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Pizzoferrato AC, Deparis J, Fritel X, Rousseau M, Blanchard V. Impact of educational workshops to increase awareness of pelvic floor dysfunction and integrate preventive lifestyle habits. Int J Gynaecol Obstet 2024; 164:596-604. [PMID: 37723985 DOI: 10.1002/ijgo.15130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/08/2023] [Accepted: 08/29/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVES Our objectives were to evaluate the impact of group pelvic floor education workshops on participants' knowledge, their satisfaction, and the modification of their urinary and digestive behaviors, and to compare health care providers' (HCP) knowledge with that of the general population. METHODS For this prospective observational study, group pelvic floor education workshops were proposed between May 2021 and June 2022 in a web-conference format. Each workshop covered pelvic floor anatomy and physiology, urinary and digestive physiology as well as risk factors of PFD and preventive measures. At the start and the end of the workshops, participants completed a questionnaire on their knowledge and their beliefs about the pelvic floor. Questions about their satisfaction were asked at the end of the workshops. A 2-month questionnaire assessed changes in urinary and digestive habits and whether participants had talked about the workshop around them. RESULTS A total of 856, with an average age 40.1 years, participated and completed the questionnaires before and after the workshops; 694 responded at 2 months. The education workshops significantly improved knowledge about the pelvic floor in the "HCP" and "non-HCP" groups. At 2 months, 591 participants (85.2%) 85.2% had talked about the workshop content; 557 (80.3%) reported having changed, or planned to change, their urinary behaviors and 495 (71.3%) their defecatory behaviors. CONCLUSIONS Pelvic floor education workshops can increase level of knowledge and thus limit risky behaviors for the pelvic floor. The high rate of participation and the satisfaction of the participants shows the interest for the theme.
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Affiliation(s)
- Anne-Cécile Pizzoferrato
- Department of Obstetrics and Gynecology, Université de Poitiers, CIC-Inserm, DECLAN, CHU de Poitiers, Poitiers, France
| | - Julia Deparis
- Department of Obstetrics and Gynecology, Université de Poitiers, CIC-Inserm, DECLAN, CHU de Poitiers, Poitiers, France
| | - Xavier Fritel
- Department of Obstetrics and Gynecology, Université de Poitiers, CIC-Inserm, DECLAN, CHU de Poitiers, Poitiers, France
| | - Marion Rousseau
- Department of Obstetrics and Gynecology, Caen University Hospital, Caen, France
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Deffieux X, Pizzoferrato AC, Gaucher L, Rousset-Jablonski C, Le Ray C, Brillac T, Maruani J, Maitrot-Mantelet L, Mignot S, Athiel Y, Baffet H, Bailleul A, Bernard V, Bourdon M, Cardaillac C, Carneiro Y, Chariot P, Corroenne R, Dabi Y, Dahlem L, Frank S, Freyens A, Grouthier V, Hernandez I, Iraola E, Lambert M, Lauchet N, Legendre G, Le Lous M, Louis-Vahdat C, Martinat Sainte-Beuve A, Masson M, Matteo C, Pinton A, Sabbagh E, Sallee C, Thubert T, Heron I, Artzner F, Tavenet A, Gantois A, Fauconnier A. Pelvic exam in Gynecology and Obstetrics: French Guidelines for Clinical Practice. Eur J Obstet Gynecol Reprod Biol 2023; 291:131-140. [PMID: 37871350 DOI: 10.1016/j.ejogrb.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/18/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023]
Affiliation(s)
- Xavier Deffieux
- Université Paris-Saclay, AP-HP, Hôpital Antoine Béclère, Service de gynécologie obstétrique, Clamart F-92140, France.
| | - Anne-Cécile Pizzoferrato
- Service de Gynécologie Obstétrique, Hôpital Universitaire de La Miletrie, Poitiers F-86000, France; INSERM CIC 1402, Université de Poitiers, Poitiers F-86000, France
| | - Laurent Gaucher
- Collège National des Sages-Femmes de France, CNSF, Paris F-75010, France; Public Health Unit, Hospices Civils de Lyon, Bron F-69500, France; INSERM U1290, Research on Healthcare Performance (RESHAPE), Université Claude Bernard, Lyon 1, Lyon F-69008, France; Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1206 Geneva, Switzerland
| | - Christine Rousset-Jablonski
- Centre Léon Bérard, Département de Chirurgie, et Centre Hospitalier Lyon Sud, Service de Gynécologie-Obstétrique, INSERM U1290 RESHAPE, Lyon F-69000, France
| | - Camille Le Ray
- Maternité Port Royal, Groupe Hospitalier Paris Centre, APHP, Université Paris Cité, FHU Prema, Paris F-75014, France
| | | | - Julia Maruani
- Cabinet Médical, 6 Rue Docteur Albert Schweitzer, Marseille F-13006, France
| | - Lorraine Maitrot-Mantelet
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paris Centre (HUPC), Unité de gynécologie médicale, hôpital Port-Royal, Paris F-75014, France
| | | | - Yoann Athiel
- Maternité Port Royal, Groupe Hospitalier Paris Centre, APHP, Université Paris Cité, FHU Prema, Paris F-75014, France
| | - Hortense Baffet
- Service de gynécologie médicale, orthogénie et sexologie, CHU de Lille, Université de Lille, Lille F-59000, France
| | - Alexandre Bailleul
- Service de Gynécologie Obstétrique, Center Hospitalier de Poissy Saint Germain en Laye, Poissy F-78300, France; Equipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », Université Paris Saclay, UVSQ, Montigny le Bretonneux F-78180, France
| | - Valérie Bernard
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, Centre Hospitalo-Universitaire Pellegrin, Bordeaux F-33000, France
| | - Mathilde Bourdon
- Université Paris Cité, APHP, Center Hospitalier Universitaire (CHU) Cochin Port Royal, Service de Gynécologie Obstétrique II et Médecine de la Reproduction, F-75014, France
| | - Claire Cardaillac
- Service de gynécologie-obstétrique, CHU de Nantes, Nantes F-44000, France
| | | | - Patrick Chariot
- Département de médecine légale et sociale, Assistance Publique - Hôpitaux de Paris, Bondy F-93140, France; Institut de Recherche Interdisciplinaire sur Les Enjeux Sociaux, UMR 8156-997, UFR SMBH, Université Sorbonne Paris Nord, Bobigny F-9300, France
| | - Romain Corroenne
- Service de gynécologue-obstétrique, CHU Angers, Angers F-49000, France
| | - Yohann Dabi
- Sorbonne université - APHP - Hôpital Tenon, Service de gynécologie obstétrique et médecine de la reproduction, Paris F75020, France
| | - Laurence Dahlem
- Département universitaire de médecine générale, Faculté de médecine, Université de Bordeaux, 146 rue Léo Saignat, Bordeaux F-33076, France
| | - Sophie Frank
- Service d'oncogénétique, Institut Curie, Paris F-75005, France
| | - Anne Freyens
- DUMG (Département Universitaire de Médecine Générale), Université Paul Sabatier, Toulouse F-31000, France
| | - Virginie Grouthier
- Department of Endocrinology, Diabetes and Nutrition, University of Bordeaux, Bordeaux, France; Univ. Bordeaux, Inserm U1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Isabelle Hernandez
- Département de maïeutique, Center hospitalier de Melun Santepole, Melun F-77000, France
| | - Elisabeth Iraola
- Institut de Recherche interdisciplinaire sur les Enjeux Sociaux (IRIS), UMR 8156-997, CNRS U997 Inserm EHESS UP13 UFR SMBH, Université Sorbonne Paris Nord, Paris, France; Direction de la protection maternelle et infantile et promotion de la santé, Conseil départemental du Val-de-Marne, Créteil F-94000, France
| | - Marie Lambert
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, Centre Hospitalo-Universitaire Pellegrin, Bordeaux F-33000, France; Université de Bordeaux, Bordeaux Institute of Oncology - Unité Inserm 1312, Bordeaux F-33000, France
| | - Nadege Lauchet
- Groupe Médical François Perrin, 9 rue François Perrin, Limoges F-87000, France
| | - Guillaume Legendre
- Service de gynécologue-obstétrique, CHU Angers, Angers F-49000, France; UMR_S1085, Université d'Angers, CHU Angers, University of Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), Angers, France
| | - Maela Le Lous
- Université de Rennes 1, INSERM, LTSI - UMR 1099, Rennes F-35000, France; Département de gynécologie et obstétrique, CHU de Rennes, Rennes F-35000, France
| | - Christine Louis-Vahdat
- Cabinet de gynécologie et obstétrique, 126 Boulevard Saint Germain, Paris F-75006, France
| | | | - Marine Masson
- Département de médecine générale, Poitiers F-86000, France
| | - Caroline Matteo
- Cabinet de maïeutique, 181 rue du Docteur Cauvin, Marseille F-13015, France
| | - Anne Pinton
- Service de gynécologie obstétrique, Hôpital Trousseau, APHP, 26, avenue du Dr-Arnold-Netter, Paris F-75012, France; Sorbonne Université, Paris F-75013, France
| | - Emmanuelle Sabbagh
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital universitaire Paris Centre (HUPC), Unité de gynécologie médicale, hôpital Port-Royal, Paris F-75014, France
| | - Camille Sallee
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU de Limoges, Limoges F-87000 France
| | - Thibault Thubert
- Service de Gynécologie-Obstétrique, CHU de Nantes, Nantes F- 44000, France; Laboratoire Mouvement, Interactions, Performance (MIP), EA 4334, Nantes Université, Nantes F- 44322, France
| | - Isabelle Heron
- Service d'endocrinologie, Université de Rouen, Hôpital Charles Nicolle, Rouen F-76000, France; Cabinet médical, 7 rue de Lessard, Rouen F-76100, France
| | - France Artzner
- CIANE, Collectif interassociatif autour de la naissance, c/o Anne Evrard, 101 rue Pierre Corneille, Lyon F-69003, France
| | - Arounie Tavenet
- ENDOFRANCE, Association de lutte contre l'endométriose. 3 rue de la Gare, Tresilley F-70190, France
| | - Adrien Gantois
- Collège National des Sages-Femmes de France hébergé au Réseau de Santé Périnatal Parisien (RSPP), Paris F75010, France
| | - Arnaud Fauconnier
- Service de Gynécologie Obstétrique, Center Hospitalier de Poissy Saint Germain en Laye, Poissy F-78300, France; Equipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », Université Paris Saclay, UVSQ, Montigny le Bretonneux F-78180, France
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Sorel M, Fradet L, Coste-Mazeau P, Aubard Y, Pizzoferrato AC, Pierre F, Gachon B. A new approach to assessing the obstetrician's posture and movement during an instrumental forceps delivery. J Gynecol Obstet Hum Reprod 2023; 52:102654. [PMID: 37643694 DOI: 10.1016/j.jogoh.2023.102654] [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: 05/11/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION The number of deliveries by forceps decreases significantly in favour of the vacuum. Now, when the use of forceps is necessary, physicians less experimented with this procedure are likely to induce serious and preventable perineal or foetal injuries. Training therefore becomes essential. However, there are no clear recommendations on the technique to perform a delivery by forceps, namely the body posture and gesture to adopt. Our goal is then to provide a protocol that can help to determine if there is an optimal technique to perform a delivery by forceps. METHOD We will include voluntary participants whose level of experience and type of practice differ. We will propose to record their postures and gestures using an optoelectronic motion analysis system during a forceps delivery simulated on a mannequin. We will also measure the traction force produced by the subject on the forceps using force platforms and technical markers placed on the forceps. We will then perform a principal component analysis to look for similar motion patterns. EXPECTED RESULTS We plan to analyse about fifty participants (25 seniors and 25 juniors). Our hypothesis is that the realism of the simulation will be deemed satisfactory by the participants, that the experimental conditions will not modify their gestures, and that the degree of experience will result in different techniques. CONCLUSION A better knowledge on the posture and gesture to adopt to realise a forceps delivery should improve the safety of women and new-borns. The results of this study could also be a valuable contribution for the training of obstetricians.
