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Bertholdt C, Dap M, Guerby P. Concerns regarding the analysis of studies on reduced fetal movements. Midwifery 2024; 132:103764. [PMID: 37393108 DOI: 10.1016/j.midw.2023.103764] [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: 03/20/2023] [Accepted: 06/19/2023] [Indexed: 07/03/2023]
Affiliation(s)
- C Bertholdt
- University of Lorraine, CHRU NANCY, Obstetrics and Gynecology Department, F-54000, NANCY, France; University of Lorraine, INSERM U1254, IADI, F-54000 NANCY, France.
| | - M Dap
- University of Lorraine, CHRU NANCY, Obstetrics and Gynecology Department, F-54000, NANCY, France; University of Lorraine, INSERM U1254, IADI, F-54000 NANCY, France
| | - P Guerby
- Obstetrics Department, CHU Toulouse, Toulouse, France
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Bertholdt C, Morel O, Hossu G, Cherifi A, Beaumont M, Eszto ML. Evaluation of utero-placental vascularization using contrast-enhanced ultrasound: Early first trimester maternal perfusion of the intervillous space is confirmed. Placenta 2024; 148:53-58. [PMID: 38401206 DOI: 10.1016/j.placenta.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/17/2024] [Accepted: 02/12/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION The objective was to confirm and semiquantify the maternal perfusion of the intervillous space between 8 and 13 + 6 gestational weeks (GW). METHODS We conducted a prospective, multicenter, and nonrandomized open study. Women undergoing voluntary termination of pregnancy at three different gestational ages (Group 8 GW: 8 to 8 + 6 GW, Group 11GW: 11 to 11 + 6 GW and Group 13GW: 13 to 13 + 6 GW) were included, with 14 subjects per group. Women presenting with a personal risk of preeclampsia and/or intrauterine growth restriction were excluded. Contrast-enhanced ultrasound (CEUS) was performed with an intravenous bolus administration of 2.4 mL of microbubbles. The region of interest (ROI) was the entire placenta. The perfusion curves and kinetic parameters, including wash-in perfusion index, peak enhancement and mean transit time, were calculated. RESULTS Of the 42 women initially included, interpretable perfusion curves could be obtained for 33. Regardless of the gestational age, contrast was observed in the entire placenta. No significant difference in perfusion parameters was observed between groups. There was an association between signal intensity and both maternal heart frequency and placental location. Signal intensity was decreased when the heart frequency increased (p < 0.05) and when the placenta was in a nonanterior position (p > 0.005). DISCUSSION We confirmed the presence of maternal perfusion of the intervillous space as early as 8 GW. No significant increase in perfusion parameters was observed between 8 and 13 + 6 GW. Our observations, in accordance with the previous experiment published by Roberts et al.1, strongly challenge the classic trophoblastic plug theory.
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Affiliation(s)
- C Bertholdt
- Université de Lorraine, CHRU-NANCY, Pôle de la Femme, F-54000, Nancy, France; Université de Lorraine, Inserm, IADI, F-54000, Nancy, France.
