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Sanchez M, Berveiller P, Behal H, Tursack A, Plurien A, Ghesquière L, Garabedian C. Impact of body mass index on sonographic measurement of head perineum distance before operative vaginal delivery. Int J Gynaecol Obstet 2024. [PMID: 38736297 DOI: 10.1002/ijgo.15568] [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: 03/03/2024] [Revised: 04/14/2024] [Accepted: 04/20/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE To evaluate the impact of body mass index (BMI) on sonographic measurement of head perineum distance (HPD) before operative vaginal delivery (OVD). METHODS This was a single-center retrospective cohort study (Lille, France) conducted from March 1, 2019 to October 31, 2020 including all singleton and OVD. HPD measurement was systematically performed without and with compression on the perineum soft tissues. The level of station was defined by vaginal examination and three maternal BMI groups were defined (normal BMI [<24.9 kg/m2] vs overweight [25-29.9 kg/m2] vs obese [≥30 kg/m2]). HPD measures were compared between BMI groups and compression, in distinct level of station, using a two-factor analysis of variance including BMI groups, the compression, and the interaction term BMI group compression. RESULTS A total of 775 women were included: 488 with normal BMI, 181 overweight patients and 106 obese patients. The measurement of HPD before OVD without and with compression on the soft tissues was significantly different between the BMI groups only in the lower part, particularly between normal BMI and obese patients (mean difference (95% CI): 6.6 mm (4.0 to 9.2) without compression; 3.8 (1.1 to 6.4) with compression). CONCLUSION The values of HPD without and with compression on the soft tissues on the maternal perineum were different according to the maternal BMI concerning lower part station. Thus, it seems important to define thresholds of HPD measures corresponding to each head station levels according to maternal BMI.
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Affiliation(s)
| | - Paul Berveiller
- Department of Gynecology and Obstetrics, Poissy-Saint Germain Hospital, Poissy, France
- UMR 1198-BREED, RHuMA, INRAE, Paris Saclay University, Montigny-Le-Bretonneux, France
| | - Hélène Behal
- Department of Biostatistics, CHU Lille, Lille, France
| | | | - Alix Plurien
- Department of Obstetrics, CHU Lille, Lille, France
| | - Louise Ghesquière
- Department of Obstetrics, CHU Lille, Lille, France
- ULR 2694-METRICS: Health Technology and Medical Practice Assessment, University of Lille, Lille, France
| | - Charles Garabedian
- Department of Obstetrics, CHU Lille, Lille, France
- ULR 2694-METRICS: Health Technology and Medical Practice Assessment, University of Lille, Lille, France
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Ghesquière L, Bengler C, Drumez E, Subtil D, Houfflin-Debarge V, Insubri S, Garabedian C. Factors associated with successful balloon catheter labor induction in women with a previous caesarean section: A retrospective single-center evaluation. J Gynecol Obstet Hum Reprod 2024; 53:102743. [PMID: 38341084 DOI: 10.1016/j.jogoh.2024.102743] [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: 10/11/2023] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Labor induction of women with a history of uterine scarring is an increasingly frequent situation and one for which there are currently no clear professional recommendations favoring one method over another. The objectives of this study were to determine the success rate of balloon catheter induction in women with a history of caesarean section and to evaluate the main factors associated with vaginal delivery. MATERIALS AND METHODS This single-center retrospective study was conducted between January 1, 2014, and December 31, 2018, in Lille, France, and included all women with one previous caesarean section who were induced by first-line balloon catheter induction. Multivariate analysis was performed to identify the factors associated with the primary outcome (vaginal delivery). RESULTS Of the 310 women in the sample, 192 delivered vaginally (62 %). After adjustment, factors associated with successful induction (vaginal delivery) were the number of previous vaginal deliveries (odds ratio [OR] 1.37; 95 % confidence interval [CI] 1.04-1.81), evolution of the Bishop score after balloon removal (OR 1.24; 95 % CI 1.10-1.41), and the initial Bishop score (OR 1.17; 95 % CI 1.00-1.37). Uterine rupture was observed in three women (1 %). CONCLUSION The vaginal delivery rate after balloon catheter induction in women with a previous caesarean section was 62 %. Prognostic factors for vaginal delivery include previous vaginal delivery, the initial Bishop score, and evolution of the Bishop score after balloon catheter induction.
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Affiliation(s)
- Louise Ghesquière
- Department of Obstetrics, CHU Lille, Lille F-59000, France; ULR 2694 - METRICS - Health Technology and Medical Practice Assessment, Univ. Lille, CHU Lille, Lille F-59000, France.
| | - Cyril Bengler
- Department of Obstetrics, CHU Lille, Lille F-59000, France
| | - Elodie Drumez
- ULR 2694 - METRICS - Health Technology and Medical Practice Assessment, Univ. Lille, CHU Lille, Lille F-59000, France; Department of Biostatistics, CHRU Lille, France
| | - Damien Subtil
- Department of Obstetrics, CHU Lille, Lille F-59000, France; ULR 2694 - METRICS - Health Technology and Medical Practice Assessment, Univ. Lille, CHU Lille, Lille F-59000, France
| | - Véronique Houfflin-Debarge
- Department of Obstetrics, CHU Lille, Lille F-59000, France; ULR 2694 - METRICS - Health Technology and Medical Practice Assessment, Univ. Lille, CHU Lille, Lille F-59000, France
| | | | - Charles Garabedian
- Department of Obstetrics, CHU Lille, Lille F-59000, France; ULR 2694 - METRICS - Health Technology and Medical Practice Assessment, Univ. Lille, CHU Lille, Lille F-59000, France
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Denoyelle J, Dujardin C, Ramdane N, Leleu A, Ghesquière L, Garabedian C. [Can we predict intrauterine balloon tamponade failure according to the mode of delivery?]. Gynecol Obstet Fertil Senol 2024:S2468-7189(24)00117-X. [PMID: 38556133 DOI: 10.1016/j.gofs.2024.03.013] [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: 01/26/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE The intrauterine balloon tamponade (IUBT) is one of the major tool to manage the postpartum hemorrhage (PPH). Previous studies identified factors predicting IUBT failure regardless the mode of delivery. Our aim was to determine if IUBT predictive failure can be determined regarding the mode of delivery. MATERIALS AND METHODS This was a retrospective cohort study among women who had IUBT secondary to severe PPH after vaginal or cesarean delivery from 2012 until 2021 at Lille (France). We compared 2 groups: success or failure of the IUBT, which was defined as the need of additional invasive procedures (uterine embolization or surgical procedure). RESULTS We included 238 women, 83 who underwent cesarean and 155 vaginal delivery. The overall success of the IUBT was 78% (80% for vaginal delivery and 75% for cesarean delivery). In the vaginal delivery group with failed IUBT, coagulopathies were significantly more frequent (84.2 vs. 33.3% P=<0.001) with higher estimated blood loss at the use of the IUBT (1865.8 vs. 1580.8mL, P=0.015) compared with the vaginal delivery group with success of IUBT. In the cesarean delivery group, none factor was significant between the two groups. CONCLUSION It is possible to identify predictors of IUBT failure in case of vaginal delivery. In contrast, in case of cesarean delivery, there is no apparent predictive facto. It could be interesting to validate our findings in a multicentric study.
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Affiliation(s)
- Juliette Denoyelle
- Clinique d'obstétrique, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59000 Lille, France
| | - Clara Dujardin
- Clinique d'obstétrique, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59000 Lille, France
| | - Nassima Ramdane
- Département d'épidémiologie, CHU de Lille, 59000 Lille, France
| | - Astrid Leleu
- Département d'obstétrique, hôpital de Roubaix, Roubaix, France
| | - Louise Ghesquière
- Clinique d'obstétrique, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59000 Lille, France; ULR 2694-METRICS, University Lille, 59000 Lille, France
| | - Charles Garabedian
- Clinique d'obstétrique, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59000 Lille, France; ULR 2694-METRICS, University Lille, 59000 Lille, France.
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Ghesquière L, Bujold E, Dubé E, Chaillet N. Comparison of National Factor-based Models for Preeclampsia Screening. Am J Perinatol 2024. [PMID: 38490251 DOI: 10.1055/s-0044-1782676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
OBJECTIVE This study aimed to compare the predictive values of the American College of Obstetricians and Gynecologists (ACOG), the National Institute for Health and Care Excellence (NICE), and the Society of Obstetricians and Gynecologists of Canada (SOGC) factor-based models for preeclampsia (PE) screening. STUDY DESIGN We conducted a secondary analysis of maternal and birth data from 32 hospitals. For each delivery, we calculated the risk of PE according to the ACOG, the NICE, and the SOGC models. Our primary outcomes were PE and preterm PE (PE combined with preterm birth) using the ACOG criteria. We calculated the detection rate (DR or sensitivity), the false positive rate (FPR or 1 - specificity), the positive (PPV) and negative (NPV) predictive values of each model for PE and for preterm PE using receiver operator characteristic (ROC) curves. RESULTS We used 130,939 deliveries including 4,635 (3.5%) cases of PE and 823 (0.6%) cases of preterm PE. The ACOG model had a DR of 43.6% for PE and 50.3% for preterm PE with FPR of 15.6%; the NICE model had a DR of 36.2% for PE and 41.3% for preterm PE with FPR of 12.8%; and the SOGC model had a DR of 49.1% for PE and 51.6% for preterm PE with FPR of 22.2%. The PPV for PE of the ACOG (9.3%) and NICE (9.4%) models were both superior than the SOGC model (7.6%; p < 0.001), with a similar trend for the PPV for preterm PE (1.9 vs. 1.9 vs. 1.4%, respectively; p < 0.01). The area under the ROC curves suggested that the ACOG model is superior to the NICE for the prediction of PE and preterm PE and superior to the SOGC models for the prediction of preterm PE (all with p < 0.001). CONCLUSION The current ACOG factor-based model for the prediction of PE and preterm PE, without considering race, is superior to the NICE and SOGC models. KEY POINTS · Clinical factor-based model can predict PE in approximately 44% of the cases for a 16% false positive.. · The ACOG model is superior to the NICE and SOGC models to predict PE.. · Clinical factor-based models are better to predict PE in parous than in nulliparous..
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Affiliation(s)
- Louise Ghesquière
- Reproduction, Mother and Child Health Unit, Research Center of the CHU de Québec, Université Laval, Québec City, QC, Canada
- Department of Obstetrics, Université de Lille, CHU de Lille, Lille, France
| | - Emmanuel Bujold
- Reproduction, Mother and Child Health Unit, Research Center of the CHU de Québec, Université Laval, Québec City, QC, Canada
- Department of Obstetrics, Gynecology and Reproduction, CHU de Québec-Université Laval, Québec City, QC, Canada
| | - Eric Dubé
- Reproduction, Mother and Child Health Unit, Research Center of the CHU de Québec, Université Laval, Québec City, QC, Canada
| | - Nils Chaillet
- Reproduction, Mother and Child Health Unit, Research Center of the CHU de Québec, Université Laval, Québec City, QC, Canada
- Department of Obstetrics, Gynecology and Reproduction, CHU de Québec-Université Laval, Québec City, QC, Canada
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Demuth B, Pellan A, Boutin A, Bujold E, Ghesquière L. Aspirin at 75 to 81 mg Daily for the Prevention of Preterm Pre-Eclampsia: Systematic Review and Meta-Analysis. J Clin Med 2024; 13:1022. [PMID: 38398335 PMCID: PMC10888723 DOI: 10.3390/jcm13041022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
Background: Aspirin at 150 mg daily, initiated in the 1st trimester of pregnancy, prevents preterm pre-eclampsia. We aimed to estimate whether a dose of 75 to 81 mg daily can help to prevent preterm pre-eclampsia as well. Methods: A systematic search was conducted using multiple databases and meta-analyses of randomized controlled trials (RCTs) that compared aspirin initiated in the first trimester of pregnancy to placebo or no treatment, following the PRISMA guidelines and the Cochrane risk of bias tool. Results: We retrieved 11 RCTs involving 13,981 participants. Five RCTs had a low risk of bias, one at unclear risk, and fiver had a high risk of bias. A pooled analysis demonstrated that doses of 75 to 81 mg of aspirin, compared to a placebo or no treatment, was not associated with a significant reduction in preterm pre-eclampsia (8 studies; 12,391 participants; relative risk, 0.66; 95% confidence interval: 0.27 to 1.62; p = 0.36), but there was a significant heterogeneity across the studies (I2 = 61%, p = 0.02). Conclusion: It cannot be concluded that taking 75 to 81 mg of aspirin daily reduces the risk of preterm pre-eclampsia. However, given the significant heterogeneity between the studies, the true effect that such a dose of aspirin would have on pregnancy outcomes could not be properly estimated.
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Affiliation(s)
- Brielle Demuth
- Centre de Recherche du CHU de Québec, Université Laval, Québec, QC G1V 0A6, Canada; (B.D.); (A.B.); (L.G.)
| | - Ariane Pellan
- Centre de Recherche du CHU de Québec, Université Laval, Québec, QC G1V 0A6, Canada; (B.D.); (A.B.); (L.G.)
| | - Amélie Boutin
- Centre de Recherche du CHU de Québec, Université Laval, Québec, QC G1V 0A6, Canada; (B.D.); (A.B.); (L.G.)