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Affiliation(s)
- Manon Sorel
- Department of Obstetrics and Gynecology, University Hospital Center of Poitiers, 2 rue de la Milétrie, CS 90577, 86021 Poitiers Cedex, France.
| | - Laetitia Fradet
- Pprime Institute UPR 3346-CNRS, Axe RoBioSS, University of Poitiers, 2 Boulevard des Frères Lumière 86360 Chasseneuil-du-Poitou, France
| | - Perrine Coste-Mazeau
- Department of Obstetrics and Gynecology, University Hospital Center of Limoges, 2 Avenue Martin Luther King 87000 Limoges, France
| | - Yves Aubard
- Department of Obstetrics and Gynecology, University Hospital Center of Limoges, 2 Avenue Martin Luther King 87000 Limoges, France
| | - Anne-Cécile Pizzoferrato
- Department of Obstetrics and Gynecology, University Hospital Center of Poitiers, 2 rue de la Milétrie, CS 90577, 86021 Poitiers Cedex, France; Clinical investigation center, INSERM CIC 1402, Entrée 5 - Cours Est Jean Bernard CHU de Poitiers 2 rue de la Milétrie 86000 Poitiers, France
| | - Fabrice Pierre
- Department of Obstetrics and Gynecology, University Hospital Center of Poitiers, 2 rue de la Milétrie, CS 90577, 86021 Poitiers Cedex, France
| | - Bertrand Gachon
- Department of Obstetrics and Gynecology, University Hospital Center of Poitiers, 2 rue de la Milétrie, CS 90577, 86021 Poitiers Cedex, France; Clinical investigation center, INSERM CIC 1402, Entrée 5 - Cours Est Jean Bernard CHU de Poitiers 2 rue de la Milétrie 86000 Poitiers, France; Motricité Interaction Performance, EA 4334, University of Nantes, 23 rue du Recteur Schmitt Bâtiment F0 - BP 92235 44322 Nantes France
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4
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Dupuis N, Pizzoferrato AC, Garabedian C, Rozenberg P, Kayem G, Harvey T, Mandelbrot L, Doret M, Fuchs F, Azria E, Sénat MV, Ceccaldi PF, Seco A, Chantry A, Le Ray C. Moderate or intensive management of the active phase of second-stage labor and risk of urinary and anal incontinence: results of the PASST randomized controlled trial. Am J Obstet Gynecol 2023; 229:528.e1-528.e17. [PMID: 37499991 DOI: 10.1016/j.ajog.2023.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/12/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Incontinence occurs frequently in the postpartum period. Several theoretical pathophysiological models may underlie the hypothesis that different types of management of the active phase of the second stage of labor have different effects on pelvic floor muscles and thus perhaps affect urinary and anal continence. OBJECTIVE This study aimed to evaluate the impact of "moderate pushing" on the occurrence of urinary or anal incontinence compared with "intensive pushing," and to determine the factors associated with incontinence at 6 months postpartum. STUDY DESIGN This was a planned analysis of secondary objectives of the PASST (Phase Active du Second STade) trial, a multicenter randomized controlled trial. PASST included nulliparous women with singleton term pregnancies and epidural analgesia, who were randomly assigned at 8 cm of dilatation to either the intervention group that used "moderate" pushing (pushing only twice during each contraction, resting regularly for 1 contraction in 5 without pushing, and no time limit on pushing) or the control group following the usual management of "intensive" pushing (pushing 3 times during each contraction, with no contractions without pushing, with an obstetrician called to discuss operative delivery after 30 minutes of pushing). Data about continence were collected with validated self-assessment questionnaires at 6 months postpartum. Urinary incontinence was defined by an ICIQ-UI SF (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form) score ≥1 and anal incontinence by a Wexner score ≥2. A separate analysis was also performed among the more severely affected women (ICIQ-UI SF ≥6 and Wexner ≥5). Factors associated with incontinence were assessed with univariate and multivariable analyses. RESULTS Among 1618 women initially randomized, 890 (55%) returned the complete questionnaire at 6 months. The rate of urinary incontinence was 36.6% in the "moderate" pushing group vs 38.5% in the "intensive" pushing group (relative risk, 0.95; 95% confidence interval, 0.80-1.13), whereas the rate of anal incontinence was 32.2% vs 34.6% (relative risk, 0.93; 95% confidence interval, 0.77-1.12). None of the obstetrical factors studied related to the second stage of labor influenced the occurrence of urinary or anal incontinence, except operative vaginal delivery, which increased the risk of anal incontinence (adjusted odds ratio, 1.50; 95% confidence interval, 1.04-2.15). CONCLUSION The results of the PASST trial indicate that neither moderate nor intensive pushing efforts affect the risk of urinary or anal incontinence at 6 months postpartum among women who gave birth under epidural analgesia.
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Affiliation(s)
- Ninon Dupuis
- Université Paris Cité, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Institut national de la santé et de la recherche médicale (Inserm), Institut national de recherche pour l'agriculture, l'alimentation et l'environnement (INRAE), Paris, France; Centre hospitalier universitaire (CHU) de Toulouse, Pole de Gynécologie Obstétrique, Hôpital Paule de Viguier, Toulouse, France.
