharaux
- Université de Paris, CRESS, Équipe de recherche en épidémiologie obstétricale périnatale et pédiatrique, EPOPé, INSERM U1153, INRA, Paris, France.
| | - E Azria
- Maternité Notre-Dame-de-Bon-Secours, Groupe Hospitalier Paris-Saint- Joseph, 185, rue Raymond-Losserand, 75876 Paris cedex 14, France; Université de Paris, CRESS, Équipe de recherche en épidémiologie obstétricale périnatale et pédiatrique, EPOPé, INSERM U1153, INRA, Paris, France.
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Bléas C, Llouquet F, Neveu ME, Gaudu S, Fernandez H, Vigoureux S. Study on the use practices and knowledges of French practitioners about the use of intra-uterine devices in early post-partum contraception in France. J Gynecol Obstet Hum Reprod 2021; 51:102240. [PMID: 34610488 DOI: 10.1016/j.jogoh.2021.102240] [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: 06/04/2021] [Accepted: 09/30/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Intra-Uterine Device (IUD) insertion is possible in early postpartum. Although this contraception method is recognized and used in lots of country, it seems infrequent and poorly known in France. Our study aims to assess the barriers to the application of this method in France. METHODS A questionnaire was sent to obstetricians-gynaecologist professionals and midwives in France, through the affiliation to CNGOF (French National College of Obstetricians and Gynecologists) and to CNSF (French National College of Midwives). Questions were focused on the practices and knowledge about the insertion of IUD in early postpartum. RESULTS four hundred eight practitioners responded. Amongst them, 63% knew about the possibility to use IUDs after a vaginal delivery and 31% knew it could be inserted during cesarean section. Ten percent of them used this method. Most of these practitioners (80% of them) would like to discuss the insertion of an IUD in early postpartum with their patients and 71% would like to perform the insertion themselves after training. Besides, this study shows that contraception is rarely addressed by physicians during the follow-up of pregnancies. Less than 15% of respondents report discussing the topic systematically with the patient during the pregnancy follow during pregnancy follow. CONCLUSION insertion of IUDs in early postpartum is uncommon in France. The main limitation seems to be a lack of knowledge, but practitioners seem to be interested in this practice. Training courses could be created in order to rase up the adoption of this practice.
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Affiliation(s)
- C Bléas
- Faculty of medicine University Hospital of Guadeloupe, Pointe-à-Pitre, Guadeloupe, France.
| | - F Llouquet
- Faculty of medicine Université Paris-Descartes, 12 Rue de l'École de Médecine, 75006 Paris, France
| | - M-E Neveu
- AP-HP, GHU-Sud, Hospital Bicêtre, Department of Gynecology and Obstetrics, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France. Service de gynécologie obstétrique, hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), 78, rue du Général-Leclerc, 94000 Le Kremlin-Bicêtre, France
| | - S Gaudu
- AP-HP, GHU-Sud, Hospital Bicêtre, Department of Gynecology and Obstetrics, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France. Service de gynécologie obstétrique, hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), 78, rue du Général-Leclerc, 94000 Le Kremlin-Bicêtre, France
| | - H Fernandez
- AP-HP, GHU-Sud, Hospital Bicêtre, Department of Gynecology and Obstetrics, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France. Service de gynécologie obstétrique, hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), 78, rue du Général-Leclerc, 94000 Le Kremlin-Bicêtre, France; CESP-INSERM, U1018, Soins Primaires, Paris-Sud University, Paris-Saclay University, UVSQ, INSERM, Villejuif Cedex, France
| | - S Vigoureux
- CESP-INSERM, U1018, Soins Primaires, Paris-Sud University, Paris-Saclay University, UVSQ, INSERM, Villejuif Cedex, France; Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
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Vigoureux S, Clément L, Bianchi C, Stehr Y, Delagrave R, Azria E, Huneau JF. Consommations alimentaires et apports nutritionnels de femmes enceintes en situation de précarité socio-économique. NUTR CLIN METAB 2021. [DOI: 10.1016/j.nupar.2021.01.081] [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: 10/21/2022]
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Mignot S, Ringa V, Vigoureux S, Zins M, Panjo H, Saulnier PJ, Fritel X. Correlates of premature pap test screening, under 25 years old: analysis of data from the CONSTANCES cohort study. BMC Public Health 2021; 21:595. [PMID: 33765986 PMCID: PMC7993455 DOI: 10.1186/s12889-021-10603-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 03/10/2021] [Indexed: 12/05/2022] Open
Abstract
Background Many countries currently recommend that screening for cervical cancer begin at the age of 25 years. Premature screening (before that age) could lead to unnecessary follow-up examinations and procedures that turn out to be useless. Our objective is to ascertain if the use of particular contraceptive methods are associated with premature screening. Methods This cross-sectional study based on the CONSTANCES cohort enabled us to include 4297 women younger than 25 years. The factors associated with premature screening were modeled by logistic regression. Missing data were handled by multiple imputations. The multivariate analyses were adjusted for sex life, social and demographic characteristics, and health status. Results Nearly half (48.5%) the women younger than 25 years had already undergone premature screening. Women not using contraceptives (aOR 0.3, 95% CI 0.3–0.5) and those using nonmedicalized contraceptives (condom, spermicide, etc.) (aOR 0.5, 95% CI 0.4–0.6) had premature screening less often than women using birth control pills. Higher risks of premature screening were observed in 20-year-old women (aOR 2.7, 95% CI 2.2–3.3) and in those with more than 5 lifetime partners (aOR 2.5, 95% CI 2.0–3.1), compared respectively with women who were younger and those with 5 or fewer lifetime partners. Conclusion Young women using contraceptives that require a doctor’s prescription are exposed to premature screening more often than those not using contraception and those with nonmedicalized contraceptives.