- Department of Pediatry, Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Emmanuel Bujold
- Centre de Recherche du CHU de Québec, Université Laval, Québec, QC G1V 0A6, Canada; (B.D.); (A.B.); (L.G.)
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Louise Ghesquière
- Centre de Recherche du CHU de Québec, Université Laval, Québec, QC G1V 0A6, Canada; (B.D.); (A.B.); (L.G.)
- Department of Obstetrics, Centre Hospitalier Universitaire de Lille, 59000 Lille, France
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Hadhoum S, Ghesquière L, Drumez E, Subtil D, Garabedian C. [Comparison of vaginal prostaglandins with oral misoprostol as a second line of cervical ripening after using a cervical balloon catheter]. Gynecol Obstet Fertil Senol 2024; 52:68-73. [PMID: 37995911 DOI: 10.1016/j.gofs.2023.11.004] [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: 03/08/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE To compare vaginal prostaglandins with oral misoprostol as a second line of cervical ripening after using a cervical balloon catheter. MATERIAL AND METHODS This is a retrospective monocentric study (Lille, France), according to a "before"/"after" design. The inclusion criteria were a singleton pregnancy, with a fetus in cephalic presentation, a term >37 WA, with a cervix having a Bishop score lower than 6 after a first line of maturation by cervical balloon catheter. Two groups were formed: "before" corresponding to the continuation of maturation by vaginal prostaglandins, from March 2019 to November 2019, and "after": corresponding to the continuation of maturation by oral misoprostol, from June 2020 to December 2020. The primary outcome was vaginal delivery rate. RESULTS One hundred women were included in each group. The rate of vaginal delivery was similar between the 2 groups (76% vs 81%, p=0.39), as were the times between the start of induction and the birth and between the start of induction and the transition to birth room. There was no difference in the indication for caesarean section, with in particular an identical rate of caesarean sections for induction failure (p=0.52). Subgroup analysis in obese women showed a significantly higher rate of vaginal delivery in the "after" group (OR=4.17;95% CI [1.02;17.07]). CONCLUSION The vaginal delivery rate is similar when using vaginal prostaglandins or oral misoprostol as second line cervical ripening after use of a cervical balloon catheter.
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Affiliation(s)
- S Hadhoum
- Service de gynécologie obstétrique, CHU Lille, avenue Eugène-Avinée, 59000 Lille, France.
| | - L Ghesquière
- Service de gynécologie obstétrique, CHU Lille, avenue Eugène-Avinée, 59000 Lille, France; University Lille, ULR 2694-METRICS, 59000 Lille, France
| | - E Drumez
- University Lille, ULR 2694-METRICS, 59000 Lille, France; Département de biostatistiques, CHU Lille, 59000 Lille, France
| | - D Subtil
- Service de gynécologie obstétrique, CHU Lille, avenue Eugène-Avinée, 59000 Lille, France; University Lille, ULR 2694-METRICS, 59000 Lille, France
| | - C Garabedian
- Service de gynécologie obstétrique, CHU Lille, avenue Eugène-Avinée, 59000 Lille, France; University Lille, ULR 2694-METRICS, 59000 Lille, France
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Chevalier G, Garabedian C, Pekar JD, Wojtanowski A, Le Hesran D, Galan LE, Sharma D, Storme L, Houfflin-Debarge V, De Jonckheere J, Ghesquière L. Early heart rate variability changes during acute fetal inflammatory response syndrome: An experimental study in a fetal sheep model. PLoS One 2023; 18:e0293926. [PMID: 38032884 PMCID: PMC10688759 DOI: 10.1371/journal.pone.0293926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/21/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Fetal infection during labor with fetal inflammatory response syndrome (FIRS) is associated with neurodevelopmental disabilities, cerebral palsy, neonatal sepsis, and mortality. Current methods to diagnose FIRS are inadequate. Thus, the study aim was to explore whether fetal heart rate variability (HRV) analysis can be used to detect FIRS. MATERIAL AND METHODS In chronically instrumented near-term fetal sheep, lipopolysaccharide (LPS) was injected intravenously to model FIRS. A control group received saline solution injection. Hemodynamic, blood gas analysis, interleukin-6 (IL-6), and 14 HRV indices were recorded for 6 h. In both groups, comparisons were made between the stability phase and the 6 h following injection (H1-H6, respectively) and between LPS and control groups. RESULTS Fifteen lambs were instrumented. In the LPS group (n = 8), IL-6 increased significantly after LPS injection (p < 0.001), confirming the FIRS model. Fetal heart rate increased significantly after H5 (p < 0.01). In our FIRS model without shock or cardiovascular decompensation, five HRV measures changed significantly after H2 until H4 in comparison to baseline. Moreover, significant differences between LPS and control groups were observed in HRV measures between H2 and H4. These changes appear to be mediated by an increase of global variability and a loss of signal complexity. CONCLUSION As significant HRV changes were detected before FHR increase, these indices may be valuable for early detection of acute FIRS.
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Affiliation(s)
- Geoffroy Chevalier
- ULR 2694—METRICS—Evaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, France
- Department of Obstetrics, CHU Lille, France
| | - Charles Garabedian
- ULR 2694—METRICS—Evaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, France
- Department of Obstetrics, CHU Lille, France
| | | | | | | | | | - Dyuti Sharma
- ULR 2694—METRICS—Evaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, France
- Department of Pediatric Surgery, CHU Lille, France
| | - Laurent Storme
- ULR 2694—METRICS—Evaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, France
- Department of Neonatology, CHU Lille, France
| | - Veronique Houfflin-Debarge
- ULR 2694—METRICS—Evaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, France
- Department of Obstetrics, CHU Lille, France
| | - Julien De Jonckheere
- ULR 2694—METRICS—Evaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, France
- CIC-IT 1403, CHU Lille, France
| | - Louise Ghesquière
- ULR 2694—METRICS—Evaluation des Technologies de Santé et des Pratiques Médicales, University Lille, CHU Lille, France
- Department of Obstetrics, CHU Lille, France
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Merlier M, Ghesquière L, Huissoud C, Drumez E, Morel O, Garabedian C. How do French Obstetrician-Gynaecologists perceive their quality of life? A national survey. Eur J Obstet Gynecol Reprod Biol 2023; 286:112-117. [PMID: 37243999 DOI: 10.1016/j.ejogrb.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/28/2023] [Accepted: 05/11/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Obstetrics is a constraining specialty due to heavy workloads and repeated stressful situations. French maternity wards are facing many difficulties to recruit, as a consequence of the conversion of a significant number of Obstetrician-Gynecologists (OB-GYNs) to exclusive daily private practice. The aim of this study was to evaluate the quality of life (QOL) of OB-GYNs in order to identify burnout risk factors, develop prevention strategies and therefore ensure patient safety. STUDY DESIGN A Google forms questionnaire assessing QOL and life/work balance was distributed by e-mail to 1397 members of the National College of French OB-GYNs (CNGOF). This was a declarative multicenter cross-sectional survey. RESULTS Four hundred sixty-one responses were collected (response rate 30%). A burnout episode was reported by 31.3% of respondents. Main burnout risk factors were limited staff on the on-call schedule (p = 0.008) and low salary (p < 0.001). On-call work was considered to have a negative personal life impact by 57.8% of the sample; 34.1% wanted to stop this practice and 81.3% believed that financial compensation would help reinforce its attractiveness. Medico-legal risks influenced the daily practices of 70% of respondents and 86.8% had been personally affected by media coverage of obstetrical violence. CONCLUSIONS This report confirms a high burnout rate within a stressful profession, with major impacts from on-call activity, insufficient salary relative to the arduousness of this practice, high exposure to medico-legal actions and media attention. Revising shift duration to a maximum 12 h, better control over global workload, higher salary and renewed social recognition are urgent priorities.
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Affiliation(s)
- Margaux Merlier
- CHU Lille, Department of Obstetrics, Avenue Eugène Avinée, F-59000 Lille, France.
| | - Louise Ghesquière
- CHU Lille, Department of Obstetrics, Avenue Eugène Avinée, F-59000 Lille, France; University of Lille, ULR 26 94- METRICS, Avenue Eugène Avinée, F-59000 Lille, France
| | - Cyril Huissoud
- Department of Gynaecology, Hôpital universitaire de la Croix-Rousse (Hospices Civils de Lyon), Universities Claude Bernard Lyon 1, Lyon, France
| | - E Drumez
- CHU Lille, Department of Statistics, Avenue Eugène Avinée, 59000 Lille, France
| | - Oliver Morel
- Obstetrics & Gynaecology, CHRU de Nancy, University of Lorraine, 10 rue Heydenreich, 54000 Nancy, France
| | - Charles Garabedian
- CHU Lille, Department of Obstetrics, Avenue Eugène Avinée, F-59000 Lille, France; University of Lille, ULR 26 94- METRICS, Avenue Eugène Avinée, F-59000 Lille, France
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Ghesquière L, Moreeuw M, Drumez E, Gilbert M, Hanssens S, Védé M, Garabedian C. [Is it possible to safely reduce the use of in utero pH in the delivery room? Analysis of practices]. Gynecol Obstet Fertil Senol 2023; 51:270-274. [PMID: 36931599 DOI: 10.1016/j.gofs.2023.03.005] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/04/2023] [Accepted: 03/08/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To evaluate our clinical practices since the implementation of different tools to reduce the use of pH in utero (pHiu) in the delivery room. METHODS A single-centre retrospective study was conducted in our university maternity hospital of Lille from October 2016 to March 2021. All patients in labour with a vaginal delivery agreement, a fetus in cephalic presentation and no contraindication to perform a pHiu were included. Since 2019, team training in fetal heart rate interpretation and a change in birth room practices with the introduction of fetal scalp pacing have been implemented to reduce the use of pH in utero. In order to evaluate the impact on clinical practices, the rate of pHiu, the number of pHiu performed per patient, the rates of instrumental deliveries, caesarean sections and pH at birth below 7.0 were studied and compared over time. RESULTS In total, 1515 patients had one or more pHiu during our study period, i.e. 7.3% (1515/20,562). The rate of pHiu decreased significantly from 2016 to 2021: in 2016, 12.1% (142/1171) of our sample had a pHiu during their labour, compared to 3.4% (33/963) in 2021. pH < 7.0 remained stable, ranging from 1.6 to 2.2%. Similarly, the rates of instrumental deliveries and caesarean sections remained stable, ranging from 17.7% to 21% and from 9.8% to 11.6%, respectively. CONCLUSION Improved knowledge of fetal physiology, awareness of teams of the limits of pHiu and introduction of fetal scalp stimulation have led to a decrease in the number of pHiu, without an increase in the rates of neonatal acidosis, instrumental deliveries and caesarean sections.
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Affiliation(s)
- Louise Ghesquière
- Department of Gynecology and Obstetrics, CHU de Lille, Lille University Hospital, 59000 Lille, France; ULR 2694 - METRICS : évaluation des technologies de santé et des pratiques médicales, CHU de Lille, University of Lille, 59000 Lille, France.
| | - Marine Moreeuw
- Department of Gynecology and Obstetrics, CHU de Lille, Lille University Hospital, 59000 Lille, France
| | - Elodie Drumez
- ULR 2694 - METRICS : évaluation des technologies de santé et des pratiques médicales, CHU de Lille, University of Lille, 59000 Lille, France; Department of Biostatistics, CHU de Lille, Lille University Hospital, 59000 Lille, France
| | - Mélissa Gilbert
- Department of Gynecology and Obstetrics, CHU de Lille, Lille University Hospital, 59000 Lille, France
| | - Sandy Hanssens
- Department of Gynecology and Obstetrics, CHU de Lille, Lille University Hospital, 59000 Lille, France
| | - Morgane Védé
- Department of Gynecology and Obstetrics, CHU de Lille, Lille University Hospital, 59000 Lille, France
| | - Charles Garabedian
- Department of Gynecology and Obstetrics, CHU de Lille, Lille University Hospital, 59000 Lille, France; ULR 2694 - METRICS : évaluation des technologies de santé et des pratiques médicales, CHU de Lille, University of Lille, 59000 Lille, France
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10
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Demeyère M, Richardson M, Deken V, Estevez MG, Domanski O, Gautier S, Marsili L, Constans B, Hamoud Y, Ghesquière L. Obstetrical outcomes in cases of maternal heart disease with a risk of cardiac decompensation: A retrospective study since the establishment of a multidisciplinary consultation meeting "heart and pregnancy". J Gynecol Obstet Hum Reprod 2023; 52:102537. [PMID: 36669644 DOI: 10.1016/j.jogoh.2023.102537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/27/2022] [Accepted: 01/16/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND Pregnant women with chronic heart failure (CHF) are at increased risk for cardiac complications. However, the frequency of obstetrical and neonatal complications in pregnant women with CHF remains unclear. OBJECTIVE The objective of our study was to describe obstetrical and neonatal outcomes in pregnant with CHF. METHOD This single-center retrospective cohort study involves pregnant women with a CHF who delivered at Jeanne de Flandre, the Lille's university hospital, from 2017 to 2021. The frequency of obstetrical, neonatal, and cardiovascular complications was collected. RESULT During this period, we identified 26 pregnant women with a CHF. The main cardiac diseases responsible for CHF were cardiomyopathies (53.8%) and congenital heart disease (46.2%). Acute heart failure occurred in 30.8% of the cases and mainly concerned patients with no follow-up of their heart disease. The main obstetrical complications were fetal growth restriction (38.5%) and premature rupture of fetal membranes (19.2%). The 26 pregnancies comprised 25 live births and 1 stillbirth. Newborn infants were delivered via cesarean in 69.2%. Of the live births, 60% were preterm at a median gestational age of 36 (34-38) weeks. CONCLUSION Pregnant women with CHF had a higher risk for obstetrical and neonatal outcomes.
