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Sauvegrain P, Schantz C, Rousseau A, Gaucher L, Dupont C, Chantry EAA. Midwifery research in France: Current dynamics and perspectives. Midwifery 2024; 131:103935. [PMID: 38382416 DOI: 10.1016/j.midw.2024.103935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 02/23/2024]
Affiliation(s)
- P Sauvegrain
- Sorbonne Université, Department of Maïeutics, F-75013, Paris, France; Université Paris Cité, Epidemiology and Statistics Research Center/CRESS/EPOPé Research Team, INSERM, INRA, F-75014 Paris, France.
| | - Clémence Schantz
- Université Paris Cité, IRD, Inserm, Ceped, F-75006 Paris, France
| | - Anne Rousseau
- Université Paris-Saclay, Inserm U1018, CESP, Epidémiologie Clinique Team, F-78180, Montigny le Bretonneux, France; Poissy-Saint Germain-en-Laye Hospital, Maternity Ward, F-78498 Poissy, France
| | - Laurent Gaucher
- Université Claude Bernard Lyon 1, INSERM U1290, Research on Healthcare Performance (RESHAPE), F-69000, Lyon, France; Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Corinne Dupont
- Université Claude Bernard Lyon 1, INSERM U1290, Research on Healthcare Performance (RESHAPE), F-69000, Lyon, France; Université Lyon 1, University of Medicine and Maieutics, F-69921, Lyon, France
| | - Et Anne Alice Chantry
- Université Paris Cité, Epidemiology and Statistics Research Center/CRESS/EPOPé Research Team, INSERM, INRA, F-75014 Paris, France; Université Paris-Cité, Departement of Maïeutics, F-75006 Paris, France
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Rousseau A, Fourmond M, Baumann S. Prophylactic administration of oxytocin by midwives: A qualitative study of facilitators and barriers. Midwifery 2023; 118:103604. [PMID: 36716615 DOI: 10.1016/j.midw.2023.103604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/19/2022] [Accepted: 01/22/2023] [Indexed: 01/25/2023]
Affiliation(s)
- Anne Rousseau
- Department of Maieutics, UFR Simone Veil-Santé, University of Versailles-Saint-Quentin-en-Yvelines, University Paris-Saclay, 2 avenue de la Source de la Bièvre, Montigny le Bretonneux 78180, France; UVSQ, UFR S. Veil-Santé, CESP, Clinical Epidemiology Team, Université Paris-Saclay, Montigny le Bretonneux 78180, France; Department of Obstetrics, CHI Poissy-Saint Germain en Laye, Poissy 78300, France
| | - Marion Fourmond
- Department of Maieutics, UFR Simone Veil-Santé, University of Versailles-Saint-Quentin-en-Yvelines, University Paris-Saclay, 2 avenue de la Source de la Bièvre, Montigny le Bretonneux 78180, France; Department of Obstetrics, CHI Poissy-Saint Germain en Laye, Poissy 78300, France
| | - Sophie Baumann
- Department of Maieutics, UFR Simone Veil-Santé, University of Versailles-Saint-Quentin-en-Yvelines, University Paris-Saclay, 2 avenue de la Source de la Bièvre, Montigny le Bretonneux 78180, France.
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Bláha J, Bartošová T. Epidemiology and definition of PPH worldwide. Best Pract Res Clin Anaesthesiol 2022; 36:325-339. [PMID: 36513428 DOI: 10.1016/j.bpa.2022.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/17/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022]
Abstract
Postpartum/peripartum hemorrhage (PPH) is an obstetric emergency complicating 1-10% of all deliveries and is a leading cause of maternal mortality and morbidity worldwide. However, the incidence of PPH differs widely according to the definition and criteria used, the way of measuring postpartum blood loss, and the population being studied with the highest numbers in developing countries. Despite all the significant progress in healthcare, the incidence of PPH is rising due to an incomplete implementation of guidelines, resulting in treatment delays and suboptimal care. A consensus clinical definition of PPH is needed to enable awareness, early recognition, and initiation of appropriate intensive treatment. Unfortunately, the most used definition of PPH based on blood loss ≥500 ml after delivery suffers from inaccuracies in blood loss quantification and is not clinically relevant in most cases, as the amount of blood loss does not fully reflect the severity of bleeding.