| | - O Morel
- Université de Lorraine, CHRU-NANCY, Pôle de la Femme, F-54000, Nancy, France; Université de Lorraine, Inserm, IADI, F-54000, Nancy, France
| | - G Hossu
- Université de Lorraine, Inserm, IADI, F-54000, Nancy, France; CHRU-NANCY, Inserm, Université de Lorraine, CIC, Innovation Technologique, F-54000, Nancy, France
| | - A Cherifi
- CHRU-NANCY, Inserm, Université de Lorraine, CIC, Innovation Technologique, F-54000, Nancy, France
| | - M Beaumont
- Université de Lorraine, Inserm, IADI, F-54000, Nancy, France; CHRU-NANCY, Inserm, Université de Lorraine, CIC, Innovation Technologique, F-54000, Nancy, France
| | - M L Eszto
- Obstetric Department, Metz-Thionville Regional Hospital Center, Mercy Hospital, 1 Allée du Château, 57085, Metz, Cedex 03, France
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Vallet Y, Baldit A, Bertholdt C, Rahouadj R, Morel O, Laurent C. Characterization of the skin-to-bone mechanical interaction on porcine scalp: A combined experimental and computational approach. J Mech Behav Biomed Mater 2023; 147:106139. [PMID: 37757616 DOI: 10.1016/j.jmbbm.2023.106139] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/03/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023]
Abstract
Fasciae are soft tissues permitting a large but finite sliding between organs, but also between skin and its underlying elements. The contribution of fasciae has been seldomly reported in the literature, and is usually neglected or overly simplified within simulations. In the present contribution, we propose to use peeling tests in order to quantify the skin-to-bone interaction associated with a simple computational approach based on a geometrical modeling of the skin-to-bone interface. To this aim, a new experimental set up combined with a computational model to characterize the skin-to-bone interaction were proposed. The current work is devoted to the porcine scalp complex since it constitutes a common mechanical surrogate for the human scalp complex. The ad hoc computational approach and peeling set up were firstly evaluated on a validation material, before being used to characterize the skin-to-bone interaction within 6 porcine specimens harvested from the scalp. Our experimental setup allowed to measure the peeling response of porcine scalp, showing a three-regimes response including a plateau force. The computational approach satisfyingly reproduced the peeling response based uniquely on experimental-based parameters and on a discrete modeling of skin-to-bone interface. The presented methodology is a first attempt to propose a computationally efficient geometrically based model able to take into account the skin-to-bone interaction up to failure and corroborated by experimental data, and may be largely extended to the modeling of soft interactions between biological human tissues in the future.
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Affiliation(s)
- Y Vallet
- CNRS UMR 7239 LEM3 - Université de Lorraine, Nancy, France.
| | - A Baldit
- CNRS UMR 7239 LEM3 - Université de Lorraine, Nancy, France
| | - C Bertholdt
- Université de Lorraine, CHRU-NANCY, Pôle de la Femme, F-54000, Nancy, France; IADI, INSERM U1254, Rue du Morvan, 54500, Vandoeuvre-lès-nancy, France
| | - R Rahouadj
- CNRS UMR 7239 LEM3 - Université de Lorraine, Nancy, France
| | - O Morel
- Université de Lorraine, CHRU-NANCY, Pôle de la Femme, F-54000, Nancy, France; IADI, INSERM U1254, Rue du Morvan, 54500, Vandoeuvre-lès-nancy, France
| | - C Laurent
- CNRS UMR 7239 LEM3 - Université de Lorraine, Nancy, France
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Vallet Y, Lefebvre J, Laurent C, Rahouadj R, Morel O, Bertholdt C. A preliminary quantification of the clinical gesture during vacuum assisted delivery on a training dummy. Clin Biomech (Bristol, Avon) 2023; 109:106093. [PMID: 37734119 DOI: 10.1016/j.clinbiomech.2023.106093] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The vacuum assisted delivery represents, in France, the most used operative vaginal delivery technique. The purpose was to provide a preliminar quantification of the operator's hand kinematics while performing a vacuum assisted delivery. METHODS A group of 21 participants composed of 12 trainees and 9 obstetricians were recorded performing a vacuum assisted delivery on a training dummy, the matching fetal presentation was a left occiput anterior position. FINDINGS The mean movement was composed of a first phase corresponding to a descendant pull, followed by an ascendant finish of the gesture. No significative difference were found between the trainees and the obstetricians' mean gesture. INTERPRETATION This is the first quantification of the clinical gesture associated with the vacuum assisted delivery.
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Affiliation(s)
- Y Vallet
- CNRS UMR 7239 LEM3 - Université de Lorraine, Nancy, France.