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Affiliation(s)
- Mathilde Demeyère
- Pôle Femme Mère Nouveau-né, obstetrics clinic, Hôpital Jeanne de Flandre, Université Nord de France, Lille, France
| | - Marjorie Richardson
- Department of Cardiovascular Functional Explorations, Heart-Lung Institute, University Hospital of Lille, Lille, France
| | - Valerie Deken
- Biostatistics Department, Lille University Hospital, Lille, France
| | - Max Gonzalez Estevez
- Department of Anesthesiology and Intensive Care, Jeanne de Flandre Hospital, University Hospital of Lille, Lille, France
| | - Olivia Domanski
- Department of Pediatric Cardiology, Heart-Lung Institute, University Hospital of Lille, Lille, France
| | - Sophie Gautier
- Centre Régional de Pharmacovigilance, CHRU de Lille, 1, place de Verdun, 59045 Lille Cedex, France
| | | | - Benjamin Constans
- Department of Anesthesiology and Intensive Care, Jeanne de Flandre Hospital, University Hospital of Lille, Lille, France
| | - Yasmine Hamoud
- Pôle Femme Mère Nouveau-né, obstetrics clinic, Hôpital Jeanne de Flandre, Université Nord de France, Lille, France
| | - Louise Ghesquière
- Pôle Femme Mère Nouveau-né, obstetrics clinic, Hôpital Jeanne de Flandre, Université Nord de France, Lille, France; University of Lille, CHU de Lille, ULR2694 METRICS, Health Technology and Medical Practice Assessment, F-59000 Lille, France.
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11
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Ghesquière L, Leroy J, Deken V, Tournier A, Vaast P, Subtil D, Delsalle A, Alluin G, Garabedian C, Houfflin-Debarge V. Anti-RH1 alloimmunization: At what maternal antibody threshold is there a risk of severe fetal anemia? Transfusion 2023; 63:629-637. [PMID: 36734370 DOI: 10.1111/trf.17264] [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: 06/20/2022] [Revised: 12/16/2022] [Accepted: 12/27/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND To define a threshold of maternal antibodies at risk of severe fetal anemia in patients followed for anti-RH1 alloimmunization (AI). STUDY, DESIGN, AND METHODS We conducted a retrospective study of patients followed for anti-RH1 AI at the Lille University Hospital. The first group, severe anemia, included patients who received one or more in utero transfusions (IUT) or who were induced before 37 weeks of pregnancy for suspected severe fetal anemia. The second group, absence of severe anemia, corresponded to patients without intervention during pregnancy related to AI. Sensitivities, specificities, and positive and negative predictive values for screening for severe fetal anemia were calculated for the antibody thresholds of 3.5 and 5 IU/ml for the quantification. RESULTS Between 2000 and 2018, 207 patients were included 135 in the severe anemia group and 72 in the no severe anemia group. No severe anemia was observed for an antibody titer below 16. For an antibody threshold of 3.5 IU/ml, the sensitivity was 98.2%, with 30.2% false positives. All severe anemias were detected in the second trimester; two cases of severe anemia were not detected in the third trimester. For an antibody threshold of 5 IU/ml, the sensitivity was lower at 95.6%, with five cases of severe anemia not detected. CONCLUSION The antibody threshold of 3.5 IU/ml for the quantification and 16 for the titration allow targeting patients requiring close monitoring by an experienced team in case of anti-RH1 AI.
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Affiliation(s)
- Louise Ghesquière
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille, Lille, France
- Univ. Lille, CHU Lille, ULR 2694 - METRICS - Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Julie Leroy
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille, Lille, France
| | - Valérie Deken
- Univ. Lille, CHU Lille, ULR 2694 - METRICS - Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
- Department of Biostatistics, CHU Lille, Lille, France
| | - Alexane Tournier
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille, Lille, France
| | - Pascal Vaast
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille, Lille, France
| | - Damien Subtil
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille, Lille, France
- Univ. Lille, CHU Lille, ULR 2694 - METRICS - Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Anne Delsalle
- French Blood Establishment, Nord Pas de Calais, France
| | | | - Charles Garabedian
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille, Lille, France
- Univ. Lille, CHU Lille, ULR 2694 - METRICS - Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Véronique Houfflin-Debarge
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille, Lille, France
- Univ. Lille, CHU Lille, ULR 2694 - METRICS - Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
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12
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Peroz M, Ghesquière L, Pouypoudat L, Lehembre V, Debarge V, Rakza T, Garabedian C, Subtil D. [Couder's maneuver. Knowledge and practices in a French university maternity hospital]. Gynecol Obstet Fertil Senol 2023; 51:35-40. [PMID: 36243297 DOI: 10.1016/j.gofs.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/02/2022] [Accepted: 10/06/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND During childbirth, the performance of a systematic Couder's maneuver could be linked to a reduction in the risk of perineal tear. OBJECTIVE To know the practices and knowledge of childbirth professionals regarding the Couder's maneuver. To measure the effect of a training program for juniors. MATERIALS AND METHODS Single-center questionnaire survey of senior and junior obstetricians and midwives. Before-and-after study in juniors to evaluate maneuver training. RESULTS One hundred and twenty-five caregivers responded to the questionnaire: (19 physicians and 46 senior midwives; 21 residents and 39 midwifery students). Only one third of the respondents said they practiced the Couder's maneuver "always or almost always" (41/125, 32.8%) and less than one third felt "very comfortable" with the maneuver (34/125, 27.2%), with large differences according to profession and senior vs junior status. Being a doctor (vs midwife) was significantly related to systematic or frequent practice of the maneuver (70.0 vs 15.3%, ORMH=42.7 [9.4; 192.3]) as was being a senior (vs junior) (46.2 vs 18.3%, ORMH=15.9 [3.5; 72.9]). Less than half of the seniors surveyed had received education in maneuvering. Of those who did not practice the maneuver, the majority did not consider its systematic practice to be useful (19/26, 73.1%), and one third considered it potentially harmful (8/26, 30.8%). Theoretical and practical training of the juniors significantly improved their knowledge. CONCLUSION There are great differences in the practice of the Couder's maneuver. It deserves to be better known, practiced and evaluated.
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Affiliation(s)
- M Peroz
- Pôle Femme-Mère-Nouveau-né, university Lille, hôpital Jeanne-de-Flandre, CHU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France.
| | - L Ghesquière
- Pôle Femme-Mère-Nouveau-né, university Lille, hôpital Jeanne-de-Flandre, CHU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France; University Lille, EA 2694, METRICS, évaluation des technologies de santé et des pratiques médicales, hôpital Jeanne-de-Flandre, CHU de Lille, 59000 Lille, France
| | - L Pouypoudat
- Pôle Femme-Mère-Nouveau-né, university Lille, hôpital Jeanne-de-Flandre, CHU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France
| | - V Lehembre
- University Lille, école de Sages-Femmes, institut Gernez-Rieux, CHU de Lille, 59000 Lille, France
| | - V Debarge
- Pôle Femme-Mère-Nouveau-né, university Lille, hôpital Jeanne-de-Flandre, CHU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France; University Lille, EA 2694, METRICS, évaluation des technologies de santé et des pratiques médicales, hôpital Jeanne-de-Flandre, CHU de Lille, 59000 Lille, France
| | - T Rakza
- Pôle Femme-Mère-Nouveau-né, university Lille, hôpital Jeanne-de-Flandre, CHU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France
| | - C Garabedian
- Pôle Femme-Mère-Nouveau-né, university Lille, hôpital Jeanne-de-Flandre, CHU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France; University Lille, EA 2694, METRICS, évaluation des technologies de santé et des pratiques médicales, hôpital Jeanne-de-Flandre, CHU de Lille, 59000 Lille, France
| | - D Subtil
- Pôle Femme-Mère-Nouveau-né, university Lille, hôpital Jeanne-de-Flandre, CHU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France; University Lille, EA 2694, METRICS, évaluation des technologies de santé et des pratiques médicales, hôpital Jeanne-de-Flandre, CHU de Lille, 59000 Lille, France
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13
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Tollon P, Blanc-Petitjean P, Drumez E, Ghesquière L, Le Ray C, Garabedian C. Prediction of successful labor induction with very unfavorable cervix: A comparison of six scores. Int J Gynaecol Obstet 2023; 160:53-58. [PMID: 35246840 DOI: 10.1002/ijgo.14171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/24/2022] [Accepted: 03/01/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare the ability of six scoring systems to predict successful labor induction with cervical ripening among women with a Bishop score <3. METHODS Secondary analysis of data from a prospective, multicenter observational Methods of Induction of Labor and Perinatal Outcomes (MEDIP) cohort study in 94 obstetrical French units. We included women with a Bishop score <3 before cervical ripening. We compared six scores: Bishop, simplified Bishop, modified Bishop, simplified Bishop including parity, Hughey, and Levine scores. Vaginal delivery defined successful labor induction. The ability of each score to predict successful labor induction was evaluated by comparing their area under the curve (AUC). RESULTS Among the 600 eligible women in this study, 408 (68%) delivered vaginally. Body mass index (calculated as weight in kilograms divided by the square of height in meters; mean ± standard deviation [SD]: 24.7 ± 5.5 vs 26.0 ± 5.7; P = 0.01) and nulliparity (48.8% vs 85.4%; P < 0.001) were lower in the successful induction group, whereas height was higher (mean ± SD: 165.3 ± 6.0 cm vs 163.7 ± 6.0 cm; P = 0.002). The simplified Bishop including parity, Hughey, and Levine scores had the highest AUC (0.70, 95% confidence interval [CI] 0.65-0.73; 0.68, 95% CI 0.64-0.74; and 0.69, 95% CI 0.65-0.74, respectively). CONCLUSION In women with a very unfavorable cervix, scores that include parity predict successful labor induction more accurately, such as simplified Bishop including parity, Hughey, or Levine scores.
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Affiliation(s)
| | - Pauline Blanc-Petitjean
- EPOPé Team, Center of Research in Epidemiology and Statistics/CRESS, INSERM, Université de Paris, INRA, Paris, France
| | - Elodie Drumez
- Department of Statistics, CHU Lille, Lille, France.,EA 2694 ULR METRICS, University of Lille, Lille, France
| | - Louise Ghesquière
- Department of Obstetrics, CHU Lille, Lille, France.,EA 2694 ULR METRICS, University of Lille, Lille, France
| | - Camille Le Ray
- EPOPé Team, Center of Research in Epidemiology and Statistics/CRESS, INSERM, Université de Paris, INRA, Paris, France.,Port-Royal Maternity Unit, Department of Obstetrics, Cochin Broca Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), FHU PREMA, Paris, France
| | - Charles Garabedian
- Department of Obstetrics, CHU Lille, Lille, France.,EA 2694 ULR METRICS, University of Lille, Lille, France
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14
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Tollini V, Lemaître M, Garabedian C, Martin C, Bengler C, Vambergue A, Ghesquière L. The impact of lockdown on maternal and neonatal morbidity in gestational diabetes mellitus. Am J Obstet Gynecol 2022; 227:775-777. [PMID: 35764141 PMCID: PMC9617643 DOI: 10.1016/j.ajog.2022.06.033] [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: 05/19/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Valentine Tollini
- CHU Lille, Department of Gynecology and Obstetrics, Lille University Hospital, Lille, France
| | - Madleen Lemaître
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, Lille, France
| | - Charles Garabedian
- CHU Lille, Department of Gynecology and Obstetrics, Lille University Hospital, Lille, France; Univ. Lille, CHU Lille, ULR 2694 - METRICS : évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Claire Martin
- CHU Lille, Department of Biostatistics, Lille University Hospital, Lille, France; Univ. Lille, CHU Lille, ULR 2694 - METRICS : évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Cyril Bengler
- CHU Lille, Department of Gynecology and Obstetrics, Lille University Hospital, Lille, France
| | - Anne Vambergue
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, Lille, France; European Genomic Institute for Diabetes, University School of Medicine, Lille, France
| | - Louise Ghesquière
- CHU Lille, Department of Gynecology and Obstetrics, Lille University Hospital, Lille, France; Univ. Lille, CHU Lille, ULR 2694 - METRICS : évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France.