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Affiliation(s)
- Stéphanie Mignot
- Department of General Practice, University of Poitiers, France: 3 rue de la Milétrie, 86000, Poitiers, France.
| | - Virginie Ringa
- CESP Centre for research in Epidemiology and Population Health, U1018, Gender, Sexuality and Health team, University Paris-Saclay, University Paris-Sud, UVSQ, Villejuif, Ined, France
| | - Solène Vigoureux
- CESP Centre for research in Epidemiology and Population Health, U1018, Gender, Sexuality and Health team, University Paris-Saclay, University Paris-Sud, UVSQ, Villejuif, Ined, France.,Obstetrics & Gynecology department, Hôpital Bicêtre, GHU Sud, AP-HP, Faculty of Medicine, Univ of Paris Sud, F-94276, Le Kremlin Bicêtre, France
| | - Marie Zins
- Epidemiological Population-Based Cohorts Unit, INSERM UMS 11,Villejuif, France, University of Paris-Descartes, Paris, France
| | - Henri Panjo
- CESP Centre for research in Epidemiology and Population Health, U1018, Gender, Sexuality and Health team, University Paris-Saclay, University Paris-Sud, UVSQ, Villejuif, Ined, France
| | - Pierre-Jean Saulnier
- Clinical Investigation Centre CIC1402 INSERM, School of Medicine, Poitiers University, CHU Poitiers (University Hospital), 86000, Poitiers, France
| | - Xavier Fritel
- Clinical Research Centree CIC1402, INSERM, Department of Obstetrics, Gynecology, and Reproductive Medicine Poitiers University Hospital Centre, University of Poitiers, Poitiers, France
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Bouchghoul H, Teboul JL, Senat MV, Vigoureux S. Does socioeconomic status have any influence on success at the national ranking exam?, a prospective survey. BMC Med Educ 2020; 20:402. [PMID: 33138812 PMCID: PMC7607746 DOI: 10.1186/s12909-020-02321-z] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The weight of social inequalities during education is a reality. Students of lower socioeconomic status may have less chance of success in higher education, particularly in medical studies. However, the role of students' socioeconomic factors, such as their parents' profession, in their success in the national ranking exam (NRE) has not been studied. Our aim was to investigate the association between socioeconomic factors and success in the national ranking exam among sixth year medical students at the Paris-Sud Faculty of Medicine. METHODS This was a prospective survey of all sixth-year medical students at the Paris-Sud Faculty of Medicine, using a questionnaire on socioeconomic factors, which were compared according to NRE rank. RESULTS Of 172 sixth year medical students, 110 completed the questionnaire. Their ranking ranged from 20 to 7695, with a median of 2815 (interquartile range: 1029-4581). The factors associated with the NRE rank were a high school diploma (baccalauréat) A or B grade, success at the first attempt in the first-year medical examination, and enrollment in the NRE preparatory lectures during the sixth year of medical training (linear regression, p < 0.001). The educational status and socio-professional category of the parents were not associated with the NRE rank (linear regression, p = 0.92). CONCLUSION At the Paris-Sud Faculty of Medicine, there was no association between parental socioeconomic status and sixth year students' success in the NRE.
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Affiliation(s)
- Hanane Bouchghoul
- Département de gynécologie obstétrique, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, Faculté de médecine Paris-Saclay, Université Paris-Saclay, 78, rue du Général Leclerc, 94275, Le Kremlin Bicetre Cedex, France.
- Faculté de médecine, Université Paris-Saclay, University Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.
| | - Jean-Louis Teboul
- Département de réanimation médicale, Hôpital Bicêtre, Hôpitaux universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, Faculté de médecine Paris-Saclay, Université Paris-Saclay, Orsay, France
| | - Marie-Victoire Senat
- Département de gynécologie obstétrique, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, Faculté de médecine Paris-Saclay, Université Paris-Saclay, 78, rue du Général Leclerc, 94275, Le Kremlin Bicetre Cedex, France
- Faculté de médecine, Université Paris-Saclay, University Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - Solène Vigoureux
- Département de gynécologie obstétrique, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, Faculté de médecine Paris-Saclay, Université Paris-Saclay, 78, rue du Général Leclerc, 94275, Le Kremlin Bicetre Cedex, France
- Faculté de médecine, Université Paris-Saclay, University Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
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Azria E, Sauvegrain P, Blanc J, Crenn-Hebert C, Fresson J, Gelly M, Gillard P, Gonnaud F, Vigoureux S, Ibanez G, Ngo C, Regnault N, Deneux-Tharaux C. [Systemic racism and health inequalities, a sanitary emergency revealed by the COVID-19 pandemic]. ACTA ACUST UNITED AC 2020; 48:847-849. [PMID: 32950731 PMCID: PMC7497546 DOI: 10.1016/j.gofs.2020.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- E Azria
- Maternité Notre-Dame-de-Bon-Secours, Groupe Hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75876 Paris cedex 14, France; Université de Paris, epidemiology and statistics research center/CRESS, INSERM, INRA, 75004 Paris, France; Unité santé périnatale, petite enfance et santé mentale, santé publique France, France.
| | - P Sauvegrain
- Université de Paris, epidemiology and statistics research center/CRESS, INSERM, INRA, 75004 Paris, France; Unité santé périnatale, petite enfance et santé mentale, santé publique France, France
| | - J Blanc
- Service de gynécologie-obstétrique, Hôpital Nord, pôle Femmes-Parents-Enfants, hôpitaux universitaire de Marseille, AP-HM, chemin des Bourrely, 13015 Marseille, France; Aix-Marseille université, faculté de médecine, campus La-Timone, EA 3279, CEReSS, centre d'études et de recherches sur les services de santé et qualité de vie, Marseille, France; Unité santé périnatale, petite enfance et santé mentale, santé publique France, France
| | - C Crenn-Hebert
- Service de gynécologie-obstétrique, hôpital Louis-Mourier, Assistance Publique-Hôpitaux de Paris, HUPNVS, Colombes, France; Unité santé périnatale, petite enfance et santé mentale, santé publique France, France
| | - J Fresson
- Département d'information médicale, maternité du CHRU de Nancy, Nancy, France; Unité santé périnatale, petite enfance et santé mentale, santé publique France, France
| | - M Gelly
- Centre de recherches sociologiques et politiques de Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, hôpitaux universitaires Paris-Seine-Saint-Denis, Paris, France; Unité santé périnatale, petite enfance et santé mentale, santé publique France, France
| | - P Gillard
- Service de gynécologie obstétrique, Centre Hospitalier Universitaire d'Angers, Angers, France; Unité santé périnatale, petite enfance et santé mentale, santé publique France, France
| | - F Gonnaud
- Service de pédopsychiatre, hospices civiles de Lyon, Lyon, France; Maternité et unité néonatale de la Croix-Rousse, Lyon, France; Unité santé périnatale, petite enfance et santé mentale, santé publique France, France