| | - J Lefebvre
- Université de Lorraine, CHRU-NANCY, Pôle de la Femme, F-54000 Nancy, France
| | - C Laurent
- CNRS UMR 7239 LEM3 - Université de Lorraine, Nancy, France
| | - R Rahouadj
- CNRS UMR 7239 LEM3 - Université de Lorraine, Nancy, France
| | - O Morel
- Université de Lorraine, CHRU-NANCY, Pôle de la Femme, F-54000 Nancy, France; IADI, INSERM U1254, Rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France
| | - C Bertholdt
- Université de Lorraine, CHRU-NANCY, Pôle de la Femme, F-54000 Nancy, France; IADI, INSERM U1254, Rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France
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Vallet Y, Laurent C, Bertholdt C, Rahouadj R, Morel O. Analysis of suction-based gripping strategies in wildlife towards future evolutions of the obstetrical suction cup. Bioinspir Biomim 2022; 17:061003. [PMID: 36206746 DOI: 10.1088/1748-3190/ac9878] [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: 02/10/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
The design of obstetrical suction cups used for vacuum assisted delivery has not substantially evolved through history despite of its inherent limitations. The associated challenges concern both the decrease of risk of soft tissue damage and failure of instrumental delivery due to detachment of the cup. The present study firstly details some of the suction-based strategies that have been developed in wildlife in order to create and maintain an adhesive contact with potentially rough and uneven substratum in dry or wet environments. Such strategies have permitted the emergence of bioinspired suction-based devices in the fields of robotics or biomedical patches that are briefly reviewed. The objective is then to extend the observations of such suction-based strategies toward the development of innovative medical suction cups. We firstly conclude that the overall design, shape and materials of the suction cups could be largely improved. We also highlight that the addition of a patterned surface combined with a viscous fluid at the interface between the suction cup and scalp could significantly limit the detachment rate and the differential pressure required to exert a traction force. In the future, the development of a computational model including a detailed description of scalp properties should allow to experiment various designs of bioinspired suction cups.
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Affiliation(s)
- Y Vallet
- CNRS UMR 7239 LEM3-Université de Lorraine, Nancy, France
| | - C Laurent
- CNRS UMR 7239 LEM3-Université de Lorraine, Nancy, France
| | - C Bertholdt
- Université de Lorraine, CHRU-NANCY, Pôle de la Femme, F-54000 Nancy, France
- IADI, INSERM U1254, Rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France
| | - R Rahouadj
- CNRS UMR 7239 LEM3-Université de Lorraine, Nancy, France
| | - O Morel
- Université de Lorraine, CHRU-NANCY, Pôle de la Femme, F-54000 Nancy, France
- IADI, INSERM U1254, Rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France
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Bertholdt C, Dap M, Pillot R, Chavatte-Palmer P, Morel O, Beaumont M. Assessment of placental perfusion using contrast-enhanced ultrasound: A longitudinal study in pregnant rabbit. Theriogenology 2022; 187:135-140. [DOI: 10.1016/j.theriogenology.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 11/15/2022]
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Bertholdt C, Epstein J, Alleyrat C, Ambroise G, Claudel L, Banasiak C, Morel O. Comparative evaluation of the impact of the COVID-19 lockdown on perinatal experience: a prospective multicentre study. BJOG 2021; 129:1333-1341. [PMID: 34954895 DOI: 10.1111/1471-0528.17082] [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: 09/13/2021] [Revised: 12/03/2021] [Accepted: 12/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare in the early postpartum the perinatal experience during a COVID-19 related lockdown ("lockdown" group) and a pandemic control group subject to looser restrictions. DESIGN & SETTING This national multicentre prospective cohort study took place in four French maternity units. POPULATION Women were recruited during the postpartum stay for the lockdown and pandemic control groups, according to their enrolment period. Both faced the same labour and delivery restrictions, but only the pandemic control group could have a postpartum visitor. MAIN OUTCOME MEASURES The primary outcome was the perinatal experience during childbirth, assessed by the Labour Agentry Scale (LAS) self-administered questionnaire, completed before discharge. RESULTS The study included 596 women and analysed 571: 260 in the lockdown group and 311 in the pandemic control group. The mean LAS score was lower in the lockdown group (161.1 ± 26.8, 95% confidence interval [CI] 157.8-164.3 versus 163.3 ± 24.0, 95% CI 160.6-166.0; P=0.289). In multivariable analysis, the LAS score was lower in the lockdown group (-6.2 points, P= 0.009), in women with caesarean (-21.6 points, P<0.001) versus spontaneous deliveries, and among women financially impacted by the lockdown (-6.4 points, P=0.007) or who experienced restrictions during childbirth (-8.1 points, P<0.001). The LAS score rose with the prenatal care quality score (P<0.001). CONCLUSIONS The perinatal experience was more negatively affected by lockdown restrictions than by the looser pandemic restrictions for controls, but mode of delivery remained the main factor influencing this experience.