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Affiliation(s)
- Jan Bláha
- Department of Anaesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08, Prague 2, Czech Republic.
| | - Tereza Bartošová
- Department of Anaesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08, Prague 2, Czech Republic.
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Voillequin S, Rozenberg P, Letutour K, Rousseau A. Comparative satisfaction and effectiveness of virtual simulation and usual supervised work for postpartum hemorrhage management: a crossover randomized controlled trial. BMC MEDICAL EDUCATION 2022; 22:709. [PMID: 36203183 PMCID: PMC9540154 DOI: 10.1186/s12909-022-03761-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Because virtual simulation promotes learning and cognitive skill development, it may be useful for teaching students to manage postpartum hemorrhage (PPH) and its complex decision algorithm. OBJECTIVE This study aimed to compare the satisfaction and effectiveness of virtual simulation with usual supervised work in producing knowledge and satisfaction. METHODS This two-center two-stage crossover randomized controlled trial included student midwives. One group underwent the virtual simulation intervention in the first period (January 2018) and the usual supervised classroom work in the second (May 2018); the other group followed the reverse chronology. Satisfaction was the primary outcome. The secondary outcome was knowledge of the PPH management algorithm, assessed by responses to a case vignette after each intervention session. RESULTS The virtual simulation -supervised work (VS-SW) chronology was allocated to 48 students, and its inverse (SW-VS) to 47; Satisfaction was significantly higher for the virtual simulation for its overall grade (6.8 vs. 6.1, P = 0.009), engagingness (very good 82.1% vs. 24.3%, P < 0.001), and ease of use (very good 77.9% vs. 46.1%, P < 0.001). Knowledge did not differ between the two groups (respectively, 89.5% versus 83.5%, P = 0.3). CONCLUSION Satisfaction is higher with virtual simulation without lowering knowledge scores, which argues for the use of such innovative teaching strategies. This could lead to an increase in students' motivation to learn.
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Affiliation(s)
| | - P Rozenberg
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, 78300, Poissy, France
- Clinical Epidemiology, Paris Saclay University, CESP, UVSQ, Inserm, Team U1018, 78180, Montigny- le-Bretonneux, France
| | - K Letutour
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, 78300, Poissy, France
- Midwifery Department, UVSQ, 78180, Montigny-le-Bretonneux, France
| | - A Rousseau
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, 78300, Poissy, France
- Clinical Epidemiology, Paris Saclay University, CESP, UVSQ, Inserm, Team U1018, 78180, Montigny- le-Bretonneux, France
- Midwifery Department, UVSQ, 78180, Montigny-le-Bretonneux, France
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Voillequin S, Rozenberg P, Ravaud P, Rousseau A. Promptness of oxytocin administration for first-line treatment of postpartum hemorrhage: a national vignette-based study among midwives. BMC Pregnancy Childbirth 2022; 22:353. [PMID: 35461215 PMCID: PMC9034651 DOI: 10.1186/s12884-022-04648-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide. Midwives play a key role in the initial management of PPH. Uterotonic agents are widely used in its prevention and treatment, with oxytocin the first-line agent. Nonetheless, a standardized guideline for optimal dose and rate of administration has not been clearly defined. The aim of this study was to investigate French midwives’ practices regarding first-line oxytocin treatment and the factors influencing its delayed administration. Methods This multicenter study was based on clinical vignettes of PPH management collected using an anonymous online questionnaire. A random sample of midwives from 145 maternity units in France from 15 randomly selected perinatal networks were invited to participate by email. The Previously validated case vignettes described two different scenarios of severe PPH. Vignette 1 described a typical immediate, severe PPH, and vignette 2 a less typical case of severe but gradual PPH They were constructed in three successive steps and included multiple-choice questions proposing several types of clinical practice options at each stage. For each vignette separately, we analyzed the lack of prompt oxytocin administration and the factors contributing to them, that is, characteristics of the midwives and organizational features of maternity units. Bivariate analysis and multivariable logistic regression analysis were applied. Results In all, 450 midwives from 87 maternity units provided complete responses. Lack of promptness was observed in 21.6% of responses (N = 97) in Vignette 1 and in 13.8% (N = 62) in Vignette 2 (p < .05). After multivariate analysis, the risk of delay was lower among with midwives working in university maternity hospitals (ORa 0.47, 95% 0.21, 0.97) and in units with 1500 to 2500 births per year (ORa 0.49, 95% CI 0.26, 0.90) for Vignette 1. We also noticed that delay increased with the midwives’ years of experience (per 10-year period) (ORa 1.30, 95% CI 1.01, 1.69). Conclusions This study using clinical vignettes showed delays in oxytocin administration for first-line treatment of PPH. Because delay in treatment is a major cause of preventable maternal morbidity in PPH, these findings suggest that continuing training of midwives should be considered, especially in small maternity units. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04648-5.