| | - S Vigoureux
- Service de gynécologie, CHU de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France; Unité santé périnatale, petite enfance et santé mentale, santé publique France, France
| | - G Ibanez
- Centre de recherche en epidémiologie et santé des populations (CESP), université Paris-Sud, université Paris-Saclay, Inserm, Villejuif, France; Unité santé périnatale, petite enfance et santé mentale, santé publique France, France
| | - C Ngo
- Sorbonne université, Inserm, institut Pierre-Louis d'épidémiologie et de santé publique, 75012 Paris, France; Hôpital privé des Peupliers, Ramsay santé, Paris, France; Unité santé périnatale, petite enfance et santé mentale, santé publique France, France
| | - N Regnault
- Centre de recherche des Cordeliers, Sorbonne université, Inserm, université de Paris, équipe ETRES, 75006 Paris, France; Unité santé périnatale, petite enfance et santé mentale, santé publique France, France
| | - C Deneux-Tharaux
- Université de Paris, epidemiology and statistics research center/CRESS, INSERM, INRA, 75004 Paris, France; Unité santé périnatale, petite enfance et santé mentale, santé publique France, France
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Mignot S, Ringa V, Vigoureux S, Zins M, Panjo H, Saulnier PJ, Fritel X. Pap tests for cervical cancer screening test and contraception: analysis of data from the CONSTANCES cohort study. BMC Cancer 2019; 19:317. [PMID: 30952209 PMCID: PMC6451274 DOI: 10.1186/s12885-019-5477-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 09/03/2018] [Accepted: 03/14/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In France, a Pap test for cervical cancer screening is recommended every three years for all sexually active women aged 25 to 65 years. Modes of contraception (any or no contraception, with or without a visit to a physician, and with or without a gynecological examination) may influence adhesion to screening: women who use intrauterine device (IUD) should be more up to date with their cervical cancer screening more often than those using other means of contraception. Our objectives were to analyze the association between modes of contraception and Pap tests for screening. METHODS This cross sectional study is based on the CONSTANCES cohort enabled us to include 16,764 women aged 25-50 years. The factors associated with adhesion to cervical cancer screening (defined by a report of a Pap test within the previous 3 years) was modeled by logistic regression. Missing data were imputed by using multiple imputations. The multivariate analyses were adjusted for sex life, social and demographic characteristics, and health status. RESULTS Overall, 11.2% (1875) of the women reported that they were overdue for Pap test screening. In the multivariate analysis there was no significant difference between women using an IUD and those pills or implant of pap test overdue ORa:0.9 CI95% [0.8-1.1], ORa 1.3 CI95% [0.7-2.7] respectively. Women not using contraceptives and those using non-medical contraceptives (condoms, spermicides, etc.) were overdue more often ORa: 2.6 CI95% [2.2-3.0] and ORa: 1.8 CI95% [1.6-2.1] respectively than those using an IUD. CONCLUSION Women seeing medical professionals for contraception are more likely to have Pap tests.
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Affiliation(s)
- Stéphanie Mignot
- Department of General Practice, University of Poitiers, France: 3 rue de la Milétrie, 86000 Poitiers, France
| | - Virginie Ringa
- CESP Centre for Research in Epidemiology and Population Health, U1018, Gender, Sexuality and Health team, University of Paris-Saclay, University of Paris-Sud, UVSQ, Villejuif, France
| | - Solène Vigoureux
- CESP Centre for Research in Epidemiology and Population Health, U1018, Gender, Sexuality and Health team, University of Paris-Saclay, University of Paris-Sud, UVSQ, Villejuif, France
- Ined, Paris, France
- Obstetrics & Gynecology Department, Hôpital Bicêtre, GHU Sud, AP-HP, Faculty of Medicine, University of Paris Sud, F-94276 Le Kremlin Bicêtre, France
| | - Marie Zins
- Epidemiological Population-Based Cohorts Unit, INSERM UMS 11, Villejuif, France
- University of Paris-Descartes, Paris, France
| | - Henri Panjo
- CESP Centre for Research in Epidemiology and Population Health, U1018, Gender, Sexuality and Health team, University of Paris-Saclay, University of Paris-Sud, UVSQ, Villejuif, France
- Ined, Paris, France
| | - Pierre-Jean Saulnier
- Clinical Research Centree CIC1402, INSERM, Department of Obstetrics, Gynecology, and Reproductive Medicine Poitiers University Hospital Centre, University of Poitiers, Poitiers, France
| | - Xavier Fritel
- Clinical Research Centree CIC1402, INSERM, Department of Obstetrics, Gynecology, and Reproductive Medicine Poitiers University Hospital Centre, University of Poitiers, Poitiers, France
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10
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Szmulewicz C, Neveu ME, Vigoureux S, Fernandez H, Capmas P. Emergency vaginal cervico-isthmic cerclage. J Gynecol Obstet Hum Reprod 2019; 48:391-394. [PMID: 30905851 DOI: 10.1016/j.jogoh.2019.03.023] [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: 12/13/2018] [Revised: 03/14/2019] [Accepted: 03/20/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Cervical cerclage is the principal treatment for women with a cervical insufficiency, which is a predominant factor in second trimester loss and preterm birth. A cervico-isthmic cerclage is recommended in case of a previous failure of McDonald cerclage or in case of an absent portio vaginalis of the cervix. In women who have prolapsed membranes at or beyond a dilated external cervical os before 24 weeks of gestation, an emergency cerclage can sometimes be performed. The aim of this study is to report our experience with emergency transvaginal cervico-isthmic cerclage. STUDY DESIGN This is a retrospective, single-centre study conducted between 2009 and 2017 of women who received a transvaginal cervico-isthmic emergency cerclage. Emergency cerclage was defined as cerclage performed on women who had prolapsed membranes at or beyong a dilated external cervical os before 24 weeks of gestation. The exclusion criteria were twin pregnancy, preterm rupture of membranes, and clinical or biological signs of infection. RESULTS Three women were included. One woman had a history of failure of emergency McDonald cerclage during her previous pregnancy. The two other women had a failure of McDonald cerclage during index pregnancy. All women presented prolapsed membranes at or beyond a dilated external cervical os as defined for an emergency cerclage. The emergency cerclage was performed at a mean gestational age of 21.5 weeks of gestation. The average gestational age of delivery was 38.5 weeks of gestation by caesarean section. CONCLUSION Despite the small number of women, this study shows that this type of cerclage was effective in pregnancy prolongation for women at high risk of preterm birth in case of McDonald cerclage failure. Nevertheless, this technique requires a trained surgical team. A randomised trial should be performed to evaluate the need for emergency vaginal cervico-isthmic cerclage.