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15
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Deruelle P, Sentilhes L, Ghesquière L, Desbrière R, Ducarme G, Attali L, Jarnoux A, Artzner F, Tranchant A, Schmitz T, Sénat MV. [Expert consensus from the College of French Gynecologists and Obstetricians: Management of nausea and vomiting of pregnancy and hyperemesis gravidarum]. Gynecol Obstet Fertil Senol 2022; 50:700-711. [PMID: 36150647 DOI: 10.1016/j.gofs.2022.09.002] [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: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To determine the management of patients with 1st trimester nausea and vomiting and hyperemesis gravidarum. METHODS A panel of experts participated in a formal consensus process, including focus groups and two Delphi rounds. RESULTS Hyperemesis gravidarum is distinguished from nausea and vomiting during pregnancy by weight loss≥5 % or signs of dehydration or a PUQE score≥7. Hospitalization is proposed when there is, at least, one of the following criteria: weight loss≥10%, one or more clinical signs of dehydration, PUQE (Pregnancy Unique Quantification of Emesis and nausea) score≥13, hypokalemia<3.0mmol/L, hyponatremia<120mmol/L, elevated serum creatinine>100μmol/L or resistance to treatment. Prenatal vitamins and iron supplementation should be stopped without stopping folic acid supplementation. Diet and lifestyle should be adjusted according to symptoms. Aromatherapy is not to be used. If the PUQE score is<6, even in the absence of proof of their benefit, ginger, pyridoxine (B6 vitamin), acupuncture or electrostimulation can be used, even in the absence of proof of benefit. It is proposed that drugs or combinations of drugs associated with the least severe and least frequent side effects should always be chosen for uses in 1st, 2nd or 3rd intention, taking into account the absence of superiority of a class over another to reduce the symptoms of nausea and vomiting of pregnancy and hypermesis gravidarum. To prevent Gayet Wernicke encephalopathy, Vitamin B1 must systematically be administered for hyperemesis gravidarum needing parenteral rehydration. Patients hospitalized for hyperemesis gravidarum should not be placed in isolation (put in the dark, confiscation of the mobile phone or ban on visits, etc.). Psychological support should be offered to all patients with hyperemesis gravidarum as well as information on patient' associations involved in supporting these women and their families. When returning home after hospitalization, care will be organized around a referring doctor. CONCLUSION This work should contribute to improving the care of women with hyperemesis gravidarum. However, given the paucity in number and quality of the literature, researchers must invest in the field of nausea and vomiting in pregnancy, and HG to identify strategies to improve the quality of life of women with nausea and vomiting in pregnancy or hyperemesis gravidarum.
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Affiliation(s)
- P Deruelle
- UNISTRA, département de gynécologie-obstétrique, hôpitaux universitaires de Strasbourg, 67000 Strasbourg cedex, France.
| | - L Sentilhes
- Department of obstetrics and gynecology, Bordeaux university hospital, Bordeaux, France
| | - L Ghesquière
- ULR 2694 - METRICS - évaluation des technologies de santé et des pratiques médicales, university Lille, CHU Lille, 59000 Lille, France; Department of obstetrics, CHU Lille, 59000 Lille, France
| | | | - G Ducarme
- Service de gynécologie obstétrique, centre hospitalier départemental Vendée, 85000 La Roche-sur-Yon, France
| | - L Attali
- UNISTRA, département de gynécologie-obstétrique, hôpitaux universitaires de Strasbourg, 67000 Strasbourg cedex, France
| | | | - F Artzner
- Association 9mois avec ma bassine, France
| | - A Tranchant
- Association de lutte contre l'hyperémèse gravidique, France
| | - T Schmitz
- Université Paris Cité, 75006 Paris, France; Service de gynécologie obstétrique, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris, Paris, France
| | - M-V Sénat
- Department of obstetrics and gynecology, Bicêtre hospital, Assistance publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
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16
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Ghesquière L, Perbet R, Lacan L, Hamoud Y, Stichelbout M, Sharma D, Nguyen S, Storme L, Houfflin-Debarge V, De Jonckheere J, Garabedian C. Associations between fetal heart rate variability and umbilical cord occlusions-induced neural injury: An experimental study in a fetal sheep model. Acta Obstet Gynecol Scand 2022; 101:758-770. [PMID: 35502642 DOI: 10.1111/aogs.14352] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/27/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study evaluated the association between fetal heart rate variability (HRV) and the occurrence of hypoxic-ischemic encephalopathy in a fetal sheep model. MATERIAL AND METHODS The experimental protocol created a hypoxic condition with repeated cord occlusions in three phases (A, B, C) to achieve acidosis to pH <7.00. Hemodynamic, gasometric and HRV parameters were analyzed during the protocol, and the fetal brain, brainstem and spinal cord were assessed histopathologically 48 h later. Associations between the various parameters and neural injury were compared between phases A, B and C using Spearman's rho test. RESULTS Acute anoxic-ischemic brain lesions in all regions was present in 7/9 fetuses, and specific neural injury was observed in 3/9 fetuses. The number of brainstem lesions correlated significantly and inversely with the HRV fetal stress index (r = -0.784; p = 0.021) in phase C and with HRV long-term variability (r = -0.677; p = 0.045) and short-term variability (r = -0.837; p = 0.005) in phase B. The number of neurological lesions did not correlate significantly with other markers of HRV. CONCLUSIONS Neural injury caused by severe hypoxia was associated with HRV changes; in particular, brainstem damage was associated with changes in fetal-specific HRV markers.
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Affiliation(s)
- Louise Ghesquière
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Obstetrics, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Romain Perbet
- Department of Anatomopathology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Laure Lacan
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Neuropediatrics, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Yasmine Hamoud
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Obstetrics, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Morgane Stichelbout
- Department of Anatomopathology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Dyuti Sharma
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Pediatric Surgery, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Sylvie Nguyen
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Neuropediatrics, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Laurent Storme
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Neonatology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Véronique Houfflin-Debarge
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Obstetrics, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Julien De Jonckheere
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Clinical Investigation Center - Technological Innovation (CIC-IT 1403), Centre Hospitalier Universitaire de Lille, Lille, France
| | - Charles Garabedian
- Evaluation of Health Technologies and Medical Practices (METRICS) - ULR 2694, University of Lille, Centre Hospitalier Universitaire de Lille, Lille, France.,Department of Obstetrics, Centre Hospitalier Universitaire de Lille, Lille, France
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17
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Ghesquière L, Ternynck C, Sharma D, Hamoud Y, Vanspranghels R, Storme L, Houfflin-Debarge V, De Jonckheere J, Garabedian C. Heart rate markers for prediction of fetal acidosis in an experimental study on fetal sheep. Sci Rep 2022; 12:10615. [PMID: 35739219 PMCID: PMC9226053 DOI: 10.1038/s41598-022-14727-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 06/10/2022] [Indexed: 11/09/2022] Open
Abstract
To overcome the difficulties in interpreting fetal heart rate (FHR), several tools based on the autonomic nervous system and heart rate variability (HRV) have been developed. The objective of this study was to use FHR and HRV parameters for the prediction of fetal hypoxia. It was an experimental study in the instrumented fetal sheep. Repeated umbilical cord occlusions were performed to achieve severe acidosis. Hemodynamic parameters, ECG, and blood gases were analyzed. The variables used were heart rate baseline, HRV analysis (RMSSD, SDNN, LF, HF, HFnu, Fetal Stress Index (FSI), …), and morphological analysis of decelerations. The gold standard used to classify hypoxia was the fetal arterial pH (pH < 7.10). Different multivariable statistical methods (logistic regression and decision trees) were applied for the detection of acidosis. 21 lambs were instrumented. A total of 130 pairs of FHR/fetal pH analysis were obtained of which 29 in the acidosis group and 101 in the non-acidosis group. After logistic regression model with bootstrap resampling and stepwise backward selection, only one variable was selected, FSI. The AUC of FSI alone in this model was 0.81 with a sensitivity of 0.66, specificity of 0.88, PPV of 0.61, and NPV of 0.90 considering a threshold of 68. Decision trees with CHAID and CART algorithms showed a sensitivity of 0.48 and 0.59, respectively, and a specificity of 0.94 for both. All employed methods identified HRV variables as the most predictive of acidosis. The primary variables selected automatically were those from the HRV. Supporting the use of FHRV measures for the screening of fetal acidosis during labour is interesting.
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Affiliation(s)
- Louise Ghesquière
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France. .,Department of Obstetrics, CHU Lille, 59000, Lille, France. .,Department of Obstetrics, CHU Lille, Avenue Eugène Avinée, 59037, Lille Cedex, France.
| | - C Ternynck
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France.,Department of Biostatistics, CHU Lille, 59000, Lille, France
| | - D Sharma
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France.,Department of Pediatric Surgery, CHU Lille, 59000, Lille, France
| | - Y Hamoud
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France.,Department of Obstetrics, CHU Lille, 59000, Lille, France
| | - R Vanspranghels
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France.,Department of Obstetrics, CHU Lille, 59000, Lille, France
| | - L Storme
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France.,Department of Neonatology, CHU Lille, 59000, Lille, France
| | - V Houfflin-Debarge
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France.,Department of Obstetrics, CHU Lille, 59000, Lille, France
| | - J De Jonckheere
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France.,CHU Lille, CIC-IT 1403, 59000, Lille, France
| | - C Garabedian
- Univ. Lille, CHU Lille, ULR 2694-METRICS-Evaluation des technologies de santé et des pratiques médicales, 59000, Lille, France.,Department of Obstetrics, CHU Lille, 59000, Lille, France
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Ghesquière L, Rouilles J, Drumez E, Houfflin-Debarge V, Subtil D, Garabedian C. Is it reasonable to propose vaginal delivery with twin pregnancies, when the first twin is in breech presentation? J Gynecol Obstet Hum Reprod 2022; 51:102377. [DOI: 10.1016/j.jogoh.2022.102377] [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: 09/23/2021] [Revised: 04/03/2022] [Accepted: 04/07/2022] [Indexed: 11/28/2022]
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19
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Lemaitre M, Passet M, Ghesquière L, Martin C, Drumez E, Subtil D, Vambergue A. Is the Development of Gestational Diabetes Associated With the ABO Blood Group/Rhesus Phenotype? Front Endocrinol (Lausanne) 2022; 13:916903. [PMID: 35813660 PMCID: PMC9256971 DOI: 10.3389/fendo.2022.916903] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/19/2022] [Indexed: 12/02/2022] Open
Abstract
AIMS There are few published data on the putative association between the ABO blood group/rhesus (Rh) factor and the risk of developing gestational diabetes mellitus (GDM). Our aim was to explore the link between each one factor and GDM development. METHODS All women having given birth at Lille University Medical Center (Lille, France) between August 1st, 2017, and February 28th, 2018, were tested for GDM, using the method recommended in the French national guidelines. The risk of GDM was assessed for each ABO blood group, each Rh phenotype and combinations thereof, using logistic regression models. RESULTS 1194 women had at least one GDM risk factor. The percentage of GDM varied with the ABO group (p=0.013). Relative to group O women, group AB women were more likely to develop GDM (OR = 2.50, 95% CI [1.43 to 4.36], p=0.001). Compared with the Rh-positive O group, only the Rh-positive AB group had an elevated risk of developing GDM (OR = 3.02, 95% CI [1.69 to 5.39], p < 0.001). CONCLUSIONS Our results showed that Rh-positive group AB women have a greater risk of GDM. With a view to preventing GDM, at-risk individuals could be identified by considering the ABO blood group phenotype either as a single risk factor or in combination with other risk factors.
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Affiliation(s)
- M. Lemaitre
- University of Medicine, Lille, France
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, Lille, France
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - M. Passet
- CHU Lille, Department of Gynecology and Obstetrics, Lille University Hospital, Lille, France
| | - L. Ghesquière
- University of Medicine, Lille, France
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: évaluation des technologies de santé et des pratiques médicales, Lille, France
- CHU Lille, Department of Gynecology and Obstetrics, Lille University Hospital, Lille, France
| | - C. Martin
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: évaluation des technologies de santé et des pratiques médicales, Lille, France
- CHU Lille, Department of Biostatistics, Lille University Hospital, Lille, France
| | - E. Drumez
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: évaluation des technologies de santé et des pratiques médicales, Lille, France
- CHU Lille, Department of Biostatistics, Lille University Hospital, Lille, France
| | - D. Subtil
- University of Medicine, Lille, France
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: évaluation des technologies de santé et des pratiques médicales, Lille, France
- CHU Lille, Department of Gynecology and Obstetrics, Lille University Hospital, Lille, France
| | - A. Vambergue
- University of Medicine, Lille, France
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, Lille, France
- European Genomic Institute for Diabetes, University School of Medicine, Lille, France
- *Correspondence: A. Vambergue, ; orcid.org/0000-0003-4307-8695
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Hamoud Y, Pekar JD, Drumez E, Lacan L, Maboudou P, De Jonckheere J, Storme L, Houfflin-Debarge V, Sharma D, Garabedian C, Ghesquière L. Changes in S100B and troponin levels in a fetal sheep model of worsening acidosis. Eur J Obstet Gynecol Reprod Biol 2021; 264:173-177. [PMID: 34304026 DOI: 10.1016/j.ejogrb.2021.06.042] [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: 03/21/2021] [Revised: 06/20/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND S100B and cardiac troponin T (c-TnT) are relevant biomarkers at birth of hypoxic-ischemic encephalopathy (HIE) and myocardial ischemia secondary to metabolic acidosis during labor, respectively. The purpose was to assess in-utero changes in S100B and c-TnT levels in an experimental model of labor-like acidosis. METHODS Repeated umbilical cord occlusions (UCOs) in ten experiments were performed in mild (phase A, 1 UCO/5 mn), moderate (phase B, 1 UCO/3 mn), and severe (phase C, 1 UCO/2 mn) period. The experiments were stopped if arterial pH reached 6.90. RESULTS UCOs resulted in fetal acidosis with pH dropping to 6.99 ±0.13. When compared to the baseline period fetal S100B increased between phases A and B (7% ± 4 vs 17% ± 13, p = 0.030) and between phases A and C (7% ± 4 vs 24% ± 8, p < 0.001). Fetal c-TnT serum levels increased during occlusions: 102 ng/L (58-119) in phase A, vs 119 ng/L (103-198) in phase B vs 169 ng / L (128-268) in phase C (p < 0.05, for all). When compared to the baseline control period, fetal ΔcTnT was significantly modified throughout UCO series: 5.0% (-3; 45) in phase A, 51% (4; 263) in phase B, and 77% (56.5; 269) in phase C (p < 0.05 for all). CONCLUSIONS S100B and c-TnT increased when fetal acidosis occurred, which reflects the potential neurological damage and fetal cardiovascular adaptation.
