1
|
Girault A, Carteau M, Kefelian F, Menard S, Goffinet F, Le Ray C. Benefits of the «en caul» technique for extremely preterm breech vaginal delivery. J Gynecol Obstet Hum Reprod 2021; 51:102284. [PMID: 34906693 DOI: 10.1016/j.jogoh.2021.102284] [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: 09/14/2021] [Revised: 11/19/2021] [Accepted: 12/03/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The "en caul" technique, i.e. delivery with intact membranes, may reduce the risk of obstetric trauma in vaginal breech delivery of extreme preterm infants. We aimed at comparing perinatal mortality and morbidity among extremely preterm breech vaginal deliveries between infants delivered "en caul" and those with "ruptured membranes". MATERIAL AND METHODS We performed a fourteen-year retrospective study in a tertiary university center. All vaginal deliveries of singleton breech live infants with an antenatal decision of active resuscitation between 24 weeks and 27+6 weeks were included. Perinatal outcomes were compared between the "en caul" group, with intact membranes at the onset of pushing efforts and the "ruptured membranes" group, with ruptured membranes at the onset of pushing efforts. The primary outcome was perinatal mortality defined by intrapartum or neonatal death. The secondary outcomes were fetal extraction difficulties, arterial pH and 5 min Apgar score. RESULTS We included 52 infants in the "en caul" group and 71 in the "ruptured membranes" group. The perinatal mortality rate did not differ between the two groups (19.2% in the "en caul" group versus 28.2% in the "ruptured membranes" group, p = 0.25). The mean arterial pH at birth was higher in the « en caul » group (7.32 ± 0.1 vs 7.24 ± 0.1, p = 0.001). There were no differences between the groups for fetal extraction difficulties, especially fetal head entrapment (9.6% versus 9.9%). CONCLUSION Even though the "en caul" technique does not seem to decrease the perinatal mortality rate, it remains a simple technique, which could improve neonatal morbidity.
Collapse
Affiliation(s)
- A Girault
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, 123 boulevard de Port Royal, Paris 75014, France; Hôpital Cochin Port Royal, Maternité Port Royal, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France.
| | - M Carteau
- Hôpital Cochin Port Royal, Maternité Port Royal, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - F Kefelian
- Hôpital Cochin Port Royal, Maternité Port Royal, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - S Menard
- Hôpital Cochin Port Royal, Maternité Port Royal, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - F Goffinet
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, 123 boulevard de Port Royal, Paris 75014, France; Hôpital Cochin Port Royal, Maternité Port Royal, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - C Le Ray
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, 123 boulevard de Port Royal, Paris 75014, France; Hôpital Cochin Port Royal, Maternité Port Royal, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| |
Collapse
|
2
|
Demiri S, Kefelian F, Berl M, Goffinet F, Rackelboom T. Role of a long-lasting uterotonic drug in the implementation of a fast track rehabilitation protocol after caesarian section. Anaesth Crit Care Pain Med 2019; 38:277-278. [PMID: 31079705 DOI: 10.1016/j.accpm.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/09/2018] [Accepted: 10/15/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Suela Demiri
- Maternité Port Royal, Hôpital Cochin-Port Royal, 123, boulevard de Port Royal, 75014 Paris, France.
| | - Fleur Kefelian
- Maternité Port Royal, Hôpital Cochin-Port Royal, 123, boulevard de Port Royal, 75014 Paris, France
| | - Monique Berl
- Maternité Port Royal, Hôpital Cochin-Port Royal, 123, boulevard de Port Royal, 75014 Paris, France
| | - François Goffinet
- Maternité Port Royal, Hôpital Cochin-Port Royal, 123, boulevard de Port Royal, 75014 Paris, France
| | - Thibaut Rackelboom
- Maternité Port Royal, Hôpital Cochin-Port Royal, 123, boulevard de Port Royal, 75014 Paris, France
| |
Collapse
|
3
|
Bourdon M, Santulli P, Kefelian F, Vienet-Legue L, Maignien C, Pocate-Cheriet K, de Mouzon J, Marcellin L, Chapron C. Prolonged estrogen (E2) treatment prior to frozen-blastocyst transfer decreases the live birth rate. Hum Reprod 2019. [PMID: 29529202 DOI: 10.1093/humrep/dey041] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