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Affiliation(s)
- S Voillequin
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France. .,INSERM UMR1018 "Clinical Epidemiology Team", Research Center on Epidemiology and Population Health (CESP), UVSQ, Paris Saclay University, Villejuif, France. .,Midwifery Department, Strasbourg University, Strasbourg, France.
| | - P Rozenberg
- INSERM UMR1018 "Clinical Epidemiology Team", Research Center on Epidemiology and Population Health (CESP), UVSQ, Paris Saclay University, Villejuif, France.,Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France
| | - Ph Ravaud
- INSERM UMR1153, Centre of Research Epidemiology and Statistics (CRESS), Université de Paris, Paris, France.,Center for Clinical Epidemiology, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Hôtel Dieu, Paris, France
| | - A Rousseau
- INSERM UMR1018 "Clinical Epidemiology Team", Research Center on Epidemiology and Population Health (CESP), UVSQ, Paris Saclay University, Villejuif, France.,Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France
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Jourdren G, Berveiller P, Rousseau A. Practices for RhD alloimmunization prevention: a vignette-based survey of midwives. J Matern Fetal Neonatal Med 2021; 35:7629-7639. [PMID: 34433367 DOI: 10.1080/14767058.2021.1957822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Despite the availability guidelines to prevent RhD alloimmunization, severe hemolytic disease of fetus and newborn still occurs in high-income countries. The aim of the study was (1) To assess variations in practices for the prevention of RhD alloimmunization, and (2) to understand midwives' acceptance and appropriation of fetal RhD genotyping. METHODS Descriptive cross-sectional survey of French midwives from September 2017 through January 2018. Participants were asked to complete an internet-based questionnaire that included three clinical vignettes. They were questioned about their practices concerning early pregnancy visit by RhD-negative women, prevention of RhD alloimmunization in women with second-trimester metrorrhagia, and RhD fetal genotyping. RESULTS A total of 827 midwives completed the questionnaire. Only 21.1% reported that they practice all the preventive measures recommended in early pregnancy. In a situation at high risk of RhD alloimmunization during pregnancy, 97.2% of midwives would perform immunoprophylaxis. Nearly, all midwives reported providing information about RhD alloimmunization (92.4%) at the beginning of pregnancy, although only 11.3% offered both written and verbal information; at the time of systematic anti-D immunoprophylaxis (28 weeks), 78% provided information, but only 2.7% both verbally and in writing. Finally, only 50.8% of midwives preferred to include RhD fetal genotyping in routine prenatal prophylaxis. DISCUSSION This study showed significant variations in French midwives' practices to prevent RhD alloimmunization. Better dissemination of guidelines is needed to improve both consistent use of these practices and the quality of information delivered to RhD-negative pregnant women.