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Affiliation(s)
- Yasmine Hamoud
- CHU Lille, Department of Obstetrics, F-59000 Lille, France.
| | - Jean David Pekar
- CHU Lille, Automated Biochemistry (UF 8832), F-59000 Lille, France
| | - Elodie Drumez
- University of Lille, CHU Lille, EA 2694 - Public Health Epidemiology and Quality of Care, F-59000 Lille, France
| | - Laure Lacan
- CHU Lille, Department of Neuropediatrics, F-59000 Lille, France
| | - Patrice Maboudou
- CHU Lille, Automated Biochemistry (UF 8832), F-59000 Lille, France
| | | | - Laurent Storme
- CHU Lille, Department of Neonatology, F-59000 Lille, France
| | | | - Dyuti Sharma
- CHU Lille, Department of Pediatric Surgery, F-59000 Lille, France
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Dupuis H, Ghesquière L, Pierache A, Subtil D, Houfflin-Debarge V, Garabedian C. Evaluation and impact of fetal physiology training on fetal heart rate analysis. J Gynecol Obstet Hum Reprod 2021; 50:102185. [PMID: 34129991 DOI: 10.1016/j.jogoh.2021.102185] [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: 03/15/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Evaluation of fetal well-being during labor is based on fetal heart rate (FHR) analysis, which requires physiology expertise. The aim of the present study was to assess medical residents' fetal physiology training in terms of theoretical knowledge, FHR interpretation, and use of second-line examinations. METHODS This single-center, prospective study of obstetrics and gynecology residents (N = 34) at CHU de Lille Hospital (Lille, France) was conducted from November 2017 to November 2018. Evaluation and training were conducted in three stages. First, residents' pre-training knowledge of FHR interpretation and use of fetal scalp blood sampling (FBS) was assessed using clinical cases. Second, a didactic training session on fetal physiology was delivered. Finally, post-training knowledge was evaluated using the same cases presented during pre-training. I: Pre-training, 3%, 11.8%, and 14.7% of residents considered their training on fetal physiology, FHR analysis, and second-line examinations, respectively, to be sufficient. Training significantly improved their theoretical knowledge, which was assessed using multiple-choice questions (median [interquartile range]: 1.5 [1.0-2.0] vs. 4.0 [3.0-4.5], p<0.001), and reduced the number of FBS requested (36.3% vs. 29.5%, p = 0.002). Krippendorff's alpha coefficient for the reproducibility of residents' responses improved significantly, reflecting greater homogenization of clinical practice decisions (alpha [95% confidence interval]: 0.60 [0.55-0.65] vs. 0.72 [0.67-0.76]). CONCLUSION Improved fetal physiology knowledge promotes more accurate FHR interpretation, better indications for second-line examinations, and greater homogenization of clinical practice decisions. Future studies should evaluate the impact of fetal physiology training on clinical practice.
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Affiliation(s)
- H Dupuis
- Univ. Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France.
| | - L Ghesquière
- Univ. Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France
| | - A Pierache
- Univ. Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, EA 2694 - Public Health: epidemiology and quality of care, F-59000 Lille, France
| | - D Subtil
- Univ. Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France
| | - V Houfflin-Debarge
- Univ. Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France
| | - C Garabedian
- Univ. Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France
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22
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Ghesquière L, De Jonckheere J, Storme L, Garabedian C. Measurement of fetal parasympathetic activity during labor: a new pathway for evaluation of fetal well-being? Am J Physiol Regul Integr Comp Physiol 2020; 320:R467-R468. [PMID: 33326344 DOI: 10.1152/ajpregu.00325.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- L Ghesquière
- Public Health Epidemiology and Quality of Care, University of Lille, CHU Lille, Lille, France.,Department of Obstetrics, CHU Lille, Lille, France
| | - J De Jonckheere
- Public Health Epidemiology and Quality of Care, University of Lille, CHU Lille, Lille, France.,CHU Lille, Lille, France
| | - L Storme
- Public Health Epidemiology and Quality of Care, University of Lille, CHU Lille, Lille, France.,Department of Neonatology, CHU Lille, Lille, France
| | - C Garabedian
- Public Health Epidemiology and Quality of Care, University of Lille, CHU Lille, Lille, France.,Department of Obstetrics, CHU Lille, Lille, France
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Grabarz A, Ghesquière L, Debarge V, Ramdane N, Delporte V, Bodart S, Deruelle P, Subtil D, Garabedian C. Cesarean section complications according to degree of emergency during labour. Eur J Obstet Gynecol Reprod Biol 2020; 256:320-325. [PMID: 33264691 DOI: 10.1016/j.ejogrb.2020.11.047] [Citation(s) in RCA: 9] [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: 08/30/2020] [Revised: 11/11/2020] [Accepted: 11/14/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Evaluate the complications rate of cesarean section delivery based on degree of labour emergency. STUDY DESIGN Monocentric (Lille, France), retrospective study of all term, singleton, and cesarean deliveries during labour. Three groups were categorized based on the degree of emergency according to a color code: green (no time limit between surgical decision and birth), orange (birth within 30 min), and red (birth within 20 min). Scheduled cesareans were excluded. Complications were defined as minor/major and intra-/post-operative. RESULTS A total of 881 patients were included. Among these, 303 (34.5 %) were in the green group, 353 (40.1 %) in the orange group, and 225 (25.4 %) in the red group. Major intra-operative complications, mainly postpartum hemorrhage, were more frequent in the red group compared with the green group (16.9 % vs. 9.9 %, p = 0.05; OR 1.9; 95 % CI [1.1-3.1]). Among the minor complications, there was no difference on moderate postpartum hemorrhage and four times uterine artery wounds in the red group (1.7 % vs. 7.1 %, respectively; p = 0.007; OR 4.6; 95 % CI [1.6-12.6]). The overall major post-operative complication rate, mainly infectious morbidity, was 6.1 % and this was more frequent in the red group compared with the green group (12.4 % vs. 1.7 %, respectively; p < 0.0001; OR 8.5; 95 % CI [3.2-22.3]). CONCLUSION Pre- and post-operative complications of cesarean section delivery during labour (i.e., emergency cesarean) increase with the degree of labour emergency. It would be ideal to identify women in labour who are at increased risk of emergency cesarean earlier, so that the situation does not escalate to a red code cesarean.
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Affiliation(s)
- A Grabarz
- CHU Lille, Department of Obstetrics, F-59000 Lille, France
| | - L Ghesquière
- CHU Lille, Department of Obstetrics, F-59000 Lille, France; Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France.
| | - V Debarge
- CHU Lille, Department of Obstetrics, F-59000 Lille, France; Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - N Ramdane
- CHU Lille, Studies and Research in Medical Informatics Center, F-59045 Lille cedex, France
| | - V Delporte
- CHU Lille, Department of Obstetrics, F-59000 Lille, France
| | - S Bodart
- CHU Lille, Department of Obstetrics, F-59000 Lille, France
| | - P Deruelle
- CHU Lille, Department of Obstetrics, F-59000 Lille, France
| | - D Subtil
- CHU Lille, Department of Obstetrics, F-59000 Lille, France; Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - C Garabedian
- CHU Lille, Department of Obstetrics, F-59000 Lille, France; Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
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Ghesquière L, Garabedian C, Drumez E, Lemaître M, Cazaubiel M, Bengler C, Vambergue A. Effects of COVID-19 pandemic lockdown on gestational diabetes mellitus: A retrospective study. Diabetes Metab 2020; 47:101201. [PMID: 33069845 PMCID: PMC7557293 DOI: 10.1016/j.diabet.2020.09.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/15/2020] [Accepted: 08/14/2020] [Indexed: 11/19/2022]
Abstract
Objective The objective of our study was to evaluate the impact of the lockdown period on the glycemic balance in patients with GDM. Methods A retrospective study in one center (Lille, France) compared two periods: the COVID-19 lockdown of 18 March 2020 to 7 May 2020 versus the same period during 2019. Glucose targets were defined by a capillary fasting glucose target < 5.1mmol/L and/or a 2-hour postprandial capillary glucose < 6.6 mmol/L. GDM control was defined as: good (< 20% of the glycemic values were not within the target range), acceptable (20 to 40% of the glycemic values were not within the target range) or poor (> 40% of the glycemic values were not within the target range). Results Two hundred twenty-nine patients were included in 2019 and 222 in 2020. The same mean number of capillary blood sugar tests was performed by the two groups. Postprandial blood sugar was significantly less well controlled in 2020, with a lower rate of good control (61.6% vs 69.4%) and higher rates of acceptable (24.7% vs 21.8%) and poor control (13.7% and 8.7%) (p < 0.05). Use of insulin therapy was significantly higher in 2020 compared with 2019 (47.7% and 36.2%, respectively; p < 0.05). Conclusion Diabetes control was lower during the COVID-19 pandemic lockdown, even if follow-up was not impacted. This may be explained by reduced physical activity, modified dietary habits and anxiety during this period.
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Affiliation(s)
- L Ghesquière
- CHU Lille, Department of Obstetrics, F-59000 Lille, France; University of Lille, CHU Lille, ULR 2694 - METRICS: Assessment of Health Technologies and Medical Practices, F-59000 Lille, France.
| | - C Garabedian
- CHU Lille, Department of Obstetrics, F-59000 Lille, France; University of Lille, CHU Lille, ULR 2694 - METRICS: Assessment of Health Technologies and Medical Practices, F-59000 Lille, France
| | - E Drumez
- University of Lille, CHU Lille, ULR 2694 - METRICS: Assessment of Health Technologies and Medical Practices, F-59000 Lille, France; CHU Lille, Department of Biostatistics, F-59000 Lille, France
| | - M Lemaître
- CHU Lille, Department of Endocrinology, Diabetology, Metabolism and Nutrition, F-59000 Lille, France
| | - M Cazaubiel
- CHU Lille, Department of Endocrinology, Diabetology, Metabolism and Nutrition, F-59000 Lille, France
| | - C Bengler
- CHU Lille, Department of Obstetrics, F-59000 Lille, France
| | - A Vambergue
- CHU Lille, Department of Endocrinology, Diabetology, Metabolism and Nutrition, F-59000 Lille, France; University of Lille, European Genomics Institute for Diabetes (EGID), F-59000 Lille, France
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Ghesquière L, Deruelle P, Ramdane Y, Garabedian C, Charley-Monaca C, Dalmas AF. Obstructive sleep apnea in obese pregnant women: A prospective study. PLoS One 2020; 15:e0238733. [PMID: 32898189 PMCID: PMC7478531 DOI: 10.1371/journal.pone.0238733] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/22/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Define the prevalence of OSA in a population of obese pregnant women. Secondary objectives were to assess its obstetric consequences and define its risk factors in this population. METHODS This single-center prospective study took place at the Lille University Hospital from 2010 to 2016 and included pregnant women with a body mass index (BMI) > 35 kg/m2. They underwent polysomnography (type 1 sleep testing) between 24 and 32 weeks of gestation to diagnose OSA. Clinical, obstetric, and fetal data were collected monthly and at delivery. We compared the groups with and without OSA and calculated its prevalence. RESULTS This study included 67 women with a mean BMI of 42.4 ± 6.2 kg/m2. Among them, 29 had OSA, for a prevalence of 43.3% (95% confidence interval, 31.4-55.2); it was mild or moderate in 25 women and severe in 4. Comparison of the two groups showed that women in the OSA group were older (31.9 ± 4.7 years vs 29.5 ± 4.8 years, P = .045), had chronic hypertension more frequently (37.9% vs 7.9%, P = .0027), and had a higher mean BMI (43.8 ± 6.2 kg/m2 vs 41.2 ± 6 kg/m2, P = .045). During pregnancy, they developed gestational diabetes more often (48.3% vs 23.7%, P = .04). No significant differences were observed for any of the other criteria studied. CONCLUSIONS The prevalence of OSA was high in our study, and women with it developed gestational diabetes during pregnancy more often. No other obstetric complications were observed.