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Affiliation(s)
- Claire Szmulewicz
- AP-HP, Hôpital Bicêtre, GHU Sud, Department of Gynecology and Obstetrics, 94276 Le Kremlin-Bicêtre, France
| | - Marie-Emmanuelle Neveu
- AP-HP, Hôpital Bicêtre, GHU Sud, Department of Gynecology and Obstetrics, 94276 Le Kremlin-Bicêtre, France; Inserm, Centre of Research in Epidemiology and Population Health (CESP), U1018, 94276 Le Kremlin-Bicêtre, France
| | - Solène Vigoureux
- AP-HP, Hôpital Bicêtre, GHU Sud, Department of Gynecology and Obstetrics, 94276 Le Kremlin-Bicêtre, France; Inserm, Centre of Research in Epidemiology and Population Health (CESP), U1018, 94276 Le Kremlin-Bicêtre, France; University Paris Sud Orsay, 94276 Le Kremlin-Bicêtre, France
| | - Hervé Fernandez
- AP-HP, Hôpital Bicêtre, GHU Sud, Department of Gynecology and Obstetrics, 94276 Le Kremlin-Bicêtre, France; Inserm, Centre of Research in Epidemiology and Population Health (CESP), U1018, 94276 Le Kremlin-Bicêtre, France; University Paris Sud Orsay, 94276 Le Kremlin-Bicêtre, France
| | - Perrine Capmas
- AP-HP, Hôpital Bicêtre, GHU Sud, Department of Gynecology and Obstetrics, 94276 Le Kremlin-Bicêtre, France; Inserm, Centre of Research in Epidemiology and Population Health (CESP), U1018, 94276 Le Kremlin-Bicêtre, France; University Paris Sud Orsay, 94276 Le Kremlin-Bicêtre, France.
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11
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Jegaden M, Scetbun E, Gaudu S, Fernandez H, Vigoureux S. A Lost Balloon-The Interest of a Systematic Ultrasonographyafter a Postabortion Hemorrhage. J Minim Invasive Gynecol 2019; 26:997-998. [PMID: 30708119 DOI: 10.1016/j.jmig.2019.01.011] [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: 01/16/2019] [Accepted: 01/20/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Margaux Jegaden
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France (Drs. Jegaden, Scetbun, Gaudu, Fernandez, and Vigoureux)
| | - Elsa Scetbun
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France (Drs. Jegaden, Scetbun, Gaudu, Fernandez, and Vigoureux)
| | - Sophie Gaudu
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France (Drs. Jegaden, Scetbun, Gaudu, Fernandez, and Vigoureux)
| | - Herve Fernandez
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France (Drs. Jegaden, Scetbun, Gaudu, Fernandez, and Vigoureux); Faculté de Médecine Paris-Sud, Université Paris-Sud, Le Kremlin-Bicêtre, France (Drs. Fernandez and Vigoureux); CESP Centre for Research in Epidemiology and Population Health, U1018, Reproduction and Child Development, Institut national de la santé et de la recherche médicale, Villejuif, France (Drs. Fernandez and Vigoureux)
| | - Solène Vigoureux
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France (Drs. Jegaden, Scetbun, Gaudu, Fernandez, and Vigoureux); Faculté de Médecine Paris-Sud, Université Paris-Sud, Le Kremlin-Bicêtre, France (Drs. Fernandez and Vigoureux); CESP Centre for Research in Epidemiology and Population Health, U1018, Reproduction and Child Development, Institut national de la santé et de la recherche médicale, Villejuif, France (Drs. Fernandez and Vigoureux)..
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12
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Vigoureux S, Le Guen M. [Current knowledge on contraceptive knowledge in France: CNGOF Contraception Guidelines]. ACTA ACUST UNITED AC 2018; 46:777-785. [PMID: 30416022 DOI: 10.1016/j.gofs.2018.10.005] [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: 10/04/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To summarize current knowledge on contraceptive coverage in France and worldwide, describe the effectiveness of different types of contraceptives, describe the characteristics of women using contraception, contraceptive failure situations and describe the different medical risks associated with contraceptive methods. METHODS Consultation of the Medline database and of national or international reports on contraception. RESULTS Contraceptive coverage in France is high: 97% of women in 2013 use a contraceptive method (among fertile, sexually active women without a desire for pregnancy), with a majority using medical methods (72% using pills and other hormonal contraceptives, intrauterine devices and 25% using natural and traditional barrier methods). The 2013 pill scare called into question the use of estrogen-progestogenic contraception and the information provided by doctors, but the pill remains the first contraceptive method followed by the intrauterine device, condoms and the traditional and natural methods. Lifetime contraceptive coverage changes according to a defined standard in France: condoms for the teen-agers, pills before pregnancy and then intrauterine devices after childbirth. Sterilization is very rarely chosen and offered. Contraception in France remains a predominantly female domain. Women and couples should be informed about all contraceptive methods, allowing them to choose the method that best suits their health, living conditions and sexuality.
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Affiliation(s)
- S Vigoureux
- Service de gynécologie obstétrique, hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), 78, rue du Général-Leclerc, 94000 Le Kremlin-Bicêtre, France; Faculté de médecine Paris-Sud, université Paris-Sud, 94276 Le Kremlin-Bicêtre, France; Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, Équipe « Genre, sexualité, santé », hôpital Paul-Brousse, 94807 Villejuif, France.
| | - M Le Guen
- Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, Équipe « Genre, sexualité, santé », hôpital Paul-Brousse, 94807 Villejuif, France; Institut National d'Etudes Démographiques, 75020 Paris, France
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13
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Chabbert-Buffet N, Marret H, Agostini A, Cardinale C, Hamdaoui N, Hassoun D, Jonville-Bera AP, Lambert M, Linet T, Pienkowski C, Plu-Bureau G, Pragout D, Robin G, Rousset-Jablonski C, Scheffler M, Vidal F, Vigoureux S, Hédon B. [Contraception: CNGOF Guidelines for Clinical Practice (Short Version)]. ACTA ACUST UNITED AC 2018; 46:760-776. [PMID: 30416023 DOI: 10.1016/j.gofs.2018.10.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Indexed: 12/26/2022]
Abstract
The French College of Obstetrics and Gynecology (CNGOF) releases its first global recommendations for clinical practice in contraception, to provide physicians with an updated synthesis of available data as a basis for their practice. The French Health Authority (HAS) methodology was used. Twelve practical issues were selected by the organizing committee and the task force members. The available literature was screened until December 2017, and allowed the release of evidence-based, graded recommendations. This synthesis is issued from 12 developed texts, previously reviewed by experts and physicians from public and private practices, with an experience in the contraceptive field. Male and female sterilization, as well as the use of hormonal treatments without contraceptive label were excluded from the field of this analysis. Specific practical recommendations on the management of contraception prescription, patient information including efficacy, risks, and benefits of the different contraception methods, follow up, intrauterine contraception, emergency contraception, local and natural methods, contraception in teenagers and after 40, contraception in vascular high-risk situations, and in case of cancer risk are provided. The short/mid-term future of contraception mostly relies on improving the use of currently available methods. This includes reinforced information for users and increased access to contraception for women, whatever the social and clinical context. That is the goal of these recommendations.