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Affiliation(s)
- C Bertholdt
- Université de Lorraine, CHRU-Nancy, Pôle de Gynécologie-Obstétrique, F-54000, Nancy, France.,Université de Lorraine, Inserm, IADI, F-54000, Nancy, France
| | - J Epstein
- CHRU-Nancy, Inserm, Université de Lorraine, CIC Epidémiologie Clinique, F-54000, Nancy, France
| | - C Alleyrat
- CHRU-Nancy, Inserm, Université de Lorraine, CIC Epidémiologie Clinique, F-54000, Nancy, France
| | - G Ambroise
- Université de Lorraine, CHRU-Nancy, Pôle de Gynécologie-Obstétrique, F-54000, Nancy, France.,Université de Lorraine, Inserm, IADI, F-54000, Nancy, France.,Université de Lorraine, Midwifery Department, F-54000, Nancy, France
| | - L Claudel
- Université de Lorraine, Midwifery Department, F-54000, Nancy, France
| | - C Banasiak
- CHRU-Nancy, Inserm, Université de Lorraine, CIC, Innovation Technologique, F-54000, Nancy, France
| | - O Morel
- Université de Lorraine, CHRU-Nancy, Pôle de Gynécologie-Obstétrique, F-54000, Nancy, France.,Université de Lorraine, Inserm, IADI, F-54000, Nancy, France
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Abstract
Ultrasound imaging is a vital tool for exploring in vivo the placental function which is essential to understand pathological phenomena such as preeclampsia or intrauterine growth restriction. As technology advances including ready availability of three-dimensional (3D) probes and novel software, new markers of placental function become possible. The objective of this review was to provide an overview of the new ultrasound markers of placental function with a focus on the potential clinical application of three-dimensional power Doppler (3DPD). A broad-free text literature search was undertaken based on human placental studies and sixty full-text studies were included in this review. Three-dimensional power Doppler is a promising technique to predict preeclampsia in the first trimester. However, the influence of external factors such as body mass index, parameter standardisation and machine settings still need to be addressed. Contrast-enhanced ultrasound is currently reserved for research, because the required injected contrast mediums are not currently approved for use in pregnancy, although the safety data is reassuring.
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Affiliation(s)
- C Bertholdt
- Université de Lorraine, CHRU-Nancy, Pôle de Gynécologie-Obstétrique, F-54000 Nancy, France; Université de Lorraine, Inserm, IADI, F-54000 Nancy, France.
| | - M Dap
- Université de Lorraine, CHRU-Nancy, Pôle de Gynécologie-Obstétrique, F-54000 Nancy, France
| | - M Beaumont
- CHRU-Nancy, Inserm, Université de Lorraine, CIC, Innovation Technologique, F-54000 Nancy, France
| | - J Duan
- Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Hubei, 430071, China; Gynecology and Obstetrical Service, Zhongnan Hospital of Wuhan University, Hubei, 430071, China
| | - O Morel
- Université de Lorraine, CHRU-Nancy, Pôle de Gynécologie-Obstétrique, F-54000 Nancy, France; Université de Lorraine, Inserm, IADI, F-54000 Nancy, France
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Grandjean GA, Bertholdt C, Zuily S, Fauvel M, Hossu G, Berveiller P, Morel O. Fetal biometry in ultrasound: A new approach to assess the long-term impact of simulation on learning patterns. J Gynecol Obstet Hum Reprod 2021; 50:102135. [PMID: 33798748 DOI: 10.1016/j.jogoh.2021.102135] [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: 09/02/2020] [Revised: 02/18/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