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Affiliation(s)
- L. Ghesquière
- EA 4489 –Perinatal Environment and Health, University of Lille, Lille, France
- Department of Obstetrics, CHU Lille, Lille, France
| | - P. Deruelle
- EA 4489 –Perinatal Environment and Health, University of Lille, Lille, France
- Department of Obstetrics, CHU Lille, Lille, France
| | - Y. Ramdane
- Department of Biostatistics, EA 2694 –Public Health: Epidemiology and Quality of Care, University of Lille, CHU Lille, Lille, France
| | - C. Garabedian
- EA 4489 –Perinatal Environment and Health, University of Lille, Lille, France
- Department of Obstetrics, CHU Lille, Lille, France
| | - C. Charley-Monaca
- Department of Clinical Neurophysiology–Sleep Disorders Unit, University of Lille, CHU Lille, Lille, France
| | - A.-F. Dalmas
- Department of Anesthesia–Intensive Care, University of Lille, Lille, France
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Lacan L, Hamoud Y, Nguyen S, De Jonckheere J, Storme L, Houfflin-Debarge V, Auvin S, Sharma D, Garabedian C, Ghesquière L. Fetal sheep cerebral electrical activity: A new technique to record EEG. J Neurosci Methods 2020; 345:108888. [PMID: 32755616 DOI: 10.1016/j.jneumeth.2020.108888] [Citation(s) in RCA: 3] [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: 05/02/2020] [Revised: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sheep models are commonly used to study fetal cortical activity, including response to hypoxia. The standard technique consists of recording electrocorticogram (ECOG) in utero using electrodes placed on the dura mater. NEW METHOD We propose a new method for recording the electroencephalogram (EEG) of fetal sheep, using electrodes placed above the skull bone and fixed to the cranial periosteum. RESULTS Twelve animals were instrumented with this new technique. The EEG signal recorded in utero was of sufficient quality for visual and quantitative analysis of the fetal cortical activity. COMPARISON WITH EXISTING METHOD This new method is less invasive than the standard method commonly used to record cerebral activity in fetal sheep, because it avoids drilling the skull by hand. The EEG signal recorded in utero had visual and quantitative characteristics comparable to ECOG. CONCLUSIONS We present a new method of EEG recording that appears to be an acceptable alternative to the standard ECOG recording method. Fetal sheep EEG can be used to better understand the physiological mechanisms involved in the cerebral response to hypoxia.
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Affiliation(s)
- Laure Lacan
- Univ. Lille, CHU Lille, ULR 2694 - METRICS, F-59000, Lille, France; CHU Lille, Department of Pediatric Neurology, F-59000, Lille, France.
| | - Yasmine Hamoud
- Univ. Lille, CHU Lille, ULR 2694 - METRICS, F-59000, Lille, France; CHU Lille, Department of Obstetrics, F-59000, Lille, France
| | - Sylvie Nguyen
- Univ. Lille, CHU Lille, ULR 2694 - METRICS, F-59000, Lille, France; CHU Lille, Department of Pediatric Neurology, F-59000, Lille, France
| | - Julien De Jonckheere
- Univ. Lille, CHU Lille, ULR 2694 - METRICS, F-59000, Lille, France; CHU Lille, CIC-IT 1403, F-59000, Lille, France
| | - Laurent Storme
- Univ. Lille, CHU Lille, ULR 2694 - METRICS, F-59000, Lille, France; CHU Lille, Department of Neonatology, F-59000, Lille, France
| | - Véronique Houfflin-Debarge
- Univ. Lille, CHU Lille, ULR 2694 - METRICS, F-59000, Lille, France; CHU Lille, Department of Obstetrics, F-59000, Lille, France
| | - Stéphane Auvin
- APHP, Hôpital Robert Debré, Deparment of Pediatric Neurology, F-75019, Paris, France
| | - Dyuti Sharma
- Univ. Lille, CHU Lille, ULR 2694 - METRICS, F-59000, Lille, France; CHU Lille, Department of Pediatric Surgery, F-59000, Lille, France
| | - Charles Garabedian
- Univ. Lille, CHU Lille, ULR 2694 - METRICS, F-59000, Lille, France; CHU Lille, Department of Obstetrics, F-59000, Lille, France
| | - Louise Ghesquière
- Univ. Lille, CHU Lille, ULR 2694 - METRICS, F-59000, Lille, France; CHU Lille, Department of Obstetrics, F-59000, Lille, France
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Ghesquière L, Demetz J, Dufour P, Depret S, Garabedian C, Subtil D. Type of breech presentation and prognosis for delivery. J Gynecol Obstet Hum Reprod 2020; 49:101832. [PMID: 32574703 DOI: 10.1016/j.jogoh.2020.101832] [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: 11/06/2019] [Revised: 05/31/2020] [Accepted: 06/09/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although its role in the prognosis for delivery remains controversial, the type of breech is sometimes taken into account in the decision about mode of delivery. Objective of our study was to compare maternal and neonatal morbidity for trial of vaginal delivery according to the type of breech (complete or frank). MATERIAL AND METHOD Single-center retrospective study of women with trials of vaginal delivery of a singleton fetus in breech presentation at of after 37 weeks of gestation. Neonatal status was assessed by the composite variable of the Term Breech Trial, first considered alone, and then with the addition of a 5-min Apgar score < 7 or a neonatal arterial pH<7.0. RESULTS Of the 495 trials of vaginal delivery during the study period, approximately one third of them were complete breech (35.8 %) and two thirds frank (64.2 %). The frequency of cesareans during labor was similar regardless of the type of breech (16.4 for complete vs 12.6 % for frank, p=0.24), nor did neonatal morbidity differ (1.7 for complete vs 4.1 % for frank, p=0.15). On the other hand, cord prolapse occurred almost exclusively in complete breech presentations (4.5 vs 0.3 %, p<0.01), and prognosis was good in all cases. Complete breech presentations were also associated with more frequent use of forceps to the after-coming head (16.2 vs 9.7 %, p<0.05). Finally, there were non significant difference between the two types of breech concerning severe acidosis but it seemed to have it more in frank breech (2.3 vs 1.2 %, p=0.34). CONCLUSION Among women eligible for vaginal delivery, the type of breech presentation (complete or frank) has little influence on delivery maternal and neonatal morbidity. The type of breech need not be taken into account in deciding the route of delivery.
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Affiliation(s)
- Louise Ghesquière
- Pôle Femme Mère Nouveau-né, clinique d'obstétrique, Hôpital Jeanne de Flandre, Université Nord de France, Lille, France; EA 4489, Environnement périnatal et croissance. Université Lille Nord de France, F-59000, Lille, France.
| | - Julie Demetz
- Pôle Femme Mère Nouveau-né, clinique d'obstétrique, Hôpital Jeanne de Flandre, Université Nord de France, Lille, France
| | - Philippe Dufour
- Pôle Femme Mère Nouveau-né, clinique d'obstétrique, Hôpital Jeanne de Flandre, Université Nord de France, Lille, France
| | - Sandrine Depret
- Pôle Femme Mère Nouveau-né, clinique d'obstétrique, Hôpital Jeanne de Flandre, Université Nord de France, Lille, France
| | - Charles Garabedian
- Pôle Femme Mère Nouveau-né, clinique d'obstétrique, Hôpital Jeanne de Flandre, Université Nord de France, Lille, France; EA 4489, Environnement périnatal et croissance. Université Lille Nord de France, F-59000, Lille, France
| | - Damien Subtil
- Pôle Femme Mère Nouveau-né, clinique d'obstétrique, Hôpital Jeanne de Flandre, Université Nord de France, Lille, France; EA 2694, Université Lille Nord de France, F-59000, Lille, France
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Benzekri C, Ghesquière L, Drumez E, Houfflin-Debarge V, Subtil D, Garabedian C. [Comparison of antepartum management of breech versus cephalic presentation]. ACTA ACUST UNITED AC 2020; 48:722-728. [PMID: 32335341 DOI: 10.1016/j.gofs.2020.04.010] [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: 08/02/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Delivery mode of term breech presentation is still being discussed. The aim of this study was to compare the labor management of a breech presentation to a vertex presentation during a vaginal delivery attempt. METHODS It was a single-center, comparative, descriptive retrospective study from 2014 to 2017. We studied fetal heart rate (FHR) during labor and expulsion, duration of the different stage of labor, mode of delivery and neonatal outcomes for breech and vertex presentations. RESULTS Two hundred and thirty-nine patients were included whom 106 (44%) breech presentation. The use of oxytocin was more common in breech group (63,2% versus 48,1%, P=0.020). Average dilatation rate was slower for breech presentation than for vertex presentation (1.9cm/h vs. 2.8cm/h; P=0.005). There was more FHR with high risk of acidosis in the breech presentations (37.2% vs 19.1%, P=0.001) and Melchior's FHR classification were comparable in both groups. CONCLUSIONS The per-partum management of a fetus in breech presentation differs from a fetus in cephalic presentation. It must be known and anticipated for an optimal management in the delivery room.
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Affiliation(s)
- C Benzekri
- EA 4489, University Lille, 59000 Lille, France.
| | - L Ghesquière
- EA 4489, University Lille, 59000 Lille, France; Department of obstetrics, CHU de Lille, 59000 Lille, France
| | - E Drumez
- EA 2694 - Public health: epidemiology and quality of care, Department of biostatistics, University of Lille, CHU de Lille, 59000 Lille, France
| | - V Houfflin-Debarge
- EA 4489, University Lille, 59000 Lille, France; Department of obstetrics, CHU de Lille, 59000 Lille, France
| | - D Subtil
- EA 4489, University Lille, 59000 Lille, France
| | - C Garabedian
- EA 4489, University Lille, 59000 Lille, France; Department of obstetrics, CHU de Lille, 59000 Lille, France
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Peru J, Garabedian C, Drumez E, Ghesquière L. [Does rupture of membranes have an impact on the fetal heart rate during spontaneous labor?]. ACTA ACUST UNITED AC 2020; 48:715-721. [PMID: 32092489 DOI: 10.1016/j.gofs.2020.02.008] [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: 06/03/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Evaluate the influence of rupture of membranes (spontaneous or artificial) on fetal heart rate. Secondary objectives were to compare spontaneous and artificial ruptures and to investigate the risk factors associated with the occurrence of abnormalities of fetal heart rate (FHR). METHODS This is a monocentric retrospective study (Lille, France) from January to March 2018. All low-risk pregnancies with cephalic presentation, spontaneous labor, gestational age more than 37 weeks of amenorrhea, singleton pregnancy, absence of maternal or fetal pathology were included. The elements sought were the occurrence of bradycardia, tachycardia, decelerations (early, late, typical variable, atypical variable, prolonged) and abnormal variability. FHR was analyzed one hour before and one hour after rupture. The groups with and without abnormalities of FHR were compared according to the type of rupture. RESULTS Two hundred and thirty-three patients were included. A total of 44.54% (n=129, P<0.001) showed abnormalities of FHR after rupture of membranes. In the fetal heart rate time study after the rupture event, prolonged decelerations were more frequent in the first quarter hour compared to the second quarter hour. There was significantly more risk of abnormalities of fetal heart rate if the fetal heart rate before the rupture of membranes was already pathological, as well as if the time between rupture and delivery was short. The type of rupture, artificial or spontaneous, was not a risk factor. CONCLUSION The rupture of membranes increased the occurrence of abnormalities of FHR. However, there is no more deleterious impact of one type of rupture than the other.
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Affiliation(s)
- J Peru
- École de sages-femme, CHU de Lille, 59000 Lille, France
| | - C Garabedian
- Département d'obstétrique, hôpital Jeanne-de-Flandre, CHU de Lille, 59000 Lille, France; Université de Lille, EA4489-environnement périnatal et croissance, 59000 Lille, France
| | - E Drumez
- Université de Lille, CHU de Lille, EA 2694 - santé publique : épidémiologie et qualité des soins, 59000 Lille, France
| | - L Ghesquière
- Département d'obstétrique, hôpital Jeanne-de-Flandre, CHU de Lille, 59000 Lille, France; Université de Lille, EA4489-environnement périnatal et croissance, 59000 Lille, France.
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Tock S, Wallet J, Belhadia M, Hudry D, Ghesquière L, Narducci F, Leblanc E. Outcomes of the use of different vulvar flaps for reconstruction during surgery for vulvar cancer. Eur J Surg Oncol 2019; 45:1625-1631. [DOI: 10.1016/j.ejso.2019.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 04/07/2019] [Accepted: 04/16/2019] [Indexed: 12/19/2022] Open
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Ghesquière L, De Jonckheere J, Drumez E, Sharma D, Aubry E, Deruelle P, Storme L, Houfflin-Debarge V, Garabedian C. Parasympathetic nervous system response to acidosis: Evaluation in an experimental fetal sheep model. Acta Obstet Gynecol Scand 2019; 98:433-439. [PMID: 30566227 DOI: 10.1111/aogs.13515] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 12/04/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Heart rate variability and fetal heart rate decelerations are impacted by parasympathetic function and reflect acid-base status. Our team developed a new heart rate variability index, the fetal stress index (FSI), which has lower interindividual variability and higher sensitivity for detecting fluctuations in parasympathetic nervous system activity. The aim of this study was to explore the ability of the FSI to predict fetal acidosis in a fetal sheep model. MATERIAL AND METHODS Repeated 1-minute total umbilical cord occlusions (UCOs) were performed every 2.5 minutes over 3 hours to generate fetal acidosis mimicking that which occurs during labor and contractions. Fetal hemodynamic parameters, blood gas, the FSI and the magnitude (from the beginning to the nadir) of the fetal heart rate deceleration were recorded at regular intervals. The data were analyzed over three time intervals because of variation in the duration of the experiments: period A (first 12 UCOs), period B (middle 12 UCOs) and period C (last 12 UCOs). RESULTS Nine experiments were performed. Acidosis was progressive with a significant difference between the pH, lactate levels and base deficit values for the three periods of occlusion (P < 0.05). Both FSI and the magnitude of fetal heart rate decelerations gradually increased during the UCOs and both differed significantly between periods A and C (P = 0.0008 for FSI and P = 0.003 for deceleration). CONCLUSION This experimental protocol allowed the development of progressive acidosis in a good model of the physiology of labor. Parasympathetic nervous system activity increased during acidosis and could be measured using our index, the FSI, and the magnitude of fetal heart rate decelerations.