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Affiliation(s)
- N Chabbert-Buffet
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpitaux universitaires Est parisien, hôpital Tenon, Assistance publique des hôpitaux de Paris (AP-HP), 4, rue de la Chine, 75020 Paris, France; UMRS_938, Inserm Sorbonne université, 75012 Paris, France.
| | - H Marret
- Service de chirurgie pelvienne gynécologique et oncologique, centre hospitalier universitaire de Bretonneau, pôle de gynécologie-obstétrique, 2, boulevard Tonnellé, 37044 Tours cedex 1, France
| | - A Agostini
- Service de gynécologie-obstétrique, hôpital de la Conception, boulevard Baille, 13005 Marseille, France
| | - C Cardinale
- Service de gynécologie-obstétrique, hôpital de la Conception, boulevard Baille, 13005 Marseille, France
| | - N Hamdaoui
- Service de gynécologie-obstétrique, hôpital de la Conception, boulevard Baille, 13005 Marseille, France
| | - D Hassoun
- 38, rue Turenne, 75003 Paris, France
| | - A P Jonville-Bera
- Centre régional de pharmacovigilance, centre Val-de-Loire, CHRU de Tours, 37044 Tours cedex, France
| | - M Lambert
- Service de gynécologie et de médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux cedex, France
| | - T Linet
- Service de gynécologie-obstétrique, centre hospitalier de Loire-Vendée-Océan, 85302 Challans, France
| | - C Pienkowski
- Unité d'endocrinologie et de gynécologie médicale, TSA 70034, centre de référence de pathologies gynécologiques rares (PGR Toulouse), hôpital des Enfants, CHU de Toulouse, 31000 Toulouse, France
| | - G Plu-Bureau
- Unité de gynécologie endocrinienne, hôpital Port-Royal, 53, avenue de l'Observatoire, 75679 Paris, France; Université Paris Descartes, 75005 Paris, France; Inserm UMR 1153, Obstetrical, perinatal and paediatric epidemiology research team (Épopé), Centre for epidemiology and statistics Sorbonne Paris Cité (CRESS), 75005 Paris, France
| | - D Pragout
- Unité d'orthogénie, service de gynécologie-obstétrique, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - G Robin
- Centre d'assistance médicale à la procréation et de préservation de la fertilité, centre hospitalier universitaire de Lille, hôpital Jeanne de Flandre, 59000 Lille, France; EA 4308, gamétogenèse et qualité du gamète, centre hospitalier universitaire de Lille, 59000 Lille, France
| | - C Rousset-Jablonski
- Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France; Centre hospitalier de Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - M Scheffler
- Service de gynécologie, CHU, 10, rue du Dr-Heydenreich, 54000 Nancy, France
| | - F Vidal
- CHU de Purpan, hôpital Paule-de-Viguier, pôle femme-mère-couple, 330, avenue Grande-Bretagne, 31059 Toulouse, France
| | - S Vigoureux
- Service de gynécologie-obstétrique, hôpital Bicêtre, Assistance publique des Hôpitaux de Paris (AP-HP), 94276 Le Kremlin-Bicêtre, France; Faculté de médecine Paris-Sud, université Paris-Sud, 94276 Le Kremlin-Bicêtre, France; U1018, Inserm, reproduction and child development, Centre for research in epidemiology and population health (CESP), 94805 Villejuif, France
| | - B Hédon
- Département de gynécologie-obstétrique, faculté de médecine université de Montpellier (France), centre hospitalier universitaire Arnaud-de-Villeneuve, 34000 Montpellier, France
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Vigoureux S, Neveu ME, Capmas P, Levaillant JM, Senat MV, Fernandez H. Re: Three-dimensional ultrasound imaging of intra-abdominal cervical-isthmus cerclage. Ultrasound Obstet Gynecol 2018; 52:124-125. [PMID: 29974594 DOI: 10.1002/uog.19088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 04/10/2018] [Indexed: 06/08/2023]
Affiliation(s)
- S Vigoureux
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris (APHP), 94275, Le Kremlin-Bicêtre, France
- Faculté de Médecine Paris-Sud, Université Paris-Sud, 94276, Le Kremlin-Bicêtre, France
- INSERM, CESP Centre for Research in Epidemiology and Population Health, U1018, Reproduction and Child Development, Villejuif, France
| | - M-E Neveu
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris (APHP), 94275, Le Kremlin-Bicêtre, France
- Faculté de Médecine Paris-Sud, Université Paris-Sud, 94276, Le Kremlin-Bicêtre, France
| | - P Capmas
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris (APHP), 94275, Le Kremlin-Bicêtre, France
- Faculté de Médecine Paris-Sud, Université Paris-Sud, 94276, Le Kremlin-Bicêtre, France
- INSERM, CESP Centre for Research in Epidemiology and Population Health, U1018, Reproduction and Child Development, Villejuif, France
| | - J-M Levaillant
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris (APHP), 94275, Le Kremlin-Bicêtre, France
| | - M-V Senat
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris (APHP), 94275, Le Kremlin-Bicêtre, France
- Faculté de Médecine Paris-Sud, Université Paris-Sud, 94276, Le Kremlin-Bicêtre, France
- INSERM, CESP Centre for Research in Epidemiology and Population Health, U1018, Reproduction and Child Development, Villejuif, France
| | - H Fernandez
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris (APHP), 94275, Le Kremlin-Bicêtre, France
- Faculté de Médecine Paris-Sud, Université Paris-Sud, 94276, Le Kremlin-Bicêtre, France
- INSERM, CESP Centre for Research in Epidemiology and Population Health, U1018, Reproduction and Child Development, Villejuif, France
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15
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Vigoureux S, Bajos N, Ringa V. Effect of Parent-Daughter Communication about Sex on the Use of Less Effective Contraception among Women from Ages 15-24 Years in France. J Pediatr Adolesc Gynecol 2018; 31:33-39. [PMID: 28807735 DOI: 10.1016/j.jpag.2017.08.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 07/27/2017] [Accepted: 08/07/2017] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE Most women begin sexual activity as teenagers but nearly 20% of women in France younger than 25 years rely on less effective contraceptive methods (condoms or methods such as withdrawal or periodic abstinence). We sought to analyze the association with less effective contraception among women aged 15-24 years in France and communication about sex and contraception with their parents. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: The analyses focused on 713 sexually active women who did not currently want a child, were using contraception, and were interviewed in 2010 in a national cross-sectional probability survey (FEcondité CONtraception Dysfonctions sexuelles [FECOND]) when they were 15-24 years old. Associations between the use of less effective contraception, social and demographic characteristics, sexual activity, health characteristics, and communication with parents and friends about sexuality and contraception were tested with logistic regression models according to age group. RESULTS AND CONCLUSION Less effective contraception (condoms, and barrier or natural methods) is used more often by younger women: 27.5% of 15- to 19-year-old women and 14.7% of 20- to 24-year-old women (P < .001). After adjustment for demographic characteristics and aspects of their sex lives (regularity and frequency of intercourse), women who reported difficulty discussing contraception and sex with their mothers at age 15 years were more likely than those with easier communication to use less effective contraception (for those 15-19 years, odds ratio = 1.97; 95% confidence interval, 0.94-4.10, and for those 20-24 years, odds ratio = 2.36; 95% confidence interval, 1.31-4.26). Difficulty in communicating with their parents, especially their mothers, about sex, is associated with young women's choice of less effective contraception.