| | | | | | - Patrick Rozenberg
- Service d'Obstétrique et Gynécologie, Centre hospitalier intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, France; Université Paris-Saclay, University of Versailles Saint-Quentin-en-Yvelines, Inserm, Equipe U1018, Epidémiologie clinique, Centre de recherche en Epidémiologie et Santé des Populations (CESP), Montigny-le-Bretonneux, France; Service d'Obstetrique et Gynécologie, Hôpital Américain de Paris, Neuilly-sur-Seine, France
| | - Gilles Kayem
- Université Paris Cité, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Institut national de la santé et de la recherche médicale (Inserm), Institut national de recherche pour l'agriculture, l'alimentation et l'environnement (INRAE), Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Service d'Obstétrique et Gynécologie, Hôpital Armand-Trousseau, Fighting Prematurity University Hospital Federation (FHU PREMA), Paris, France
| | - Thierry Harvey
- Hospital Group Diaconesses Croix Saint-Simon, Paris, France
| | - Laurent Mandelbrot
- AP-HP, Hôpital Louis Mourier, Service de Gynécologie-Obstétrique, Colombes, France
| | - Muriel Doret
- Obstetrics and Gynecology Department, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Florent Fuchs
- Department of Obstetrics and Gynecology, CHU de Montpellier, Montpellier, France; Inserm, CESP U1018, Reproduction and Child Development Team, Villejuif, France; Desbrest Institute of Epidemiology and Public Health, University of Montpellier, Montpellier, France
| | - Elie Azria
- Université Paris Cité, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Institut national de la santé et de la recherche médicale (Inserm), Institut national de recherche pour l'agriculture, l'alimentation et l'environnement (INRAE), Paris, France; Maternity Unit, Groupe hospitalier Paris Saint Joseph, Paris, France
| | - Marie-Victoire Sénat
- AP-HP, Department of Obstetrics and Gynecology, Bicêtre Hospital, University Paris-Saclay, Le Kremlin-Bicêtre, France
| | | | - Aurélien Seco
- Université Paris Cité, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Institut national de la santé et de la recherche médicale (Inserm), Institut national de recherche pour l'agriculture, l'alimentation et l'environnement (INRAE), Paris, France; Clinical Research Unit Necker-Cochin, AP-HP, Paris, France
| | - Anne Chantry
- Université Paris Cité, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Institut national de la santé et de la recherche médicale (Inserm), Institut national de recherche pour l'agriculture, l'alimentation et l'environnement (INRAE), Paris, France
| | - Camille Le Ray
- Université Paris Cité, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Institut national de la santé et de la recherche médicale (Inserm), Institut national de recherche pour l'agriculture, l'alimentation et l'environnement (INRAE), Paris, France; AP-HP, Maternity Port Royal, FHU PREMA, Paris, France
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Deffieux X, Rousset-Jablonski C, Gantois A, Brillac T, Maruani J, Maitrot-Mantelet L, Mignot S, Gaucher L, Athiel Y, Baffet H, Bailleul A, Bernard V, Bourdon M, Cardaillac C, Carneiro Y, Chariot P, Corroenne R, Dabi Y, Dahlem L, Frank S, Freyens A, Grouthier V, Hernandez I, Iraola E, Lambert M, Lauchet N, Legendre G, Le Lous M, Louis-Vahdat C, Martinat Sainte-Beuve A, Masson M, Matteo C, Pinton A, Sabbagh E, Sallee C, Thubert T, Heron I, Pizzoferrato AC, Artzner F, Tavenet A, Le Ray C, Fauconnier A. [Pelvic exam in gynecology and obstetrics: Guidelines for clinical practice]. Gynecol Obstet Fertil Senol 2023; 51:297-330. [PMID: 37258002 DOI: 10.1016/j.gofs.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To provide guidelines for the pelvic clinical exam in gynecology and obstetrics. MATERIAL AND METHODS A multidisciplinary experts consensus committee of 45 experts was formed, including representatives of patients' associations and users of the health system. The entire guidelines process was conducted independently of any funding. The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS The committee studied 40 questions within 4 fields for symptomatic or asymptomatic women (emergency conditions, gynecological consultation, gynecological diseases, obstetrics, and pregnancy). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology. RESULTS The experts' synthesis work and the application of the GRADE method resulted in 27 recommendations. Among the formalized recommendations, 17 present a strong agreement, 7 a weak agreement and 3 an expert consensus agreement. Thirteen questions resulted in an absence of recommendation due to lack of evidence in the literature. CONCLUSIONS The need to perform clinical examination in gynecological and obstetrics patients was specified in 27 pre-defined situations based on scientific evidence. More research is required to investigate the benefit in other cases.
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Affiliation(s)
- Xavier Deffieux
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, université Paris-Saclay, AP-HP, 92140 Clamart, France.
| | - Christine Rousset-Jablonski
- Département de chirurgie, Centre Léon Bérard, 28, rue Laënnec, 69008 Lyon, France; Inserm U1290, Research on Healthcare Performance (RESHAPE), université Claude-Bernard Lyon 1, 69008 Lyon, France; Service de Gynécologie-Obstétrique, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Adrien Gantois
- Collège national des sages-femmes de France hébergé au Réseau de santé périnatal parisien (RSPP), 75010 Paris, France
| | | | - Julia Maruani
- Cabinet médical, 6, rue Docteur-Albert-Schweitzer, 13006 Marseille, France
| | - Lorraine Maitrot-Mantelet
- Unité de gynécologie médicale, hôpital Port-Royal, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital universitaire Paris centre (HUPC), 75014 Paris, France
| | | | - Laurent Gaucher
- Collège national des sages-femmes de France, CNSF, 75010 Paris, France; Public Health Unit, hospices civils de Lyon, 69500 Bron, France; Inserm U1290, Research on Healthcare Performance (RESHAPE), université Claude-Bernard Lyon 1, 69008 Lyon, France; Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1206 Genève, Suisse
| | - Yoann Athiel
- Maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, université Paris cité, FHU Prema, 75014 Paris, France
| | - Hortense Baffet
- Service de gynécologie médicale, orthogénie et sexologie, CHU de Lille, université de Lille, 59000 Lille, France
| | - Alexandre Bailleul
- Service de gynécologie-obstétrique, centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France; Équipe RISCQ « Risques cliniques et sécurité en santé des femmes et en santé périnatale », université Paris-Saclay, UVSQ, 78180 Montigny-le-Bretonneux, France
| | - Valérie Bernard
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalo-universitaire Pellegrin, 33000 Bordeaux, France; Unité Inserm 1312, université de Bordeaux, Bordeaux Institute of Oncology, 33000 Bordeaux, France
| | - Mathilde Bourdon
- Service de gynécologie-obstétrique II et médecine de la reproduction, université Paris cité, AP-HP, centre hospitalier universitaire (CHU) Cochin Port-Royal, 75014 Paris, France
| | - Claire Cardaillac
- Service de gynécologie-obstétrique, CHU de Nantes, 44000 Nantes, France
| | | | - Patrick Chariot
- Département de médecine légale et sociale, Assistance publique-Hôpitaux de Paris, 93140 Bondy, France; Institut de recherche interdisciplinaire sur les enjeux sociaux, UMR 8156-997, UFR SMBH, université Sorbonne Paris Nord, 93000 Bobigny, France
| | - Romain Corroenne
- Service de gynécologue-obstétrique, CHU d'Angers, 49000 Angers, France
| | - Yohann Dabi
- Service de gynécologie-obstétrique et médecine de la reproduction, Sorbonne université-AP-HP-hôpital Tenon, 75020 Paris, France
| | - Laurence Dahlem
- Département universitaire de médecine générale, faculté de médecine, université de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux, France
| | - Sophie Frank
- Service d'oncogénétique, Institut Curie, 75005 Paris, France
| | - Anne Freyens
- Département universitaire de médecine générale (DUMG), université Paul-Sabatier, 31000 Toulouse, France
| | - Virginie Grouthier
- Service d'endocrinologie, diabétologie, nutrition et d'endocrinologie des gonades, Hôpital Haut Lévêque, Centre Hospitalo-universitaire régional de Bordeaux, 31000 Bordeaux, France; Université de Bordeaux, Inserm U1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Isabelle Hernandez
- Collège national des sages-femmes de France hébergé au Réseau de santé périnatal parisien (RSPP), 75010 Paris, France
| | - Elisabeth Iraola
- Institut de recherche interdisciplinaire sur les enjeux sociaux (IRIS), UMR 8156-997, CNRS U997 Inserm EHESS UP13 UFR SMBH, université Sorbonne Paris Nord, Paris, France; Direction de la protection maternelle et infantile et promotion de la santé, conseil départemental du Val-de-Marne, 94000 Créteil, France
| | - Marie Lambert
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalo-universitaire Pellegrin, 33000 Bordeaux, France
| | - Nadege Lauchet
- Groupe médical François-Perrin, 9, rue François-Perrin, 87000 Limoges, France
| | - Guillaume Legendre
- Service de gynécologue-obstétrique, CHU Angers, 49000 Angers, France; UMR_S1085, université d'Angers, CHU d'Angers, université de Rennes, Inserm, EHESP, Irset (institut de recherche en santé, environnement et travail), Angers, France
| | - Maela Le Lous
- Université de Rennes 1, Inserm, LTSI - UMR 1099, 35000 Rennes, France; Département de gynécologie et obstétrique, CHU de Rennes, 35000 Rennes, France
| | - Christine Louis-Vahdat
- Cabinet de gynécologie et obstétrique, 126, boulevard Saint-Germain, 75006 Paris, France
| | | | - Marine Masson
- Département de médecine générale, 86000 Poitiers, France
| | - Caroline Matteo
- Ecole de maïeutique, Aix Marseille Université, 13015 Marseille, France
| | - Anne Pinton
- Service de gynécologie-obstétrique, hôpital Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Sorbonne université, 75013 Paris, France
| | - Emmanuelle Sabbagh
- Unité de gynécologie médicale, hôpital Port-Royal, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital universitaire Paris centre (HUPC), 75014 Paris, France
| | - Camille Sallee
- Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Limoges, 87000 Limoges, France
| | - Thibault Thubert
- Service de gynecologie-obstétrique, CHU de Nantes, 44000 Nantes, France; EA 4334, laboratoire mouvement, interactions, performance (MIP), Nantes université, 44322 Nantes, France
| | - Isabelle Heron
- Service d'endocrinologie, université de Rouen, hôpital Charles-Nicolle, 76000 Rouen, France; Cabinet médical, Clinique Mathilde, 76100 Rouen, France
| | - Anne-Cécile Pizzoferrato
- Service de gynécologie-obstétrique, hôpital universitaire de La Miletrie, 86000 Poitiers, France; Inserm CIC 1402, université de Poitiers, 86000 Poitiers, France
| | - France Artzner
- Ciane, Collectif interassociatif autour de la naissance, c/o Anne Evrard, 101, rue Pierre-Corneille, 69003 Lyon, France
| | - Arounie Tavenet
- Endofrance, Association de lutte contre l'endométriose, 3, rue de la Gare, 70190 Tresilley, France
| | - Camille Le Ray
- Maternité Port-Royal, groupe hospitalier Paris Centre, AP-HP, université Paris cité, FHU Prema, 75014 Paris, France
| | - Arnaud Fauconnier
- Service de gynécologie-obstétrique, centre hospitalier de Poissy Saint-Germain-en-Laye, 78300 Poissy, France
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Pizzoferrato AC, Thuillier C, Vénara A, Bornsztein N, Bouquet S, Cayrac M, Cornillet-Bernard M, Cotelle O, Cour F, Cretinon S, De Reilhac P, Loriau J, Pellet F, Perrouin-Verbe MA, Pourcelot AG, Revel-Delhom C, Steenstrup B, Vogel T, Le Normand L, Fritel X. Management of female pelvic organ prolapse-Summary of the 2021 HAS guidelines. J Gynecol Obstet Hum Reprod 2023; 52:102535. [PMID: 36657614 DOI: 10.1016/j.jogoh.2023.102535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023]
Abstract
When a patient presents with symptoms suggestive of pelvic organ prolapse (POP), clinical evaluation should include an assessment of symptoms, their impact on daily life and rule out other pelvic pathologies. The prolapse should be described compartment by compartment, indicating the extent of the externalization for each. The diagnosis of POP is clinical. Additional exams may be requested to explore the symptoms associated or not explained by the observed prolapse. Pelvic floor muscle training and pessaries are non-surgical conservative treatment options recommended as first-line therapy for pelvic organ prolapse. They can be offered in combination and be associated with the management of modifiable risk factors for prolapse. If the conservative therapeutic options do not meet the patient's expectations, surgery should be proposed if the symptoms are disabling, related to pelvic organ prolapse, detected on clinical examination and significant (stage 2 or more of the POP-Q classification). Surgical routes for POP repair can be abdominal with mesh placement, or vaginal with autologous tissue. Laparoscopic sacrocolpopexy is recommended for cases of apical and anterior prolapse. Autologous vaginal surgery (including colpocleisis) is a recommended option for elderly and fragile patients. For cases of isolated rectocele, the posterior vaginal route with autologous tissue should be preferentially performed over the transanal route. The decision to place a mesh must be made in consultation with a multidisciplinary team. After the surgery, the patient should be reassessed by the surgeon, even in the absence of symptoms or complications, and in the long term by a primary care or specialist doctor.