STUDY QUESTION How does the duration of estrogen (E2) treatment prior to frozen-blastocyst transfers affect the live birth rate (LBR)? SUMMARY ANSWER Prolonged E2 exposure as part of artificial endometrial preparation (AEP) significantly decreases the LBR after autologous frozen-thawed blastocyst transfer. WHAT IS KNOWN ALREADY One effective method for endometrial preparation prior to frozen embryo transfer is AEP, a sequential regimen with E2 and progesterone, which aims to mimic the endocrine exposure of the endometrium in a normal cycle. Nevertheless, the optimal duration of E2 administration prior to transfer remains unknown. STUDY DESIGN, SIZE, DURATION An observational cohort study was conducted in a tertiary care university hospital between 01/07/2012 and 31/12/2015. The main inclusion criteria was having a single frozen-thawed blastocyst transfer with an AEP using exogenous E2. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 1377 frozen-thawed blastocyst transfers were assigned to four groups according to the duration of the E2 administration prior to the embryo transfers. These comprised a '≤21 days' group (n = 330), a '22-28 days' group (n = 665), a '29-35 days' group (n = 289) and a '36-48 days' group (n = 93). The '≤21 days' group' was taken as the reference group. The main measured outcome was the LBR following frozen-thawed blastocyst transfers. Statistical analysis was conducted using univariate and multivariate logistic regression models. MAIN RESULTS AND THE ROLE OF CHANCE LBR significantly decreased when the E2 exposure prior to the frozen-thawed blastocyst transfer exceeded 28 days: OR = 0.66; 95% CI [0.46-0.95]; P = 0.026 and OR = 0.49 [0.27-0.89]; P = 0.018, respectively, for the '29 to 35 days' group and for the '36 to 48 days' group compared to the reference group. Early pregnancy loss rates significantly increased when the E2 exposure lasted more than 35 days prior to the frozen-thawed blastocyst transfer (OR = 2.37 [1.12-5.05]; P = 0.025 vs. the reference group). After multivariate logistic regression, E2 exposure lasting more than 28 days prior to the frozen-thawed blastocyst transfer was associated with a decrease in the LBR, for the '29-35 days' group (OR = 0.65; [0.45-0.95]; P = 0.044) as for the '36-48 days' group (OR = 0.49; [0.26-0.92]; P = 0.035), vs. the reference group. LIMITATIONS, REASONS FOR CAUTION One limitation is linked to the observational design of this study. WIDER IMPLICATIONS OF THE FINDINGS In order to give patients the best chance to obtain a live birth after frozen-thawed blastocyst transfer, the length of E2 exposure prior to the frozen-blastocyst transfer should not exceed 28 days. This study provides new insight in regard to endometrial preparation using AEP prior to frozen-blastocyst transfer. STUDY FUNDING/COMPETING INTEREST(S) No funding and no competing interest.
Collapse
Affiliation(s)
- Mathilde Bourdon
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine 53 avenue de l'Observatoire, 75014 Paris, France.,Institut Cochin, INSERM U1016, Département 'Stress oxydant, prolifération cellulaire et inflammation', Université Paris Descartes, Sorbonne Paris Cité, 22 rue Mechain, 75014 Paris, France
| | - Pietro Santulli
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine 53 avenue de l'Observatoire, 75014 Paris, France.,Institut Cochin, INSERM U1016, Département 'Stress oxydant, prolifération cellulaire et inflammation', Université Paris Descartes, Sorbonne Paris Cité, 22 rue Mechain, 75014 Paris, France
| | - Fleur Kefelian
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine 53 avenue de l'Observatoire, 75014 Paris, France
| | - Laurine Vienet-Legue
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine 53 avenue de l'Observatoire, 75014 Paris, France
| | - Chloé Maignien
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine 53 avenue de l'Observatoire, 75014 Paris, France
| | - Khaled Pocate-Cheriet
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Service d'Histologie-Embryologie-Biologie de la Reproduction, 53 avenue de l'Observatoire, 75014 Paris, France
| | - Jacques de Mouzon
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine 53 avenue de l'Observatoire, 75014 Paris, France.,Epidemiology, Paris, France
| | - Louis Marcellin
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine 53 avenue de l'Observatoire, 75014 Paris, France.,Institut Cochin, INSERM U1016, Département 'Stress oxydant, prolifération cellulaire et inflammation', Université Paris Descartes, Sorbonne Paris Cité, 22 rue Mechain, 75014 Paris, France.,Institut Cochin, INSERM U1016, Département de 'Génétique, Développement et Cancer', Université Paris Descartes, Sorbonne Paris Cité, 22 rue Mechain, 75014 Paris, France
| | - Charles Chapron
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine 53 avenue de l'Observatoire, 75014 Paris, France.,Institut Cochin, INSERM U1016, Département de 'Génétique, Développement et Cancer', Université Paris Descartes, Sorbonne Paris Cité, 22 rue Mechain, 75014 Paris, France
| |
Collapse
|