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Affiliation(s)
- Guenola Jourdren
- Midwifery Department, Versailles Saint Quentin University, Paris-Saclay University, Montigny-le-Bretonneux, France
| | - Paul Berveiller
- Department of Obstetrics and Gynecology, Poissy-Saint-Germain en Laye Hospital, Poissy, France.,INRAE, Paris Saclay University, UMR 1198 - BREED, RHuMA, Montigny-Le-Bretonneux, France
| | - Anne Rousseau
- Midwifery Department, Versailles Saint Quentin University, Paris-Saclay University, Montigny-le-Bretonneux, France.,Department of Obstetrics and Gynecology, Poissy-Saint-Germain en Laye Hospital, Poissy, France.,Paris-Saclay University, UVSQ, CESP, Equipe Epidémiologie clinique, Montigny-le-Bretonneux, France
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Mamakou A. The role of midwife in postpartum hemorrhage. Eur J Midwifery 2021; 4:46. [PMID: 33537647 PMCID: PMC7839132 DOI: 10.18332/ejm/128271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 10/08/2020] [Indexed: 11/24/2022] Open
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Rousseau A, Azria E, Baumann S, Deneux‐Tharaux C, Senat MV. Do obstetricians apply the national guidelines? A vignette‐based study assessing practices for the prevention of preterm birth. BJOG 2019; 127:467-476. [DOI: 10.1111/1471-0528.16039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2019] [Indexed: 01/20/2023]
Affiliation(s)
- A Rousseau
- Midwifery Department Versailles Saint Quentin University Montigny‐le‐Bretonneux France
- EA 7285 Versailles Saint Quentin University Montigny le Bretonneux France
| | - E Azria
- Maternity Unit Notre Dame de Bon Secours Paris Saint Joseph Hospital Paris Descartes University Paris France
- National Institute for Health and Medical Research (INSERM) Unit 1153 Obstetrical Perinatal and Paediatric Epidemiology Research Team (EPOPé) Center for Epidemiology and Statistics Sorbonne Paris Cité DHU Risks in Pregnancy Paris University Paris France
| | - S Baumann
- Midwifery Department Versailles Saint Quentin University Montigny‐le‐Bretonneux France
| | - C Deneux‐Tharaux
- National Institute for Health and Medical Research (INSERM) Unit 1153 Obstetrical Perinatal and Paediatric Epidemiology Research Team (EPOPé) Center for Epidemiology and Statistics Sorbonne Paris Cité DHU Risks in Pregnancy Paris University Paris France
| | - MV Senat
- Department of Obstetrics and Gynaecology Bicêtre Hospital AP‐HP Kremlin Bicêtre France
- Paris Sud Paris Saclay University Le Kremlin Bicêtre France
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Thida T, Liabsuetrakul T. Type of health care workers and quality of antenatal and delivery care in communities of Myanmar: An experience- and vignette-based study. Int J Health Plann Manage 2019; 34:e1597-e1608. [PMID: 31292997 DOI: 10.1002/hpm.2853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/05/2019] [Accepted: 06/24/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Understanding who provides antenatal and delivery care services and the quality of care in communities with high maternal deaths is essential for planning the efficient utilization of a limited health care workforce. OBJECTIVES To identify the types of health care workers for antenatal and delivery care in these communities, and assess the quality of care using vignettes of women with hypertensive disorder in pregnancy (HDP) and postpartum hemorrhage (PPH) from the provider's perspectives in Myanmar. METHODS A cross-sectional study was conducted in three townships of Myanmar during May to September 2016. Health assistants, lady health visitors, midwives, and auxiliary midwives rated the type of providers and quality of care based on four HDP vignettes and four PPH vignettes. The agreements of their assessments were analysed using prevalence-adjusted bias-adjusted kappa and Cramer's V coefficient. RESULTS Almost perfect agreement was found that midwives were the providers who provided and who should provide all routine antenatal and delivery care services. Less than 80% of the participants perceived good quality antenatal care (ANC) and delivery care for HDP and PPH, particularly in vignettes featuring cases of pre-existing hypertension or PPH with history of hospitalization. More than 85% of the participants rated quality of care for managing complications as good. Variations of ratings among the providers ranged from small to medium (Cramer's V = .22-.40). CONCLUSION Midwives were key providers of ANC and delivery care in the local communities in Myanmar, but the quality of ANC for women with HDP and PPH was poor and needs improvement.