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Affiliation(s)
- Anne-Cécile Pizzoferrato
- Department of Obstetrics and Gynaecology, La Miletrie University Hospital, Poitiers, France, INSERM CIC 1402, Poitiers University, Poitiers, France.
| | - Caroline Thuillier
- Department of Urology, Grenoble Alpes University Hospital, Grenoble, France
| | - Aurélien Vénara
- Department of Digestive Surgery, Angers University Hospital, Angers, France
| | - Nicole Bornsztein
- General practice office, Evry France, College of General Medicine, Paris, France
| | - Sylvain Bouquet
- General practice office, Lamastre, France, College of General Medicine, Paris, France
| | - Mélanie Cayrac
- GYNEPOLE, Obstetrics and Gynecology Center, Montpellier, France
| | | | - Odile Cotelle
- Department of Obstetrics and Gynaecology, AP-HP, GHU Sud, Antoine Béclère Hospital, Clamart, France
| | - Florence Cour
- Department of Urology, Foch Hospital, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - Sophie Cretinon
- Department of Obstetrics and Gynaecology, AP-HP Louis Mourier Hospital, Colombes, France
| | | | - Jérôme Loriau
- Department of Digestive Surgery, St-Joseph Hospital, Paris, France
| | - Françoise Pellet
- French Association of Gougerot Sjögren and Dry Syndromes, Paris, France
| | | | - Anne-Gaëlle Pourcelot
- Department of Gynecology and Obstetrics, AP-HP, GHU-Sud, Bicêtre Hospital, Le Kremlin Bicêtre, France
| | - Christine Revel-Delhom
- Clinical practice guidelines Unit, French National Authority for Health, Saint Denis La Plaine, France
| | | | - Thomas Vogel
- Geriatric Department, University Hospital of Strasbourg, Strasbourg, France
| | - Loïc Le Normand
- Department of Urology, Nantes University Hospital, Nantes, France
| | - Xavier Fritel
- Department of Obstetrics and Gynaecology, La Miletrie University Hospital, Poitiers, France, INSERM CIC 1402, Poitiers University, Poitiers, France
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Pizzoferrato AC, Briant AR, Le Grand C, Gaichies L, Fauvet R, Fauconnier A, Fritel X. Influence of prenatal urinary incontinence and mode of delivery in postnatal urinary incontinence: A systematic review and meta-analysis. J Gynecol Obstet Hum Reprod 2023; 52:102536. [PMID: 36646318 DOI: 10.1016/j.jogoh.2023.102536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND It is likely that the pathophysiology of urinary incontinence (UI) differs between women who are incontinent before the first delivery and those whose incontinence occurs after. In this systematic review, we aimed to assess the association between the mode of delivery and the risk of postpartum UI in primiparous women with and without prenatal UI. METHODS We searched MEDLINE, Cochrane, Web of Science, Embase and CINHAL databases. Prospective studies including primiparous women during their pregnancy with a comparison of the rate of postpartum UI in women who underwent cesarean delivery or vaginal delivery according to continence status before delivery were included. The Risk Ratio (RR) was calculated with a 95% confidence interval (95% CI) using the total number of events and patients extracted from the individual studies. A subgroup comparison analysed the potential influence of women's prenatal continence status. Heterogeneity was estimated using I² statistics. RESULTS The risk of postpartum UI was significantly higher after vaginal delivery than after cesarean section (RR 1.80, 95% CI 1.48- 2.18). According to the subgroup test, the postpartum UI risk following a vaginal delivery, compared to cesarean section, was significantly higher in the subgroup of continent women during pregnancy (RR 2.57, 95% CI 2.17-3.04) than in the subgroup of incontinent pregnant women (1.56, 95% CI 1.27-1.92). CONCLUSIONS The effect of a cesarean section in preventing postpartum UI appears controversial, particularly in women with prenatal UI.
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Affiliation(s)
- A C Pizzoferrato
- Department of Obstetrics and Gynecology, La Miletrie University Hospital, Poitiers, France; Poitiers University, INSERM CIC 1402, Poitiers, France.
| | - A R Briant
- Clinical Research Department, Caen University Hospital, Caen 14000, France
| | - C Le Grand
- Department of Obstetrics and Gynecology, University Hospital center of Caen, Avenue Cpote de Nacre, 14033 Caen Cedex 9, Caen 14000, Caen
| | - L Gaichies
- Department of Obstetrics and Gynecology, University Hospital center of Caen, Avenue Cpote de Nacre, 14033 Caen Cedex 9, Caen 14000, Caen
| | - R Fauvet
- Department of Obstetrics and Gynecology, University Hospital center of Caen, Avenue Cpote de Nacre, 14033 Caen Cedex 9, Caen 14000, Caen; Caen Normandie University, Inserm U1086 "ANTICIPE", Unité de recherche Interdisciplinaire pour la Prévention et le Traitement des Cancers, Axe 2: Biologie et Thérapies Innovantes des cancers Localement Agressifs (BIOTICLA), Caen 14000, France
| | - A Fauconnier
- Department of Obstetrics and Gynaecology, Intercommunal Hospital Center of Poissy-St Germain en Laye, Poissy, France; Research unit EA7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, Versailles St-Quentin University, Montigny-le-Bretonneux, France
| | - X Fritel
- Department of Obstetrics and Gynecology, La Miletrie University Hospital, Poitiers, France; Poitiers University, INSERM CIC 1402, Poitiers, France
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Pizzoferrato AC, Ragot S, Vérité L, Naiditch N, Fritel X. How Women Perceive Severity of Complications after Pelvic Floor Repair? J Clin Med 2022; 11:jcm11133796. [PMID: 35807080 PMCID: PMC9267401 DOI: 10.3390/jcm11133796] [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: 05/19/2022] [Revised: 06/24/2022] [Accepted: 06/29/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The Clavien-Dindo classification, used to describe postoperative complications, does not take into account patient perception of severity. Our main objective was to assess women’s perception of postoperative pelvic floor repair complications and compare it to the classification of Clavien-Dindo. Methods: Women and surgeons participating in the VIGI-MESH registry concerning pelvic floor repair surgery were invited to quote their perception of complication severity through a survey based on 30 clinical vignettes. For each vignette, four grades of severity were proposed: “not serious”, “a little serious”, “serious”, “very serious”. Results: Among the 1146 registered women, we received 529 responses (46.2%) and 70 of the 141 surgeons (49.6%) returned a completed questionnaire. A total of 25 of the 30 vignettes were considered classifiable according to the Clavien-Dindo classification. The women’s classification was concordant with Clavien-Dindo for 52.0% (13/25) of the classifiable vignettes. The women’s and surgeons’ responses were discordant for 20 of the 30 clinical vignettes (66.7%). Loss of autonomy (self-catheterization, long-term medication use) or occurrence of sequelae (organ damage or severe persistent pain) were perceived by women as more serious than Clavien-Dindo classification or than surgeons’ perceptions. Conclusions: Women’s perception of pelvic floor repair surgery seems different from the Clavien-Dindo classification. Lack of repair and long-term disability seem to be two major factors in favor of perception of the surgical complication as serious.
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Affiliation(s)
- Anne-Cécile Pizzoferrato
- Department of Obstetrics and Gynaecology, Caen University Hospital Center, 14000 Caen, France
- Correspondence: ; Tel.: +33-(0)2-31-27-27-23
| | - Stéphanie Ragot
- INSERM CIC 1402, Poitiers University, 86021 Poitiers, France; (S.R.); (L.V.); (X.F.)
| | - Louis Vérité
- INSERM CIC 1402, Poitiers University, 86021 Poitiers, France; (S.R.); (L.V.); (X.F.)
| | - Nicolas Naiditch
- Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery Laboratory (PRISMATICS), Poitiers University Hospital, 86021 Poitiers, France;
| | - Xavier Fritel
- INSERM CIC 1402, Poitiers University, 86021 Poitiers, France; (S.R.); (L.V.); (X.F.)