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Affiliation(s)
- Solène Vigoureux
- Université Paris-Saclay, Univ Paris-Sud, UVSQ, CESP Centre for research in Epidemiology and Population Health, U1018, Gender, Sexuality and Health team, Kremlin-Bicêtre, France; Ined, Paris, France; Service de Gynécologie Obstétrique, Hôpital Bicêtre, GHU Sud, AP-HP, Faculty of Medicine, Univ Paris Sud F-94276, Le Kremlin Bicêtre, France.
| | - Nathalie Bajos
- Université Paris-Saclay, Univ Paris-Sud, UVSQ, CESP Centre for research in Epidemiology and Population Health, U1018, Gender, Sexuality and Health team, Kremlin-Bicêtre, France; Ined, Paris, France
| | - Virginie Ringa
- Université Paris-Saclay, Univ Paris-Sud, UVSQ, CESP Centre for research in Epidemiology and Population Health, U1018, Gender, Sexuality and Health team, Kremlin-Bicêtre, France; Ined, Paris, France
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Vayssière C, Gaudineau A, Attali L, Bettahar K, Eyraud S, Faucher P, Fournet P, Hassoun D, Hatchuel M, Jamin C, Letombe B, Linet T, Msika Razon M, Ohanessian A, Segain H, Vigoureux S, Winer N, Wylomanski S, Agostini A. Elective abortion: Clinical practice guidelines from the French College of Gynecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol 2018; 222:95-101. [PMID: 29408754 DOI: 10.1016/j.ejogrb.2018.01.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 01/04/2018] [Accepted: 01/16/2018] [Indexed: 12/12/2022]
Abstract
The number of elective abortions has been stable for several decades. Many factors explain women's choice of abortion in cases of unplanned pregnancies. Early initiation of contraceptive use and a choice of contraceptive choices appropriate to the woman's life are associated with lower rates of unplanned pregnancies. Reversible long-acting contraceptives should be favored as first-line methods for adolescents because of their effectiveness (grade C). Ultrasound scan before an elective abortion must be encouraged but should not be obligatory (professional consensus). As soon as the embryo appears on the ultrasound scan, the date of pregnancy is estimated by measuring the crown-rump length (CRL) or, from 11 weeks on, by measuring the biparietal diameter (BPD) (grade A). Because reliability of these parameters is ±5 days, the abortion may be done if measurements are respectively less than 90 mm for CRL and less than 30 mm for BPD (professional consensus). A medically induced abortion, performed with a dose of 200 mg mifepristone combined with misoprostol, is effective at any gestational age (Level of Evidence (LE) 1). Before 7 weeks, mifepristone should be followed 24-48 h later by misoprostol, administered orally, buccally, sublingually, or even vaginally followed if needed by a further dose of 400 μg after 3 h, to be renewed if needed after 3 h (LE 1, grade A). After 7 weeks, administration of misoprostol by the vaginal, sublingual, or buccal routes is more effective and better tolerated than by the oral route (LE 1). Cervical preparation is recommended for systematic use in surgical abortions (professional consensus). Misoprostol is a first-line agent for cervical preparation at a dose of 400 μg (grade A). Vacuum aspiration is preferable to curettage (grade B). A uterus perforated during surgical aspiration should not routinely be considered to be scarred (professional consensus). An elective abortion is not associated with a higher risk of subsequent infertility or ectopic pregnancy (LE 2). The medical consultation before an elective abortion generally does not affect the decision to end or continue the pregnancy, and most women are sufficiently certain about their choice at this time. Women appear to find the method used most acceptable and to be most satisfied when they were able to choose the method (grade B). Elective abortions are not associated with an increased rate of psychiatric disorders (LE 2). However, women with psychiatric histories are at a higher risk of psychological disorders after the occurrence of an unplanned pregnancy than women with such a history (LE 2). For surgical abortions, combined hormonal contraceptives - oral or transdermal - should be started on the day of the abortion, while the vaginal ring should be inserted 5 days afterwards (grade B). For medical abortions, the vaginal ring should be inserted in the week after mifepristone administration, while the combined contraceptives should begin the same day as the misoprostol or the day after (grade C). Contraceptive implants should be inserted on the same day as a surgical abortion, and may be inserted the day the mifepristone is administered for medical abortions (grade B and C respectively). In case of medical abortion, the implant can be inserted the same day the mifepristone is administered (grade C). Both the copper IUDs and levonorgestrel intrauterine system should be inserted on the day of the surgical abortion (grade A). After medical abortions, an IUD can be inserted in 10 days after mifepristone administration, after ultrasound scan verification of the absence of an intrauterine pregnancy (grade C).
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Affiliation(s)
- Christophe Vayssière
- Pôle Femme-Mère-Couple, service de gynecologie-obstétrique, Hôpital Paule de Viguier, CHU de Toulouse, Toulouse, France; UMR 1027 INSERM, Université Paul-Sabatier Toulouse III, Toulouse, France.