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Affiliation(s)
- Louise Ghesquière
- EA 4489 - Perinatal Environment and Health, University of Lille, Lille, France.,Department of Obstetrics, University Hospital Center (CHU) Lille, Lille, France
| | - Julien De Jonckheere
- EA 4489 - Perinatal Environment and Health, University of Lille, Lille, France.,Clinical Investigation Center - Technological Innovation (CIC-IT) 1403, University Hospital Center (CHU) Lille, Lille, France
| | - Elodie Drumez
- EA 2694 - Public Health: Epidemiology and Quality of Care, Department of Biostatistics, University of Lille, University Hospital Center (CHU) Lille, Lille, France
| | - Dyuti Sharma
- EA 4489 - Perinatal Environment and Health, University of Lille, Lille, France.,Department of Pediatric Surgery, University Hospital Center (CHU) Lille, Lille, France
| | - Estelle Aubry
- EA 4489 - Perinatal Environment and Health, University of Lille, Lille, France.,Department of Pediatric Surgery, University Hospital Center (CHU) Lille, Lille, France
| | - Philippe Deruelle
- EA 4489 - Perinatal Environment and Health, University of Lille, Lille, France.,Department of Obstetrics, University Hospital Center (CHU) Lille, Lille, France
| | - Laurent Storme
- EA 4489 - Perinatal Environment and Health, University of Lille, Lille, France.,Department of Neonatology, University Hospital Center (CHU) Lille, Lille, France
| | - Véronique Houfflin-Debarge
- EA 4489 - Perinatal Environment and Health, University of Lille, Lille, France.,Department of Obstetrics, University Hospital Center (CHU) Lille, Lille, France
| | - Charles Garabedian
- EA 4489 - Perinatal Environment and Health, University of Lille, Lille, France.,Department of Obstetrics, University Hospital Center (CHU) Lille, Lille, France
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Kerbage Y, Rubod C, Hubert T, Bassil A, Ghesquière L, Garabedian C. Comment je fais… un modèle d’hystéroscopie à moindre coût. ACTA ACUST UNITED AC 2018; 46:664-666. [DOI: 10.1016/j.gofs.2018.07.001] [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: 01/14/2018] [Indexed: 11/25/2022]
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Ghesquière L, Hanssens S, Leroy A, Petit C, Deruelle P, Azaïs H. [Sport: A key element for myometrial contractility and regulation of adipokines in obese pregnant women?]. ACTA ACUST UNITED AC 2018; 46:587-592. [PMID: 29937109 DOI: 10.1016/j.gofs.2018.06.004] [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: 07/30/2017] [Indexed: 01/09/2023]
Abstract
Obesity is a major public health problem. Pregnant women are also affected by this epidemic. In pregnant women, obesity increases obstetric and neonatal complications, and is associated with alterations in the quality of labor that could be explained by reduced myometrial contractility. This leads to an increase in the rate of caesarean sections and postpartum haemorrhages in this population at risk. Adipokines, hormones secreted by adipose tissue, may have a role in altering the myometrial contractility. Weight loss in these patients is based on dietary management and on physical activity, which could be a way to improve adipokines action and uterine contractility. The objective of this literature review was to review current knowledge about the role of adipokines on uterine contractility in obese pregnant women and to assess the interest of sport in improving contractility and in reducing obstetric complications in these women.
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Affiliation(s)
- L Ghesquière
- Département d'obstétrique, hôpital Jeanne-de-Flandre, CHU de Lille, 59000 Lille, France.
| | - S Hanssens
- Département d'obstétrique, hôpital Jeanne-de-Flandre, CHU de Lille, 59000 Lille, France
| | - A Leroy
- Département d'obstétrique, hôpital Jeanne-de-Flandre, CHU de Lille, 59000 Lille, France
| | - C Petit
- Département d'obstétrique, hôpital Jeanne-de-Flandre, CHU de Lille, 59000 Lille, France
| | - P Deruelle
- Département d'obstétrique, hôpital Jeanne-de-Flandre, CHU de Lille, 59000 Lille, France; EA4489-Environnement périnatal et croissance, université de Lille, 59000 Lille, France
| | - H Azaïs
- Département d'obstétrique, hôpital Jeanne-de-Flandre, CHU de Lille, 59000 Lille, France
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Ghesquière L, Houfflin-Debarge V, Verpillat P, Fourquet T, Joriot S, Coulon C, Vaast P, Garabedian C. Contribution of fetal brain MRI in management of severe fetal anemia. Eur J Obstet Gynecol Reprod Biol 2018; 228:6-12. [PMID: 29902780 DOI: 10.1016/j.ejogrb.2018.05.044] [Citation(s) in RCA: 5] [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: 10/22/2017] [Revised: 04/10/2018] [Accepted: 05/31/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Intrauterine transfusion (IUT) has changed fetal anemia prognosis. However, long-term neurodevelopmental outcome is altered in 5% of children. Our objective was to study the contribution of fetal MRI to diagnosis brain lesions in case of fetal anemia. MATERIAL AND METHODS Retrospective monocentric descriptive study from 2005 to 2016, including all patients followed for fetal anemia requiring IUT. The indications for MRI were: hydrops fetalis and / or hemoglobin <5 g / dL and / or more than 3 IUTs and / or acute severe anemia and / or ultrasound abnormality. Fetal and neonatal outcome and pediatric neurological monitoring were studied. RESULTS 89 patients were followed for fetal anemia with IUT and 28 (29.1%) had fetal MRI, 12 of which were abnormal. Two out of twelve had abnormal ultrasound. Seven out of twelve had poor neurological prognosis: 2 medical terminations of pregnancy were performed; 2 children had severe developmental delay and 3 children had schooling difficulties. Five out of twelve children had favorable neurological prognosis. CONCLUSION MRI of the fetal brain makes it possible to better detect brain lesions than ultrasound does in the management of severe fetal anemia and seems particularly appropriate in cases of acute anemia.
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Affiliation(s)
- L Ghesquière
- CHU Lille, Jeanne de Flandre Hospital, Department of Obstetrics, 59000 Lille, France.
| | - V Houfflin-Debarge
- CHU Lille, Jeanne de Flandre Hospital, Department of Obstetrics, 59000 Lille, France; Univ. Lille North of France, EA4489 - Perinatal Environment and Infant Growth, 59000 Lille, France
| | - P Verpillat
- CHU Lille, Jeanne de Flandre Hospital, Department of Radiology, 59000 Lille, France
| | - T Fourquet
- CHU Lille, Jeanne de Flandre Hospital, Department of Radiology, 59000 Lille, France
| | - S Joriot
- CHU Lille, Department of Neuropediatrics, 59000 Lille, France
| | - C Coulon
- CHU Lille, Jeanne de Flandre Hospital, Department of Obstetrics, 59000 Lille, France
| | - P Vaast
- CHU Lille, Jeanne de Flandre Hospital, Department of Obstetrics, 59000 Lille, France
| | - C Garabedian
- CHU Lille, Jeanne de Flandre Hospital, Department of Obstetrics, 59000 Lille, France; Univ. Lille North of France, EA4489 - Perinatal Environment and Infant Growth, 59000 Lille, France
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Dupuis H, Ghesquière L, De Jonckheere J, Aubry E, Sharma D, Deruelle P, Storme L, Houfflin-Debarge V, Garabedian C. When should foetal pH measurements be performed after a prolonged deceleration? An experimental study in a fetal sheep model. Eur J Obstet Gynecol Reprod Biol 2018; 226:54-58. [PMID: 29843068 DOI: 10.1016/j.ejogrb.2018.05.031] [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: 04/24/2018] [Accepted: 05/21/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of fetal heart rate monitoring during labour is to identify and prevent foetal distress, but its evaluation is not perfect. Fetal scalp blood sampling for pH measurement is one of the second-line methods of monitoring when fetal heart rate is classified as suspicious. This study aims to determine when pH testing should be performed after a prolonged deceleration. STUDY DESIGN This was an experimental study in a fetal sheep model. A partial umbilical cord occlusion was performed for seven minutes followed by a recuperation period of 30 min. Hemodynamic parameters (heart rate, mean blood pressure and intra-amniotic pressure) and blood gases were recorded before occlusion (T0), during occlusion (T4), just after the end of occlusion (T7), and then 10, 20 and 30 min after occlusion (T17, T27 and T37 respectively). RESULTS Ten experiments were carried out. During partial cord occlusion, the fetal pH decreased significantly to acidosis. After a prolonged deceleration with fetal acidosis, the pH recovered to a normal value, defined by a pH greater than or equal to 7.25, after 20 min of recuperation. CONCLUSION After a prolonged deceleration, fetal pH normalizes between 20 and 30 min thereafter. Thus, if a foetal blood sample is indicated, this delay must be respected in order to avoid inducing an unnecessary intervention decision.
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Affiliation(s)
- H Dupuis
- Univ. Lille, EA 4489, Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France.
| | - L Ghesquière
- Univ. Lille, EA 4489, Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France
| | - Julien De Jonckheere
- Univ. Lille, EA 4489, Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, CIC-IT 1403, MRRC, F-59000 Lille, France
| | - E Aubry
- Univ. Lille, EA 4489, Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Pediatric Surgery, F-59000 Lille, France
| | - D Sharma
- Univ. Lille, EA 4489, Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Pediatric Surgery, F-59000 Lille, France
| | - P Deruelle
- Univ. Lille, EA 4489, Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France
| | - L Storme
- Univ. Lille, EA 4489, Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Neonatology, F-59000 Lille, France
| | - V Houfflin-Debarge
- Univ. Lille, EA 4489, Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France
| | - C Garabedian
- Univ. Lille, EA 4489, Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France
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Garabedian C, Aubry E, Sharma D, Bleu G, Clermont-Hama Y, Ghesquière L, Hubert T, Deruelle P, Storme L, De Jonckheere J, Houfflin-Debarge V. Exploring fetal response to acidosis in ewes: Choosing an adequate experimental model. J Gynecol Obstet Hum Reprod 2018; 47:397-403. [PMID: 29654942 DOI: 10.1016/j.jogoh.2018.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 04/10/2018] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Knowledge of fetal physiology during labor has been largely generated from animal models. Our team recently developed a new index to assess parasympathetic activity using different experimental protocols to obtain acidosis. The objective of the present study was to discuss the different protocols and to review other models proposed in the literature. MATERIAL AND METHODS Pregnant ewes underwent a surgical procedure at the 123±2 days gestational age (term=145 days). Three experimental protocols were used: protocol A consisted of 25%, 50% and 75% umbilical cord occlusion (UCO) for 20min. Protocol B consisted of partial 75% UCO until reaching a pH<7.10. Protocol C consisted of brief, repetitive complete occlusion until severe acidosis occurred. Hemodynamic and blood gas parameters were compared to those of the stability period before UCO. RESULTS Protocol A led to a progressive response depending on the degree of occlusion (decrease in fetal heart rate, arterial hypertension and pH). Protocol B led to severe acidosis, although the duration of UCO varied per animal. Protocol C also progressively led to acidosis. We observed high inter individual variability in the acidosis response. CONCLUSION Pregnant ewes are a relevant model for exploring fetal response to acidosis. The frequency of UCO and partial or complete occlusion should be adapted to the expected effects. Knowledge of these protocols is important to respect ethical guidelines and to reduce the required number of animals. Moreover, it is important to consider the high individual variability of the acidosis response in the interpretation of the results.