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Affiliation(s)
- Thida Thida
- Epidemiology Research Division, Department of Medical Research (Pyin Oo Lwin Branch), Ministry of Health and Sports, Pyin Oo Lwin, Myanmar
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Rousseau A, Rozenberg P, Perrodeau E, Ravaud P. Variation in severe postpartum hemorrhage management: A national vignette-based study. PLoS One 2018; 13:e0209074. [PMID: 30543683 PMCID: PMC6292622 DOI: 10.1371/journal.pone.0209074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 11/29/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To assess variations in management of severe postpartum hemorrhage: 1) between obstetricians in the same situation 2) by the same obstetrician in different situations. STUDY DESIGN A link to a vignette-based survey was emailed to obstetricians of 215 maternity units; the questionnaire asked them to report how they would manage the PPH described in 2 previously validated case-vignettes of different scenarios of severe PPH. Vignette 1 described a typical immediate, severe PPH, and vignette 2 a less typical case of severe but gradual PPH. They were constructed in 3 successive steps and included multiple-choice questions proposing several types of clinical practice options at each step. Variations in PPH were assessed in a descriptive analysis; agreement about management and its timing between vignette 1 and vignette 2 was assessed with the Kappa coefficient. RESULTS Analysis of complete responses from 119 (43.4%) obstetricians from 53 (24.6%) maternity units showed delayed or inadequate management in both vignettes. While 82.3% and 83.2% of obstetricians (in vignettes 1 and 2, respectively) would administer oxytocin 15 minutes after PPH diagnosis, only 52.9% and 29.4% would alert other team members. Management by obstetricians of the two vignette situations was inconsistent in terms of choice of treatment and timing of almost all treatments. CONCLUSION Case vignettes demonstrated inadequate management as well as variations in management between obstetricians and in different PPH situations. Protocols or procedures are necessary in all maternity units to reduce the variations in practices that may explain a part of the delay in management that leads to PPH-related maternal mortality and morbidity.
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Affiliation(s)
- Anne Rousseau
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France
- INSERM U1153, METHODS (Méthodes en Évaluation Thérapeutique des Maladies Chroniques) Research Unit. Paris Descartes-Sorbonne Paris Cité University, Paris, France
| | - Patrick Rozenberg
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France
- Research Unit EA 7285, Versailles-St Quentin University, Saint Quentin en Yvelines, France
| | - Elodie Perrodeau
- INSERM U1153, METHODS (Méthodes en Évaluation Thérapeutique des Maladies Chroniques) Research Unit. Paris Descartes-Sorbonne Paris Cité University, Paris, France
- Assistance Publique-Hôpitaux de Paris, Centre d’Epidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France
| | - Philippe Ravaud
- INSERM U1153, METHODS (Méthodes en Évaluation Thérapeutique des Maladies Chroniques) Research Unit. Paris Descartes-Sorbonne Paris Cité University, Paris, France
- Assistance Publique-Hôpitaux de Paris, Centre d’Epidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France
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Antidepressants during pregnancy: Guideline adherence and current practice amongst Dutch gynaecologists and midwives. Midwifery 2018. [DOI: 10.1016/j.midw.2018.02.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Le Gouic S, Lavoué V, Mimouni M, Levêque J, Huchon C. Evaluation of adherence to French clinical practice guidelines in the management of pregnancy loss issued by the French College of Obstetricians and Gynecologists, one year after publication: A vignette-based study. J Gynecol Obstet Hum Reprod 2017; 46:393-398. [DOI: 10.1016/j.jogoh.2017.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 03/15/2017] [Accepted: 03/23/2017] [Indexed: 12/16/2022]
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