| | - Adrien Gaudineau
- Département de Gynécologie-Obstétrique, Hôpital de Hautepierre, CHU de Strasbourg, 1 avenue Molière, 67098 Strasbourg, France
| | - Luisa Attali
- Département de Gynécologie-Obstétrique, Hôpital de Hautepierre, CHU de Strasbourg, 1 avenue Molière, 67098 Strasbourg, France
| | - Karima Bettahar
- Département de Gynécologie-Obstétrique, Hôpital de Hautepierre, CHU de Strasbourg, 1 avenue Molière, 67098 Strasbourg, France
| | - Sophie Eyraud
- 3 rue Pierre d'Artagnan, 92350 Le Plessis-Robinson, France
| | - Philippe Faucher
- Unité fonctionnelle d'orthogénie, Hôpital Trousseau, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Patrick Fournet
- Service de Gynécologie Obstétrique, Centre Hospitalier du Belvedere 72, rue Louis Pasteur, 76451 Mont Saint Aignan, France
| | | | | | | | - Brigitte Letombe
- Service de Gynécologoe-Obstétrique, Hôpital Jeanne de Flandre, CHRU Lille, 2 av Oscar Lambret, 59000 Lille, France
| | - Teddy Linet
- Service de Gynécologie Obstétrique, Centre Hospitalier Loire Vendée Océan, Bd Guerin, 85300, Challans, France
| | - Marie Msika Razon
- MFPF, Mouvement français pour le planning familial, Tour Manto, Bd Massena, 75013 Paris, France
| | - Alexandra Ohanessian
- Service de Gynécologie-Obstétrique, Hôpital de la Conception, 147 bd Baille, 13005 Marseille, France
| | - Hélène Segain
- Service de Gynécologie-Obstétrique, CHI de Poissy-St-Germain, 45 rue du Champs Gaillard, 78303 Poissy, France
| | - Solène Vigoureux
- Service de gynécologie-obstétrique, Hôpital Bicêtre, GHU Sud, AP-HP, 94276 Le Kremlin-Bicêtre, France; Inserm, Centre de Recherche en Epidémiologie et Santé des Populations (CESP), U1018, Equipe « Genre, Sexualité et Santé », 94276 Le Kremlin-Bicêtre, France
| | - Norbert Winer
- Service de Gynécologie-Obstétrique, CHU Hôtel-Dieu Nantes, 1 Place Alexis-Ricordeau, 44000 Nantes, France
| | - Sophie Wylomanski
- Service de Gynécologie-Obstétrique, CHU Hôtel-Dieu Nantes, 1 Place Alexis-Ricordeau, 44000 Nantes, France
| | - Aubert Agostini
- Service de Gynécologie-Obstétrique, Hôpital de la Conception, 147 bd Baille, 13005 Marseille, France
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Vigoureux S, Goffinet F, Tessier V, Boulinguez V, Saurel-Cubizolles MJ, Azria E. [Observational study of a social device for women in precarious situations during pregnancy and post-partum]. ACTA ACUST UNITED AC 2017; 45:460-465. [PMID: 28869180 DOI: 10.1016/j.gofs.2017.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/13/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess the impact of the Regional experimental accompanying nutrition and breast-feeding for pregnant women (PRENAP) 75 social device on the duration of postpartum hospitalization and breast-feeding for pregnant women in precarious situation. METHODS A retrospective observational study took place between November 2013 and May 2015 in a type III Parisian maternity. Comparison of sociodemographic, perinatal and postpartum characteristics of women in precarious situations (no stable housing and no social care or universal medical coverage or state medical aid) was done according to whether they were included in the system PRENAP or not. RESULTS Over the study period, 344 (4.6%) women in precarious situations gave birth in this maternity. Among these women, the women included in the PRENAP system were more frequently in a very unfavorable social situation than those who were not included. The inclusion in the PRENAP device did not reduce the hospitalization in post-partum. Breast-feeding was chosen more frequently by the women included in the PRENAP device. CONCLUSION The PRENAP device seems to favor the use of breast-feeding, but is not associated with a diminution of the hospitalization time in post-partum. This social device, which seems to be beneficial in terms of social and medical support for women in precarious situations, deserves to be evaluated prospectively.
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Affiliation(s)
- S Vigoureux
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Maternité Port-Royal,75014 Paris, France; Inserm, Centre of research in epidemiology and population health (CESP), U1018, 94276 Le Kremlin-Bicêtre, France; Service de gynécologie-obstétrique, hôpital Bicêtre, GHU Sud, AP-HP, 94276 Le Kremlin-Bicêtre, France.
| | - F Goffinet
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Maternité Port-Royal,75014 Paris, France; Maternité Port-Royal, Paris Descartes University, Cochin Broca Hôtel-Dieu Hospital, AP-HP, DHU Risks in pregnancy, 75014 Paris, France
| | - V Tessier
- AP-HP, DHU risques et grossesse, 53, avenue de l'Observatoire, 75014, Paris, France
| | - V Boulinguez
- Groupe hospitalier Paris centre, maternité Port-Royal, DHU risques et grossesse, AP-HP, 75014 Paris, France
| | - M-J Saurel-Cubizolles
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Maternité Port-Royal,75014 Paris, France
| | - E Azria
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Maternité Port-Royal,75014 Paris, France; Maternité du groupe hospitalier de Paris Saint-Joseph, Paris Descartes University, 75014,Paris, France
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Vigoureux S. Épidémiologie de l’interruption volontaire de grossesse en France. ACTA ACUST UNITED AC 2016; 45:1462-1476. [DOI: 10.1016/j.jgyn.2016.09.024] [Citation(s) in RCA: 6] [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] [Received: 09/20/2016] [Revised: 09/21/2016] [Accepted: 09/22/2016] [Indexed: 10/20/2022]
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Vigoureux S, Perreaud A, Legendre G, Salet-Lizée D, Villet R. [Urogynecology pelvic organ prolapse French surgical training during and after residency]. ACTA ACUST UNITED AC 2016; 44:664-668. [PMID: 27751745 DOI: 10.1016/j.gyobfe.2016.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/09/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES For the treatment of prolapse, the vaginal route is less standardized than laparoscopy and seems abandoned by younger doctors. Our objectives were to evaluate the surgical experience of resident and youth gynecology and obstetrics assistants in pelviperineology and the level of confidence and mastery of the different surgical treatment of pelvic. METHODS An anonymous questionnaire sent via an Internet platform interviewing residents and young assistants of gynecology and obstetrics (promotion 2005 to 2010) in France on their surgical training in pelviperineology. RESULTS Twenty-nine percent (208/724) of the persons contacted responded with two thirds of residents and one third of young assistants, all regions of France were represented. Sixty-four percent of respondents wanted to favor a surgical career. The laparoscopic sacrocolpopexy was declared to be the best method mastered while residents and young assistants reported being more often leading operator in vaginal techniques during their medical training. CONCLUSION Surgical practice during medical training of resident and young assistants did not seem associated with declared mastery level of technique. Different clinical surgical practice training techniques such as simulation, cadaveric study, movies on surgical technics may also improve the level of confidence and mastery of young doctors for surgical techniques.