- Department of Obstetrics and Gynaecology, La Miletrie University Hospital, 86000 Poitiers, France
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Berujon E, Thubert T, Fauvet R, Villot A, Pizzoferrato AC. Impact of uterine fibroid surgery on lower urinary tract symptoms. J Gynecol Obstet Hum Reprod 2022; 51:102355. [DOI: 10.1016/j.jogoh.2022.102355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/07/2022] [Accepted: 03/12/2022] [Indexed: 11/29/2022]
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Pizzoferrato AC, Nyangoh-Timoh K, Martin-Lasnel M, Fauvet R, de Tayrac R, Villot A. Vaginal Pessary for Pelvic Organ Prolapse: A French Multidisciplinary Survey. J Womens Health (Larchmt) 2021; 31:870-877. [PMID: 34569823 DOI: 10.1089/jwh.2021.0229] [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] [Indexed: 11/13/2022] Open
Abstract
Objective: Pessary fitting and follow-up for women with pelvic organ prolapse (POP) can be performed by different health care practitioners (HCPs). We aimed to investigate knowledge and current practices among the main HCPs involved in pessary use in France. Materials and Methods: We sent an electronic questionnaire about pessary use to the members of eight French learned societies between April and October 2020. Results: During the study period, 1017 HCPs responded to the questionnaire: 712 (70.0%) were doctors, 208 (20.4%) physiotherapists, 95 (9.3%) midwives, and 7 (0.6%) nurses. Of the respondents, 69.1% claimed to be comfortable with pessary fitting and follow-up, and 54.1% think that a pessary can be offered as a first-line treatment in the management of POP. However, 60.1% reported that the main indications for pessaries were "older women," 71.3% for women with contraindications to surgery, and 60.5% for women waiting for surgery. 23.9% do not prescribe local estrogen therapy with a pessary for postmenopausal women. The main pessaries used are the ring and cube types (63.7 and 57.5%, respectively). Wide introitus (53.3%), difficulties of use (56.3%), a short vagina (41.4%), and major unmasked urinary incontinence (47.2%) are considered to be the main risk factors for pessary failure. The most common complications related to pessaries reported by the patients are vaginal discharge (48.6%) and pain or discomfort (40.6%). Up to 43.4% of respondents considered that a follow-up visit every 3-6 months was optimal. The need for training ranged from 42.8% for nurses to 65.2% for general practitioners. Conclusions: This national multidisciplinary survey revealed that HCPs in France are on the whole comfortable with pessaries and mainly prescribe the ring and cube form. Even if opinion about pessaries appears to be changing, HCPs would welcome additional training to improve knowledge and practices.
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Affiliation(s)
- Anne-Cécile Pizzoferrato
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Caen University Hospital, Caen, France
| | - Krystel Nyangoh-Timoh
- Inserm, LTSI-UMR 1099 Unit, Department of Obstetrics and Gynecology, Rennes Hospital, Rennes University 1, Rennes, France
| | - Mathilde Martin-Lasnel
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Caen University Hospital, Caen, France
| | - Raffaèle Fauvet
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Caen University Hospital, Caen, France.,Inserm U1086 ANTICIPE Unit, Caen Normandie University, Caen, France
| | - Renaud de Tayrac
- Department of Obstetrics and Gynaecology, Carémeau University Hospital, Nîmes, France
| | - Anne Villot
- Department of Obstetrics and Gynecology, Cotentin Public Hospital Center, Cherbourg, France
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Blanchard V, Nyangoh-Timoh K, Fritel X, Fauconnier A, Pizzoferrato AC. Importance of a pelvic floor lifestyle program in women with pelvic floor dysfunctions: A pilot study. J Gynecol Obstet Hum Reprod 2020; 50:102032. [PMID: 33278657 DOI: 10.1016/j.jogoh.2020.102032] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/23/2020] [Accepted: 11/28/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We aimed to assess the impact of an educational program on the symptoms and quality of life of patients undergoing supervised pelvic floor muscle training (PFMT). Secondary objectives included: baseline assessment of patients' knowledge of the pelvic floor; and patient satisfaction and symptom improvement after the entire PFMT program. MATERIAL AND METHODS An observational questionnaire-based study in women attending a PFMT program consisting of four educational sessions, one visual feedback session, and five personalized training sessions. The patients completed the questionnaire at baseline, after the four educational sessions and then after completion of program. The questionnaires included the ICIQ-SF, USP, Contilife, PFDI 20, Kess and Wexner scores. Additional questions were added before treatment about the patient's knowledge of the pelvic floor. RESULTS Seventy-nine women were included. Improvement in symptoms was significant after the four educational sessions: mean PFDI-20 score decreased from 68.5-29.5 (p < 0.05); ICIQ-SF score from 8.0-3.1 (p < 0.05), Wexner and Kess scores from 8.2-6.5 and from 13.3-10 (p < 0.05). Symptom scores were also all significantly improved on completion of the program. After the four educational sessions, 50 of the 68 patients (73.5 %) with complete questionnaires reported feeling better or much better. Only 12 (15.2 %) women overall located the pelvic floor across the entire bottom of the pelvis. CONCLUSION This preliminary study suggests that four educational sessions can improve symptoms and quality of life before PFM reinforcement itself. If confirmed by larger prospective studies, a solid educational element should be systematically integrated in all PFMT programs.
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Affiliation(s)
| | - Krystel Nyangoh-Timoh
- Rennes University, Anatomy Laboratory, University Hospital of Rennes 1, Rennes, France
| | - Xavier Fritel
- Poitiers University, INSERM CIC1402, University Hospital of Poitiers, Poitiers, France
| | - Arnaud Fauconnier
- Paris-Saclay University, UVSQ, Research Unit 7285 "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Department of Gynaecology and Obstetrics, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, 10 rue du Champ Gaillard, 78103 Poissy, France
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Dolivet E, Foulon A, Simonet T, Sanguin S, Turck M, Pizzoferrato AC, Fauvet R. AMeTHYST (AMbulatory HYsterectomy surgery). Feasibility of minimally invasive outpatient hysterectomy, a preliminary study. Eur J Obstet Gynecol Reprod Biol 2020; 252:412-417. [PMID: 32712532 DOI: 10.1016/j.ejogrb.2020.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/30/2020] [Accepted: 07/10/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Hysterectomy, one of the most frequent surgical procedures in women, is commonly performed by a minimally-invasive approach (laparoscopic or vaginal) as recommended by the French guidelines. The French authorities aim to have 66 % of all procedures performed as same-day surgery in 2020. The aim of this study was to evaluate the feasibility and identify factors associated with success or failure of same-day surgery for minimally-invasive hysterectomy. STUDY DESIGN We conducted a prospective double-center observational study at the Caen and Amiens University Hospitals between September 2017 and May 2018 including hospitalized patients managed for a laparoscopic or vaginal hysterectomy. Patients were younger than 70 and have no major medical problems. The patients were placed into a "fit" or "unfit" group according to their Post Anaesthetic Discharge Scoring System (PADSS) score 6 h post-surgery. All the patients were asked to complete an assessment questionnaire during their hospitalization. RESULTS Of the 50 included patients, half were placed in the "fit" group. A history of laparotomy was significantly predictive of failure of same-day discharge (p = 0.003) but not uterine size or Body Mass Index (BMI). The main barriers for discharge were pain (p<0.001) and postoperative nausea/vomiting (PONV) (p<0.001). Four patients, all in the "unfit" group, had Clavien-Dindo grade 1 postoperative complications. CONCLUSION Same-day minimally invasive hysterectomy is a feasible and safe procedure. Factors associated with same-day hysterectomy failure were laparotomy, pain and postoperative nausea/vomiting.
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Affiliation(s)
- Enora Dolivet
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, University Hospital of CAEN, France; Surgery Department, Centre François Baclesse, Caen, France
| | - Arthur Foulon
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, University Hospital of AMIENS, France
| | - Thérèse Simonet
- Department of Anesthesiae, University Hospital of CAEN, France
| | - Sophie Sanguin
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, University Hospital of AMIENS, France
| | - Mélusine Turck
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, University Hospital of CAEN, France
| | - Anne-Cécile Pizzoferrato
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, University Hospital of CAEN, France
| | - Raffaèle Fauvet
- Department of Gynaecology, Obstetrics, and Reproductive Medicine, University Hospital of CAEN, France; Caen Normandie University, Inserm U1086 « ANTICIPE », Unité de Recherche Interdisciplinaire pour la Prévention et le Traitement des Cancers, Axe 2 : Biologie et Thérapies Innovantes des Cancers Localement Agressifs (BioTICLA), France.
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Vardon D, Martin-Lasnel M, Agostini A, Fauvet R, Pizzoferrato AC. Vaginal pessary for pelvic organ prolapse: A survey among french gynecological surgeons. J Gynecol Obstet Hum Reprod 2020; 50:101833. [PMID: 32585395 DOI: 10.1016/j.jogoh.2020.101833] [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: 05/18/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Because pessaries may offer symptomatic improvement for women with pelvic organ prolapse (POP), the study aimed to assess the opinion and knowledge of participants to a french general surgical gynecological congress, about this device. MATERIAL AND METHODS An anonymous survey was carried out near 150 surgeons attending a congress by handing them a questionnaire. RESULTS The average age of the 70 respondents was 50 years. 87.7 % were comfortable with fitting and monitoring pessary, 54.3 % think that a pessary can be offered as a first-line treatment in the management of POP. However, main indications of vaginal device are still old women and contraindications to surgery ; 31.4 % do not associate local estrogen therapy with a pessary for postmenopausal women. CONCLUSION The majority declares to be comfortable with pessaries, is ready to prescribe it as a first-line treatment and use local estrogen if necessary. Even if change of ideas seems to emerge about pessary, a change in beliefs and habits is still necessary. This progress can be achieved through doctors fully informed.