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Affiliation(s)
- C Garabedian
- University Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France.
| | - E Aubry
- University Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Pediatric Surgery, F-59000 Lille, France
| | - D Sharma
- University Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Pediatric Surgery, F-59000 Lille, France
| | - G Bleu
- University Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France
| | - Y Clermont-Hama
- University Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France
| | - L Ghesquière
- University Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France
| | - T Hubert
- University Lille, CHU Lille, Experimental Resources Platform, F-59000 Lille, France
| | - P Deruelle
- University Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France
| | - L Storme
- University Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Neonatology, F-59000 Lille, France
| | - J De Jonckheere
- University Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, CIC-IT 1403, MRRC, F-59000 Lille, France
| | - V Houfflin-Debarge
- University Lille, EA 4489 - Perinatal Environment and Health, F-59000 Lille, France; CHU Lille, Department of Obstetrics, F-59000 Lille, France
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Phung TV, Houfflin-Debarge V, Ramdane N, Ghesquière L, Delsalle A, Coulon C, Subtil D, Vaast P, Garabedian C. Maternal red blood cell alloimmunization requiring intrauterine transfusion: a comparative study on management and outcome depending on the type of antibody. Transfusion 2018; 58:1199-1205. [DOI: 10.1111/trf.14542] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 01/11/2018] [Accepted: 01/13/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Thanh-Vy Phung
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille; Lille France
| | - Véronique Houfflin-Debarge
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille; Lille France
- Perinatal Environment and Growth; EA 4489, University of Lille North of France; Lille France
| | - Nassima Ramdane
- Department of Biostatistics; EA 2694, UDSL, CHU Lille; Lille France
| | - Louise Ghesquière
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille; Lille France
- Perinatal Environment and Growth; EA 4489, University of Lille North of France; Lille France
| | - Anne Delsalle
- Etablissement français du Sang, Nord Pas de Calais; France
| | - Capucine Coulon
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille; Lille France
| | - Damien Subtil
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille; Lille France
- Perinatal Environment and Growth; EA 4489, University of Lille North of France; Lille France
| | - Pascal Vaast
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille; Lille France
| | - Charles Garabedian
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille; Lille France
- Perinatal Environment and Growth; EA 4489, University of Lille North of France; Lille France
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Ghesquière L, Garabedian C, Boukerrou M, Dennis T, Garbin O, Hery R, Rubod C, Cosson M. Implementation of laparoscopy surgery training via simulation in a low-income country. J Gynecol Obstet Hum Reprod 2018; 47:187-190. [PMID: 29510268 DOI: 10.1016/j.jogoh.2018.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 09/28/2017] [Revised: 02/23/2018] [Accepted: 03/02/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate laparoscopy training using pelvitrainers for gynaecological surgeons in a low-income country. METHODS The study was carried out in Madagascar from April 2016 to January 2017. The participants were gynaecological surgeons who had not previously performed laparoscopy. Each surgeon was timed to evaluate the execution times of four proposed exercises, based on the fundamentals of laparoscopic surgery (FLS) programme's skills manual, as follows: exercise 1, involving a simple object transfer; exercises 2 and 3, comprising complex object transfers; and exercise 4, a precision cutting exercise. The 8-month training and evaluation programme was divided into different stages, and the four following evaluations were compared: a pretest (T0), assessment at the end of the first training (T1) and auto-evaluation at 2 months (T2) and 8 months (T3). RESULTS Eight participants were included. The median time was significantly reduced (P<0.05) at each evaluation for exercises 1, 2 and 4 compared to the pretest. For exercise 3, there was no difference between T0 and T1 (P=0.07). After 8 months of training, all participants progressed in all exercises. CONCLUSION Our study showed that it is possible and beneficial to develop a programme for teaching laparoscopic surgery in low-income countries before providing the necessary equipment.
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Affiliation(s)
- L Ghesquière
- CHU Lille, Department of Gynaecology, 59000, Lille, France; University of Lille North of France, EA4489 - Perinatal Environment and Infant Growth, 59000 Lille, France.
| | - C Garabedian
- CHU Lille, Department of Gynaecology, 59000, Lille, France; University of Lille North of France, EA4489 - Perinatal Environment and Infant Growth, 59000 Lille, France
| | - M Boukerrou
- University Hospital of Reunion Island, Gynaecology and Obstetrics Unit, BP 350, 97448 Saint Pierre Cedex, Réunion, France; Perinatal Studies Center of the Indian Ocean, University Hospital of Reunion Island, BP 350, 97448 Saint Pierre Cedex, Réunion, France; Faculty of Medicine, University of Reunion, 97490 Saint Denis, Réunion, France
| | - T Dennis
- University Hospital of Reunion Island, Gynaecology and Obstetrics Unit, BP 350, 97448 Saint Pierre Cedex, Réunion, France
| | - O Garbin
- CHU Strasbourg, CMCO, Gynecology Unit, 67000 Strasbourg, France
| | - R Hery
- CHU Befelatanana, Maternity of Befelatanana, Antananarivo University, Madagascar
| | - C Rubod
- CHU Lille, Department of Gynaecology, 59000, Lille, France; University of Lille North of France, 59000 Lille, France
| | - M Cosson
- CHU Lille, Department of Gynaecology, 59000, Lille, France; University of Lille North of France, 59000 Lille, France
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Ghesquière L, Garabedian C, Coulon C, Verpillat P, Rakza T, Wibaut B, Delsalle A, Subtil D, Vaast P, Debarge V. Management of red blood cell alloimmunization in pregnancy. J Gynecol Obstet Hum Reprod 2018; 47:197-204. [PMID: 29476829 DOI: 10.1016/j.jogoh.2018.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 01/28/2018] [Accepted: 02/14/2018] [Indexed: 10/18/2022]
Abstract
The main cause of fetal anemia is maternal red blood cell alloimmunization (AI). The search of maternal antibodies by indirect antiglobulin test allows screening for AI during pregnancy. In case of AI, fetal genotyping (for Rh-D, Rh-c, Rh-E and Kell), quantification (for anti-rhesus antibodies) and antibody titration, as well as ultrasound monitoring, are performed. This surveillance aims at screening for severe anemia before hydrops fetalis occurs. Management of severe anemia is based on intrauterine transfusion (IUT) or labor induction depending on gestational age. After intrauterine transfusion, follow-up will focus on detecting recurrence of anemia and detecting fetal brain injury. With IUT, survival of fetuses with alloimmunization is greater than 90% but 4.8% of children with at least one IUT have neurodevelopmental impairment.
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Affiliation(s)
- L Ghesquière
- CHU de Lille, department of obstetrics, 59000 Lille, France.
| | - C Garabedian
- CHU de Lille, department of obstetrics, 59000 Lille, France
| | - C Coulon
- CHU de Lille, department of obstetrics, 59000 Lille, France
| | - P Verpillat
- CHU de Lille, department of radiology, 59000 Lille, France
| | - T Rakza
- CHU de Lille, department of neonatology, 59000 Lille, France
| | - B Wibaut
- CHU de Lille, department of pediatric hematology, 59000 Lille, France
| | - A Delsalle
- Établissement français du sang, 59000 Lille, France
| | - D Subtil
- CHU de Lille, department of obstetrics, 59000 Lille, France
| | - P Vaast
- CHU de Lille, department of obstetrics, 59000 Lille, France
| | - V Debarge
- CHU de Lille, department of obstetrics, 59000 Lille, France
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Azaïs H, Ghesquière L, Petitnicolas C, Borghesi Y, Tresch-Bruneel E, Cordoba A, Narducci F, Bresson L, Leblanc E. Pretherapeutic staging of locally advanced cervical cancer: Inframesenteric paraaortic lymphadenectomy accuracy to detect paraaortic metastases in comparison with infrarenal paraaortic lymphadenectomy. Gynecol Oncol 2017; 147:340-344. [DOI: 10.1016/j.ygyno.2017.09.012] [Citation(s) in RCA: 10] [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: 06/12/2017] [Revised: 09/09/2017] [Accepted: 09/12/2017] [Indexed: 11/28/2022]
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Ghesquière L, Houfflin-Debarge V, Behal H, Coulon C, Subtil D, Vaast P, Garabedian C. Should optimal timing between two intrauterine transfusions be based on estimated daily decrease of hemoglobin or on measurement of fetal middle cerebral artery peak systolic velocity? Transfusion 2017; 57:899-904. [DOI: 10.1111/trf.13980] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/21/2016] [Accepted: 11/21/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | - Véronique Houfflin-Debarge
- Jeanne de Flandre Hospital; Lille University Hospital CHRU
- University of Lille North of France; Lille France
| | - Hélène Behal
- Department of Biostatistics; CHRU Lille; EA2694, UDSL
| | | | - Damien Subtil
- Jeanne de Flandre Hospital; Lille University Hospital CHRU
- University of Lille North of France; Lille France
| | - Pascal Vaast
- Jeanne de Flandre Hospital; Lille University Hospital CHRU
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Ghesquière L, Clouqueur E, Garabedian C, Tsatsaris V, Houfflin-Debarge V. [Can we prevent preeclampsia?]. Presse Med 2016; 45:403-13. [PMID: 27013262 DOI: 10.1016/j.lpm.2016.02.007] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 01/29/2016] [Accepted: 02/08/2016] [Indexed: 10/22/2022] Open
Abstract
Preeclampsia (PE), a specific complication of pregnancy, is one of the most frequent causes of maternal and fetal morbidity and mortality in the world. Recently, PE risk calculation algorithms allowing early detection of PE in the first trimester of pregnancy have been described. The aim of early detection would be to rapidly introduce an effective preventive treatment. The aim of our work is to study the different preventive treatments through the literature. Aspirin has some efficiency and reduces the risk of PE from 10 to 24%. It is most effective when the dose exceeds 75mg and when introduced before 16 gestational age. Early introduction of aspirin mainly prevents severe and preterm PE. Low molecular weight heparin (LMWH) and vitamin D appear to be promising therapy for PE but further research is required. Calcium administered at 1g/day reduces the risk of PE especially to patients with low baseline calcium intake. A low dose of calcium could also reduce the risk of PE but this must be confirmed. Other preventive measures (antioxidants, nitric oxide, progesterone, rest, exercise) do not reduce the incidence of PE.
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Affiliation(s)
- Louise Ghesquière
- CHRU de Lille, clinique d'obstétrique, maternité Jeanne-de-Flandre, pôle femme-mère-nouveau-né, avenue Eugène-Avinée, 59037 Lille cedex, France.
| | - Elodie Clouqueur
- CHRU de Lille, clinique d'obstétrique, maternité Jeanne-de-Flandre, pôle femme-mère-nouveau-né, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - Charles Garabedian
- CHRU de Lille, clinique d'obstétrique, maternité Jeanne-de-Flandre, pôle femme-mère-nouveau-né, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - Vassili Tsatsaris
- AP-HP, hôpital Cochin, université Paris Descartes, service de maternité Port-Royal, 123, boulevard du Port-Royal, 75014 Paris, France; Fondation PremUP, 75014 Paris, France
| | - Veronique Houfflin-Debarge
- CHRU de Lille, clinique d'obstétrique, maternité Jeanne-de-Flandre, pôle femme-mère-nouveau-né, avenue Eugène-Avinée, 59037 Lille cedex, France; Université Lille 2-Nord de France, faculté de médecine Henri-Warembourg, 59000 Lille, France
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Ghesquière L, Deruelle P, Puech F, Garabedian C. [Early post-partum discharges: The care pathway]. Rev Prat 2016; 66:216-218. [PMID: 30512342] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Early postpartum discharges: the care pathway. Early post-partum discharge (EPPD) is addressed for patients with low medical, psychological and social risks. A care pathway for these patients is well defined. EPPD should be explained during antenatal consultation and we need to select patients with low-risk, defined by the absence of EPPD contraindications criteria in the mother and the newborn. If those conditions are met, it must be ensured that the relay is organized at home. This relay aims to the mother's accompaniment, the evaluation of her psychosocial and family situations at home, as well as, medical monitoring and screening for maternal or infant morbidity factors. It is carried out with city health professionals and through perinatal networks. Particular specifications must be respected and specific parameters need to be monitored.
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Affiliation(s)
- Louise Ghesquière
- CHU Lille, département d'obstétrique, hôpital Jeannede- Flandre, Lille, France
| | - Philippe Deruelle
- CHU Lille, département d'obstétrique, hôpital Jeannede- Flandre, Lille, France
- Université de Lille, EA 4489 - Environnement périnatal et santé, Lille, France
| | - Francis Puech
- CHU Lille, département d'obstétrique, hôpital Jeannede- Flandre, Lille, France
| | - Charles Garabedian
- CHU Lille, département d'obstétrique, hôpital Jeannede- Flandre, Lille, France
- Université de Lille, EA 4489 - Environnement périnatal et santé, Lille, France
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Ghesquière L, Deruelle P, Charbonneau P, Puech F. [Epidemiology of maternal mortality by infectious cause in France, 2007-2009, using data from confidential maternal mortality report]. J Gynecol Obstet Hum Reprod 2015; 44:1-9. [PMID: 25060866 DOI: 10.1016/j.jgyn.2014.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 05/19/2014] [Accepted: 05/21/2014] [Indexed: 06/03/2023]
Abstract
Although deaths caused by infection during pregnancy and the postpartum period are rare in France, mortality rates have increased in several countries of the European community. In France, the rate of maternal mortality by infectious cause has decreased over the last 12 years. Infectious causes are currently in fifth place of maternal deaths. Over the period 2007-2009, 18 deaths occurred, eight by direct infectious causes and 10 by indirect infectious causes. Among the 18 deaths, 17 were examined by the National Expert Committee on Maternal Mortality (CNEMM) with the objectives to determine the direct or indirect link with pregnancy, the adequacy of care and the preventability of death. Among 8 deaths from direct infectious causes, four deaths were deemed "preventable" or "possibly preventable" because of inadequate care. Among nine deaths from indirect infectious causes, preventability could not be established in two deaths, five were non-preventable and two were preventable due to non-optimal care. These cases of puerperal septicemia show that when sepsis is clinically manifest, infection is already well established and widespread deterioration is therefore often irreversible. Maternal mortality is preventable in most cases if several points are observed: early diagnosis, probabilistic antibiotics targeting most frequently involved bacteria including Escherichia coli and Streptococcus A, early transfer to ICU, control septic portal entry, simple preventive measures, influenza vaccination. A "microbiological clinical diagnosis" approach must be initiated at the first clinical signs.
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Affiliation(s)
- L Ghesquière
- Pôle Femme-Mère-Nouveau-né, clinique d'obstétrique, maternité Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - P Deruelle
- Pôle Femme-Mère-Nouveau-né, clinique d'obstétrique, maternité Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France; EA4489, environnement périnatal et croissance, faculté de médecine. université Lille 2, 59800 Lille, France.
| | - P Charbonneau
- Comité national d'experts sur la mortalité maternelle (CNEMM), 59800 Lille, France
| | - F Puech
- Faculté de médecine, université droit et santé Lille II, Comité national d'experts sur la mortalité maternelle (CNEMM), 59800 Lille, France
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