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Affiliation(s)
- S Vigoureux
- CESP-Inserm, U1018, équipe 7 « Genre, santé sexuelle et reproductive », université Paris Sud, 94276 Le Kremlin-Bicêtre cedex, France; Service de gynécologie-obstétrique, hôpital Bicêtre, GHU Sud, AP-HP, 94276 Le Kremlin-Bicêtre, France; Faculté de médecine, université Paris Sud, 94276 Le Kremlin-Bicêtre, France.
| | - A Perreaud
- Service d'urologie, hôpital Foch, 40, rue Worth, 92151 Suresnes cedex, France
| | - G Legendre
- CESP-Inserm, U1018, équipe 7 « Genre, santé sexuelle et reproductive », université Paris Sud, 94276 Le Kremlin-Bicêtre cedex, France; Service de gynécologie-obstétrique, CHU d'Angers, 4, rue Larrey, 49033 Angers cedex 01, France
| | - D Salet-Lizée
- Service de chirurgie gynécologique et viscérale, groupe hospitalier Diaconesses Croix Saint-Simon, 18, rue du Sergent-Bauchat, 75012 Paris, France
| | - R Villet
- Service de chirurgie gynécologique et viscérale, groupe hospitalier Diaconesses Croix Saint-Simon, 18, rue du Sergent-Bauchat, 75012 Paris, France
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Vigoureux S, Blondel B, Ringa V, Saurel-Cubizolles MJ. Occupational, social and medical characteristics of early prenatal leave in France. Eur J Public Health 2016; 26:1022-1027. [PMID: 27259720 DOI: 10.1093/eurpub/ckw072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In France, most women of childbearing age work. The prenatal leave law in France protects women during pregnancy and their employment. We aimed to describe how long before delivery women stopped working and analyse the association between occupational, social and medical factors and early prenatal leave (before 24 weeks' gestation). METHODS The sample was extracted from the 2010 French National Perinatal Survey. Women were interviewed in French maternity units during a 1-week period. We focused on all women with a singleton live birth who were working during pregnancy (n = 10 149). Women were interviewed between delivery and discharge to collect information on employment, date of leave, sociodemographic and medical characteristics. RESULTS Among women who worked during pregnancy, 27.5% reported early occupational leave (before 24 weeks' gestation). Early occupational leave was more frequent among women with unstable jobs (fixed-term vs. non-fixed-term contract: adjusted odds ratio aOR = 1.60 [95% confidence interval 1.40-1.84]) and with less-qualified occupational categories (manual workers vs. managers and upper-intellectual positions: aOR = 2.96 [2.30-3.82]), even after adjusting for sociodemographic and other employment characteristics. Women with a pathological or at risk pregnancy left work earlier than other women. After stratification on type of pregnancy there was still a higher rate of early leave for women with less qualified occupational group. CONCLUSION In France, social vulnerability of pregnant women, linked to low sociodemographic situation or low occupational categories, is associated with early leave during pregnancy, even after stratification on type of pregnancy.
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Affiliation(s)
- Solène Vigoureux
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, 75014 Paris, France
| | - Béatrice Blondel
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, 75014 Paris, France
| | - Virginie Ringa
- INSERM UMR 1018, CESP Centre for Research in Epidemiology and Population Health, Gender, Sexuality and Health Team, Université Paris-Saclay, Univ. Paris-Sud, UVSQ, Kremlin-Bicêtre F-94276, France.,Institut National d'Etudes Démographiques (INED), F-75020 Paris, France
| | - Marie-Josèphe Saurel-Cubizolles
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, 75014 Paris, France
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Vigoureux S, Fernandez H, Capmas P, Levaillant JM, Legendre G. Assessment of Abdominal Ultrasound Guidance in Hysteroscopic Metroplasty. J Minim Invasive Gynecol 2016; 23:78-83. [DOI: 10.1016/j.jmig.2015.08.882] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 08/18/2015] [Accepted: 08/19/2015] [Indexed: 11/28/2022]
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Jamin C, Agostini A, Asselin I, Ben M'barek I, Bettahar K, Carbonne B, David P, Faucher P, Fernandez H, Fournet P, Goffinet F, Guilbaud L, Hassoun D, Lachowsky M, Letombe B, Levy G, Trignol-Viguier N, Vayssiere C, Vigoureux S. [Emergency contraceptions: Propositions of the Orthogenics Commission of the French National College of Gynecology and Obstetrics]. Gynecol Obstet Fertil 2015; 43:571-4. [PMID: 26298815 DOI: 10.1016/j.gyobfe.2015.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 07/07/2015] [Indexed: 12/30/2022]
Affiliation(s)
- C Jamin
- 169, boulevard Haussmann, 75008 Paris, France.
| | - A Agostini
- 169, boulevard Haussmann, 75008 Paris, France
| | - I Asselin
- 169, boulevard Haussmann, 75008 Paris, France
| | | | - K Bettahar
- 169, boulevard Haussmann, 75008 Paris, France
| | - B Carbonne
- 169, boulevard Haussmann, 75008 Paris, France
| | - P David
- 169, boulevard Haussmann, 75008 Paris, France
| | - P Faucher
- 169, boulevard Haussmann, 75008 Paris, France
| | - H Fernandez
- 169, boulevard Haussmann, 75008 Paris, France
| | - P Fournet
- 169, boulevard Haussmann, 75008 Paris, France
| | - F Goffinet
- 169, boulevard Haussmann, 75008 Paris, France
| | - L Guilbaud
- 169, boulevard Haussmann, 75008 Paris, France
| | - D Hassoun
- 169, boulevard Haussmann, 75008 Paris, France
| | - M Lachowsky
- 169, boulevard Haussmann, 75008 Paris, France
| | - B Letombe
- 169, boulevard Haussmann, 75008 Paris, France
| | - G Levy
- 169, boulevard Haussmann, 75008 Paris, France
| | | | - C Vayssiere
- 169, boulevard Haussmann, 75008 Paris, France
| | - S Vigoureux
- 169, boulevard Haussmann, 75008 Paris, France
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Vigoureux S. [The first day of traineeship for gynaecology residents about in sexuality and teenagers]. Gynecol Obstet Fertil 2014; 42:626-627. [PMID: 25153437 DOI: 10.1016/j.gyobfe.2014.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Indexed: 06/03/2023]
Affiliation(s)
- S Vigoureux
- Association des gynécologues en formation (AGOF), 9, route de la Goulée, 95510 Villiers-en-Arthries, France.
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Affiliation(s)
- Zeina Chakhtoura
- Department of Endocrinology and Reproductive Medicine (Z.C., S.V., C.C., I.T., P.T.), Pitié-Salpêtrière Hospital, Assistance Publique-Hopitaux de Paris, Pierre et Marie Curie University, 75013 Paris, France; Center of Rare Gynecologic Diseases (Z.C., S.V., C.C., I.T., P.T.), Pitie-Salpetriere Hospital, Paris, 75103, France; and Center of Rare Endocrine Growth Diseases (Z.C., S.V., C.C., I.T., P.T.), Pitie-Salpetriere Hospital, Paris, 75103, France
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