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Affiliation(s)
- Delphine Vardon
- Department of Obstetrics and Gynecology, Caen University Hospital, Pôle Femme-Enfant, Avenue de la Côte de Nacre, 14033 Caen Cedex, France.
| | - Mathilde Martin-Lasnel
- Department of Obstetrics and Gynecology, Caen University Hospital, Pôle Femme-Enfant, Avenue de la Côte de Nacre, 14033 Caen Cedex, France
| | - Aubert Agostini
- Department of Obstetrics and Gynecology, La Conception Hospital, AP-HM, 147 Boulevard Baille, 13 005 Marseille, France; Aix-Marseille Medical University, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France
| | - Raffaèle Fauvet
- Department of Obstetrics and Gynecology, Caen University Hospital, Pôle Femme-Enfant, Avenue de la Côte de Nacre, 14033 Caen Cedex, France; Caen Medical University, 19 Rue Claude Blosh, 14000 Caen, France
| | - Anne-Cécile Pizzoferrato
- Department of Obstetrics and Gynecology, Caen University Hospital, Pôle Femme-Enfant, Avenue de la Côte de Nacre, 14033 Caen Cedex, France
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Zeitoun J, Pizzoferrato AC, Philippart J, Gaichies L, Benoist G, Fauvet R. Clitoral abscess, a rare cause of gynecological emergency: Diagnosis and management. Eur J Obstet Gynecol Reprod Biol 2020; 252:625-627. [PMID: 32593473 DOI: 10.1016/j.ejogrb.2020.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/08/2020] [Accepted: 06/15/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Jérémie Zeitoun
- Service de gynécologie obstétrique et médecine de la reproduction, Pôle femme-enfant Avenue de la côte de Nacre, CHU Caen Normandie, 14033, Caen, France; UFR de médecine, Université Caen Normandie, PFRS, 2 rue des Rochambelles, 14032, Caen Cedex 5, France.
| | - Anne-Cécile Pizzoferrato
- Service de gynécologie obstétrique et médecine de la reproduction, Pôle femme-enfant Avenue de la côte de Nacre, CHU Caen Normandie, 14033, Caen, France
| | - Jérôme Philippart
- CH Avranches-Granville - Site d'Avranches 59 Rue de la Liberté, 50300, Avranches, France
| | - Léopold Gaichies
- Service de gynécologie obstétrique et médecine de la reproduction, Pôle femme-enfant Avenue de la côte de Nacre, CHU Caen Normandie, 14033, Caen, France; UFR de médecine, Université Caen Normandie, PFRS, 2 rue des Rochambelles, 14032, Caen Cedex 5, France
| | - Guillaume Benoist
- Service de gynécologie obstétrique et médecine de la reproduction, Pôle femme-enfant Avenue de la côte de Nacre, CHU Caen Normandie, 14033, Caen, France; UFR de médecine, Université Caen Normandie, PFRS, 2 rue des Rochambelles, 14032, Caen Cedex 5, France; Réseau de périnatalité, CHU Caen Normandie, 14033, Caen, France
| | - Raffaèle Fauvet
- Service de gynécologie obstétrique et médecine de la reproduction, Pôle femme-enfant Avenue de la côte de Nacre, CHU Caen Normandie, 14033, Caen, France; UFR de médecine, Université Caen Normandie, PFRS, 2 rue des Rochambelles, 14032, Caen Cedex 5, France; Réseau de périnatalité, CHU Caen Normandie, 14033, Caen, France
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Dompeyre P, Pizzoferrato AC, Le Normand L, Bader G, Fauconnier A. Valsalva urethral profile (VUP): A urodynamic measure to assess stress urinary incontinence in women. Neurourol Urodyn 2020; 39:1515-1522. [PMID: 32394516 DOI: 10.1002/nau.24386] [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: 03/18/2020] [Revised: 04/25/2020] [Accepted: 05/01/2020] [Indexed: 11/06/2022]
Abstract
AIMS We aimed to assess the value of the Valsalva urethral profile (VUP) in case of stress urinary incontinence (SUI). METHODS Six hundred and ninety-four women without pelvic organ prolapse were included in this prospective monocentric study. SUI was diagnosed from symptoms using the International Continence Society definition, and severity using two validated questionnaires (USP and ICIQ-SF). The urodynamic parameters studied were maximal urethral closure pressure (MUCP) and functional length (FL). Both were performed at rest, during a Valsalva maneuver (v-MUCP and v-FL) and again at rest. Correlation analyses and ROC curves were used to assess the value of the clinical and urodynamic measurements. RESULTS In our population, based on the questionnaires, 172 (24.8%) women were diagnosed with pure SUI on symptoms, 71 (10.2%) with urgency urinary incontinence and 392 (56.5%) with mixed urinary incontinence; 59 (8.5%) women were continent. The v-MUCP was the most correlated parameter to the severity of SUI (ρ: -0.63) and the most predictive of SUI risk, with a threshold value of 35 cm H2 O (Se = 0.82, Sp = 0.86). The v-FL was significantly shortened in case of SUI. CONCLUSIONS The v-MUCP and v-FL are global measurements of urethral resistance during stress. With a threshold value of 35 cm H2 O, the v-MUCP was the most discriminating parameter for the diagnosis of SUI, with a good reliability.
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Affiliation(s)
- Philippe Dompeyre
- Department of Gynecology and Obstetrics, Intercommunal Hospital Center of Poissy-St Germain en Laye, Poissy, France
| | - Anne-Cécile Pizzoferrato
- Department of Gynecology and Obstetrics, University Hospital of Caen, Caen, France.,Department of Biology, Medicine and Health, Research unit EA7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, Versailles St-Quentin University, Montigny-le-Bretonneux, France
| | - Loïc Le Normand
- Department of Urology, University Hospital of Nantes, Nantes, France
| | - Georges Bader
- Department of Gynecology and Obstetrics, Intercommunal Hospital Center of Poissy-St Germain en Laye, Poissy, France
| | - Arnaud Fauconnier
- Department of Gynecology and Obstetrics, Intercommunal Hospital Center of Poissy-St Germain en Laye, Poissy, France.,Department of Biology, Medicine and Health, Research unit EA7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, Versailles St-Quentin University, Montigny-le-Bretonneux, France
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Blanchard V, Nyangoh Timoh K, Bruyère F, Fritel X, Pizzoferrato AC. [Benefits of pelvic floor education in perineal re-education in women]. Prog Urol 2020; 30:190-197. [PMID: 32067907 DOI: 10.1016/j.purol.2020.01.004] [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: 11/08/2019] [Revised: 01/23/2020] [Accepted: 01/23/2020] [Indexed: 12/15/2022]
Abstract
AIM Evaluate the impact of pelvic floor education on the symptoms of female patients referred for pelvic floor muscle training (PFMT). METHODS Forty female patients suffering from pelvic floor disorders and referred to independent practice for PFME between February and May 2019 answered a survey on symptoms and quality of life before PFME, after four sessions of pelvic floor education and at the end of PFME. The ICIQ-SF, USP, Contilife, PDFI 20, Kess, and Wexner scores were used to evaluate the results. The protocol consisted in four initial sessions of pelvic floor education including information on each field of perineology ; the fifth session was dedicated to visual feedback using a mirror ; the following five sessions were tailored according to the care objectives established based on the initial assessment. RESULTS The scores were significantly improved after the four initial sessions of pelvic floor education. The improvement was significant at the end of the re-education program. The PFDI-20 score dropped from 66,9 to 20,9 (P=0,002), the ICIQ-SF score from 8,4 to 1,5 (P<10-3), the Wexner score from 7,4 to 5,1 (P<10-3) and the Kess score from 14,2 to 8,7 (P=0,05). CONCLUSION The results showed that female patients undergoing perineal re-education including pelvic floor education sessions show a significant improvement in their symptoms already immediately after the pelvic floor education sessions.
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Affiliation(s)
- V Blanchard
- Cabinet de rééducation périnéale, Chanceaux-Sur-Choisille, France
| | - K Nyangoh Timoh
- Université de Rennes, Laboratoire d'Anatomie, Hôpital Universitaire de Rennes 1, Rennes, France
| | - F Bruyère
- Université François Rabelais de Tours, PRES Centre Val-de-Loire, Tours, France
| | - X Fritel
- Université de Poitiers, Inserm CIC1402, Hôpital Universitaire de Poitiers, Poitiers, France
| | - A C Pizzoferrato
- Département de Gynécologie-Obstétrique, Hôpital Universitaire de Caen Normandie, avenue Côte-de-Nacre, 14033 Caen cedex 9, France.
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Villot A, Pizzoferrato AC, Longie A, Paniel BJ, Fauconnier A. Technical considerations and mid-term follow-up after vaginal hysterocolpectomy with colpocleisis for pelvic organ prolapse. Eur J Obstet Gynecol Reprod Biol 2020; 247:73-79. [PMID: 32086114 DOI: 10.1016/j.ejogrb.2020.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES At the time of controversies on surgical treatment of pelvic organ prolapse, our aim was to describe an effective technique of hysterocolpectomy with colpocleisis for elderly patients not wishing to maintain vaginal sexual activity and present mid-term results including pelvic floor symptoms and quality of life, patient satisfaction and surgical complications using validated scores. STUDY DESIGN We conducted a retrospective study of all patients having undergone this surgery between June 2006 and June 2016. Women were examined using POP-Q classification and completed validated questionnaires concerning symptoms and quality of life before and after the surgery. Patient satisfaction was assessed using the PGI-I. Complications were described according to the Clavien-Dindo classification. RESULTS During the 10-year period, 37 women underwent the surgery with a mean age at surgery of 81.2 years (range: 61-93 years). One per-operative complication occurred (a rectal wound that was sutured) and five Clavien-Dindo grade 3b postoperative complications. Three repeat operations were necessary within 15 days; one suburethral sling had to be lowered because of urinary retention; one tension-free vaginal tape had to be unilaterally sectioned for acute urinary retention; and one woman presented a pararectal abscess requiring surgical drainage. The mean duration of hospitalization was 5.5 (+/-4.2) days. The mean follow-up time was 44.1 (±30.1) months. All symptoms and quality of life scores decreased significantly after the surgery and patient satisfaction was good (PGI-I score = 1.55 +/-0.8). CONCLUSIONS Hysterocolpectomy with colpocleisis appears to be an effective treatment with a high level of patient satisfaction among the elderly.
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Affiliation(s)
- Anne Villot
- Department of Gynaecology and Obstetrics, University Hospital of Caen, Caen, France; Caen Normandie University, Caen, France
| | - Anne-Cécile Pizzoferrato
- Department of Gynaecology and Obstetrics, University Hospital of Caen, Caen, France; Research Unit EA7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, Versailles St-Quentin University, Montigny-le-Bretonneux, France.
| | - Annie Longie
- Department of Gynaecology and Obstetrics, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, Poissy, France
| | | | - Arnaud Fauconnier
- Research Unit EA7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, Versailles St-Quentin University, Montigny-le-Bretonneux, France; Paris-Est University, Creteil, France
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Mourgues J, Villot A, Thubert T, Fauvet R, Pizzoferrato AC. Uterine myomas and lower urinary tract dysfunctions: A literature review. J Gynecol Obstet Hum Reprod 2019; 48:771-774. [PMID: 30905852 DOI: 10.1016/j.jogoh.2019.03.021] [Citation(s) in RCA: 6] [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: 12/28/2018] [Revised: 03/17/2019] [Accepted: 03/20/2019] [Indexed: 12/12/2022]
Abstract
Different types of urinary symptoms associated with myomas are reported, including urinary incontinence or dysuria. They are rarely investigated in patients and their prevalence is not well known. While myomas are the first reason to perform hysterectomy in France, few studies have evaluated the impact of surgical treatment in women with urinary symptoms. Our objective was to conduct a review of the literature regarding urinary symptoms associated with myomas and the impact of their treatment on these symptoms. We reviewed articles indexed in MEDLINE dealing with urinary symptoms and myomas, and published until September 2018. The prevalence of urinary symptoms in women with uterine myomas is highly variable depending on whether the authors are interested in symptoms or urodynamic results. The most frequently reported urinary symptoms are urgency (31-59%), dysuria (4-36%) and stress urinary incontinence (SUI, 20 80%). While some studies have found the anterior location of myomas and the size superior to 5 cm as a risk factor for UI, other studies have not found a correlation between myomas topography and symptom scores. The treatments of uterine myomas seem to have an impact on women's urinary symptoms. Although hysterectomy is considered as a risk factor for pelvic floor disorders, the removal of the uterus may sometimes improve or cure urinary symptoms. Most authors also found a significant improvement in urinary symptom scores after myomectomy and myomas embolization. More studies are needed to clarify the impact of myomas treatment on urinary symptoms.
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Affiliation(s)
- Julie Mourgues
- Department of Gynaecology and Obstetrics, University Hospital of Caen, Caen, France
| | - Anne Villot
- Department of Gynaecology and Obstetrics, University Hospital of Caen, Caen, France
| | - Thibault Thubert
- Department of Gynaecology and Obstetrics, University Hospital of Nantes, Nantes, France
| | - Raffaèle Fauvet
- Department of Gynaecology and Obstetrics, University Hospital of Caen, Caen, France; Normandie University, UNICAEN, Unité de recherche Inserm U1086 « ANTICIPE » - Axe 2 : Biologie et Thérapies Innovantes des Cancers Localement Agressifs (BioTICLA), Caen, France
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Pizzoferrato AC, Ducarme G, Jacquetin B, Fritel X. [Perineal Prevention and Protection in Obstetrics: CNGOF Guidelines for Clinical Practice - Introduction, Objectives, Methods, Definitions, Organization and Limits]. ACTA ACUST UNITED AC 2018; 46:889-892. [PMID: 30392992 DOI: 10.1016/j.gofs.2018.10.033] [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: 10/04/2018] [Indexed: 10/27/2022]
Affiliation(s)
- A C Pizzoferrato
- Service de gynécologie-obstétrique, CHU Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
| | - G Ducarme
- Service de gynécologie-obstétrique, centre hospitalier départemental Vendée, boulevard Stéphane-Moreau, 85000 La-Roche-sur-Yon, France
| | - B Jacquetin
- Pôle Femme-Enfant, CHU Estaing, 1, place Lucie-Aubrac, 63001 Clermont-Ferrand, France
| | - X Fritel
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, université de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
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Ducarme G, Pizzoferrato AC, de Tayrac R, Schantz C, Thubert T, Le Ray C, Riethmuller D, Verspyck E, Gachon B, Pierre F, Artzner F, Jacquetin B, Fritel X. [Perineal prevention and protection in obstetrics: CNGOF Clinical Practice Guidelines (short version)]. ACTA ACUST UNITED AC 2018; 46:893-899. [PMID: 30391283 DOI: 10.1016/j.gofs.2018.10.032] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The objective of these clinical practice guidelines was to analyse all of the interventions during pregnancy and childbirth that might prevent obstetric anal sphincter injuries (OASIS) and postnatal pelvic floor symptoms. MATERIAL AND METHODS These guidelines were developed in accordance with the methods prescribed by the French Health Authority (HAS). RESULTS A prenatal clinical examination of the perineum is recommended for women with a history of Crohn's disease, OASIS, genital mutilation, or perianal lesions (professional consensus). Just after delivery, a perineal examination is recommended to check for OASIS (Grade B); if there is doubt about the diagnosis, a second opinion should be requested (GradeC). In case of OASIS, the injuries (including their severity) and the technique for their repair should be described in detail (GradeC). Perineal massage during pregnancy must be encouraged among women who want it (Grade B). No intervention conducted before the start of the active phase of the second stage of labour has been shown to be effective in reducing the risk of perineal injury. The crowning of the baby's head should be manually controlled and the posterior perineum manually supported to reduce the risk of OASIS (GradeC). The performance of an episiotomy during normal deliveries is not recommended to reduce the risk of OASIS (Grade A). In instrumental deliveries, episiotomy may be indicated to avoid OASIS (GradeC). When an episiotomy is performed, a mediolateral incision is recommended (Grade B). The indication for episiotomy should be explained to the woman, and she should consent before its performance. Advising women to have a caesarean delivery for primary prevention of postnatal urinary or anal incontinence is not recommended (Grade B). During pregnancy and again in the labour room, obstetrics professionals should focus on the woman's expectations and inform her about the modes of delivery.
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Affiliation(s)
- G Ducarme
- Service de gynécologie-obstétrique, centre hospitalier départemental Vendée, boulevard Stéphane-Moreau, 85000 La Roche-sur-Yon, France.
| | - A C Pizzoferrato
- Service de gynécologie-obstétrique, CHU Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - R de Tayrac
- Service de gynécologie-obstétrique, CHU Carémeau, place du Pr-Debré, 30900 Nîmes, France
| | - C Schantz
- Centre population et développement (Ceped), institut de la recherche et du développement (IRD), université Paris Descartes, Inserm, Commission scientifique du Collège national des sages-femmes (CNSF), 75000 Paris, France
| | - T Thubert
- Service de gynécologie-obstétrique, CHU Hôtel-Dieu, hôpitaux de Nantes, université de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France; GMC-UPMC 01, GREEN (Groupe de recherche clinique en neurourologie), 4, rue de la Chine, 75020 Paris, France
| | - C Le Ray
- Maternité Port-Royal, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 123, boulevard de Port-Royal, 75014 Paris, France; Inserm U1153, épidémiologie obstétricale, périnatale et pédiatrique (équipe EPOPé), centre de recherche en épidémiologie et statistiques Sorbonne Paris cité (CRESS), DHU risques et grossesse, université Paris Descartes, 75014 Paris, France
| | - D Riethmuller
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - E Verspyck
- Service de gynécologie-obstétrique, CHU Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - B Gachon
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, université de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - F Pierre
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, université de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - F Artzner
- Collectif inter-associatif autour de la naissance (CIANE), 40, rue de Chanzy, 75011 Paris, France
| | - B Jacquetin
- Pôle Femme-Enfant, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - X Fritel
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, université de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
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Pizzoferrato AC, Fritel X. [Preoperative functional explorations of genital prolapse (urodynamics, dynamic MRI)]. ACTA ACUST UNITED AC 2018; 46:593-597. [PMID: 29997048 DOI: 10.1016/j.gofs.2018.06.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Indexed: 11/28/2022]
Abstract
The evaluation of genital prolapse is essentially clinical; however imaging tests such as dynamic MRI or urodynamic explorations may be useful in complex cases, especially before surgical management. Dynamic MRI allows morphological and dynamic analysis of pelvic floor and levator ani function. It can also detect post-obstetric injuries, although the long-term significance of these injuries remains to be discovered. Quantification of the severity of prolapse is possible with MRI; however, the correlation of these measures with clinical examination seems poor. Its interest lies mainly in the qualitative assessment of the three stages of prolapse and the detection of elytroceles, which can be difficult to clinical examination. Urodynamics provides useful information on vesico-sphincteric function, but none of these parameters seems to be decisive in the management of prolapse.
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Affiliation(s)
- A C Pizzoferrato
- Service de gynécologie-obstétrique, CHU de Caen, avenue Côte-de-Nacre, 14000 Caen, France.
| | - X Fritel
- Faculté de médecine et pharmacie, université de Poitiers, CIC1402, CESP, France
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Rejano-Campo M, Desvergée A, Pizzoferrato AC. [Relationship between perineal characteristics and symptoms and pelvic girdle pain: A literature review]. Prog Urol 2018; 28:193-208. [PMID: 29307482 DOI: 10.1016/j.purol.2017.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 12/04/2017] [Accepted: 12/12/2017] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Pelvic girdle pain (PGP) is characterized by the presence of pain in the posterior pelvic area, distally and laterally to the fifth lumbar vertebra, and/or at the pubic symphysis. PGP is a very common pain condition in women, especially during pregnancy and postpartum. After delivery, pain prevalence decreases to 7 % in the first three months. The current literature describes an association between pelvic girdle pain and different perineal characteristics and symptoms. OBJECTIVES A better understanding of perineal structures influence on PGP could assist towards the management of this condition. The aim of this review is to describe the peer-reviewed literature about perineal function in patients with PGP. METHODS A bibliographic search on PubMed was conducted. The key words used were: pelvic girdle pain, pregnacy-related low back pain, lumbopelvic pain, posterior pelvic pain, peripartum pelvic pain, pelvic girdle relaxation, pelvic joint instability, peripartum pelvic pain, sacroiliac joint pain, sacroiliac joint dysfunction, sacroiliac-joint related pelvic pain and pelvic floor. Two hundred and twenty-one (221) articles were identified. Out of them, a total of nine articles were selected. The level of evidence was determined using Oxford's scale. RESULTS Patients with PGP showed increased activity of the pelvic floor muscles (P=0.05) (LE3), decreased urogenital hiatus area (PGP 12.4 cm2±2.7, control 13.7 cm2±2.8, P=0.015) (LE3), shorter endurance time (PGP 17.8 s; control 54.0 s, P=0.00) (LE3), significantly later onset time during affected side leg elevation (PGP 25ms, control -129ms, P=0.01) (LE3), levator ani and obturator internus tenderness (PGP 25/26; control 5/25, P<0.001) (LE3) and a higher prevalence of vesico-sphincteric disorders compared to asymptomatic subjects (LE3). CONCLUSION This review confirms that subjects suffering PGP present particular perineal characteristics regarding morphology and biomechanics. It would be interesting to develop clinical research concerning pelvic floor release effect in PGP.
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Affiliation(s)
- M Rejano-Campo
- Service de médecine physique et de réadaptation, CHU de Caen, CHU de Caen Normandie, 14000 Caen, France.
| | - A Desvergée
- Service de médecine physique et de réadaptation, CHU de Caen, CHU de Caen Normandie, 14000 Caen, France
| | - A C Pizzoferrato
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, CHU de Caen Normandie, 14000 Caen, France
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Pizzoferrato AC, Fauconnier A, Bader G, de Tayrac R, Fort J, Fritel X. Is prenatal urethral descent a risk factor for urinary incontinence during pregnancy and the postpartum period? Int Urogynecol J 2016; 27:1003-11. [DOI: 10.1007/s00192-015-2918-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 12/02/2015] [Indexed: 11/28/2022]
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Pizzoferrato AC, Nyangoh Timoh K, Fritel X, Zareski E, Bader G, Fauconnier A. Dynamic Magnetic Resonance Imaging and pelvic floor disorders: how and when? Eur J Obstet Gynecol Reprod Biol 2014; 181:259-66. [PMID: 25212114 DOI: 10.1016/j.ejogrb.2014.07.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 07/11/2014] [Accepted: 07/20/2014] [Indexed: 11/29/2022]
Abstract
Pelvic Floor Disorders (PFD) are a major public health problem in the world and decrease seriously the patient's quality of life. In case of recurrence after surgery or complex prolapse, imaging techniques can be used. Dynamic MRI, introduced in the early 1990s, offers information of the four compartments of the pelvis with a high resolution and a direct visualization of muscles and fascias in multiple planes. But for a practical use, such an expensive exam should be well correlated to symptoms and clinical examination or change surgical approach. The aim of our review was to precise the evidence regarding techniques, and indication of dynamic MRI in the assessment of pelvic floor disorders in daily practice. The first part is a review of available studies on methods of carrying out the dynamic MRI. The second part consists on the comparison of dynamic MRI to other assessment methods in case of pelvic floor disorders. Results emphasize the lack of strong level studies about the interest of dynamic MRI in the diagnosis and surgical management of pelvic organ prolapse. Although dynamic MRI appears highly reproducible between examiners, especially for the anterior compartment, its correlation with the degree of prolapse or the symptoms appears low. The most interesting field of application seems the detection of levator ani (LA) avulsion with a higher risk of prolapse and recidive in case of LA defects. More prospective, randomized, comparative studies have to be done.
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Affiliation(s)
- Anne-Cécile Pizzoferrato
- Department of Gynaecology and Obstetrics, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, Poissy, France; Research Unit EA7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, Université Versailles St-Quentin, Montigny-le-Bretonneux, France.
| | - Krystel Nyangoh Timoh
- Department of Gynaecology and Obstetrics, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, Poissy, France
| | - Xavier Fritel
- Poitiers University, INSERM CIC1402, University Hospital of Poitiers, Poitiers, France
| | - Elise Zareski
- Department of Gynaecology and Obstetrics, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, Poissy, France
| | - Georges Bader
- Department of Gynaecology and Obstetrics, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, Poissy, France
| | - Arnaud Fauconnier
- Department of Gynaecology and Obstetrics, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, Poissy, France; Research Unit EA7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, Université Versailles St-Quentin, Montigny-le-Bretonneux, France
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Pizzoferrato AC, Fauconnier A, Quiboeuf E, Morel K, Schaal JP, Fritel X. Urinary incontinence 4 and 12 years after first delivery: risk factors associated with prevalence, incidence, remission, and persistence in a cohort of 236 women. Neurourol Urodyn 2013; 33:1229-34. [PMID: 24132982 DOI: 10.1002/nau.22498] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 05/16/2013] [Accepted: 09/04/2013] [Indexed: 11/12/2022]
Abstract
AIMS Our aim was to study risk factors associated with prevalence, incidence, and remission of UI 4 and 12 years after first delivery. METHODS Seven hundred seventy-four nulliparous women who gave birth in 1996 in two French maternity units at term received a questionnaire about their urinary symptoms in 2000 and again in 2008. Two hundred thirty-six women returned a questionnaire about UI 4 and 12 years after first delivery. Four groups of women were built: (A) women continent 4 and 12 years after first delivery; (B) women continent at 4 and incontinent at 12 years; (C) women incontinent at 4 and continent at 12 years; and (D) women incontinent at 4 and 12 years. Multivariate logistic regressions were used to determine risk factors of UI prevalence (groups B + D vs. A + C), incidence (B vs. A), remission (C vs. D), and onset of UI (D vs. B) RESULTS Factors associated with UI 12 years after first pregnancy were: BMI (OR = 1.17 [95%CI: 1.04-1.32], by 1 kg/m(2) ) and increasing BMI (1.43 [1.19-1.73]), first child's weight (1.08 [1.001-1.16], by 100 g) and UI during first pregnancy (3.77 [1.83-7.76]). Factors associated with UI incidence were age at first delivery (0.86 [0.75-0.98]) and high BMI (1.24 [1.05-1.45]). Increasing BMI, UI during first pregnancy, and heavy first child reduce the likelihood of UI remission (0.37 [0.20-0.68], 0.11 [0.02-0.63], and 0.73[0.59-0.91], respectively). CONCLUSIONS UI during first pregnancy could be indicative of individual susceptibility to UI. Obesity appears to be a modifiable factor for remission of UI in women.
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Affiliation(s)
- Anne-Cécile Pizzoferrato
- INSERM, UMR S953, Epidemiological research unit on perinatal health and women's' and children's health, Paris, France; Department of Gynaecology, Obstetrics, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, Poissy, France
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26
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Pizzoferrato AC, Legendre G, Demaria F, Benifla JL. [Cervical pregnancy: a rare case of reimplantation after abortion. A case report]. J Gynecol Obstet Biol Reprod (Paris) 2012; 41:587-90. [PMID: 22921158 DOI: 10.1016/j.jgyn.2012.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 06/24/2012] [Accepted: 07/13/2012] [Indexed: 11/26/2022]
Abstract
Cervical pregnancy is a rare form of ectopic pregnancy defined by the implantation of the blastocyst in the cervical canal. Most of the cervical pregnancies have been reported in patients with a history of vacuum curettage or caesarean section. The authors report a case of cervical pregnancy occurred after a failure of medical abortion. A literature review discusses the possibility of a cervical secondary implantation and describes the management of such pregnancies.
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Affiliation(s)
- A C Pizzoferrato
- Service de gynécologie-obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, 78303 Poissy, France.
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