CONTEXT Simulation-based education (SBE) has demonstrated its acceptability and effectiveness in improving ultrasound training. Because of the high cost of its implementation (investment in equipment and supervision), a pragmatic assessment of the transfer of skills learned in SBE to clinical practice and the identification of its optimal scheduling conditions have been requested to optimize its input. OBJECTIVES To quantify the long-term impact of simulation-based education (SBE) on the adequate performance of ultrasound fetal biometry measurements (I). The secondary objective was to identify the temporal patterns that enhanced SBE input in learning (II). METHODS Trainees were arbitrarily assigned to a 6-month course in obstetric ultrasound with or without an SBE workshop. In the SBE group, the workshop was implemented 'before' or at an 'early' or a 'late-stage' of the course. Those who did not receive SBE were the control group. The ultrasound skills of all trainees were prospectively collected, evaluated by calculating the delta between OSAUS (Objective Structured Assessment of Ultrasound Skills) scores before and after the course (I). Concomitantly, the accuracy of trainees' measurements was assessed throughout the course by verifying their correlation with the corresponding measurements by their supervisors. The percentage of trainees able to perform five consecutive sets of correct measurements in the control group and in each SBE subgroup were compared (II). RESULTS The study included 61 trainees (39 SBE and 22 controls). Comparisons between groups showed no significant difference in the quantitative assessment of skill enhancement (difference in the pre- and post-internship OSAUS score: 1.09 ± 0.87 in the SBE group and 0.72 ± 0.98 in the control group) (I). Conversely, the predefined acceptable skill level was reached by a significantly higher proportion of trainees in the 'early' SBE subgroup (74%, compared with 30% in the control group, P<0.01)(II). CONCLUSIONS The quantitative assessment does not support the existence of long-term benefits from SBE training, although the qualitative assessment confirmed SBE helped to raise the minimal level within a group when embedded in an 'early' stage of a practical course.
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Affiliation(s)
- G Ambroise Grandjean
- Université de Lorraine, IADI - INSERM, F-54000 Nancy, France; Department of Obstetrics and Gynecology, CHRU Nancy, F-54000 Nancy, France; Midwifery Department, Université de Lorraine, Nancy F-54000, France.
| | - C Bertholdt
- Université de Lorraine, IADI - INSERM, F-54000 Nancy, France; Department of Obstetrics and Gynecology, CHRU Nancy, F-54000 Nancy, France
| | - S Zuily
- Université de Lorraine, Hôpital virtuel de Lorraine, Nancy F-54000, France
| | - M Fauvel
- CHRU Nancy, Université de Lorraine, CIC-IT, F-54000 Nancy, France
| | - G Hossu
- CHRU Nancy, Université de Lorraine, CIC-IT, F-54000 Nancy, France
| | - P Berveiller
- Department of Obstetrics and Gynecology, CHI Poissy Saint-Germain-en-Laye, F-78300 Poissy, France; Université Versailles Saint-Quentin, EA 7404 - GIG, F-78180 Montigny le Bretonneux, France
| | - O Morel
- Université de Lorraine, IADI - INSERM, F-54000 Nancy, France; Department of Obstetrics and Gynecology, CHRU Nancy, F-54000 Nancy, France
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Ambroise Grandjean G, Berveiller P, Hossu G, Bertholdt C, Judlin P, Morel O. [Skills assessment for the practice of fetal ultrasound biometry: Prospective validation of the OSAUS METHOD score]. ACTA ACUST UNITED AC 2021; 49:275-281. [PMID: 33453459 DOI: 10.1016/j.gofs.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To develop and validate a customized variant for fetal biometry of the generic OSAUS score (Objective Structured Assessment of Ultrasound Skills) METHODS: The 5-points OSAUS METHOD grid was elaborated by defining five target skills specific to fetal biometry for each thematic item of the generic score. The level of skills of 43 trainees was prospectively assessed during an ultrasound examination by using this grid. The results of the "novice" level group (experience<10 ultrasounds) were compared to those of the "intermediate" level group (experience≥10 ultrasounds) (I). The reached/non-reached skills ratio within the different items composing the score allowed the identification of priority areas of improvement (II). Previously published distribution and actual distribution of ratings according to the generic pass/fail score were compared (III). RESULTS Median scores of "novices" (n=29) and "intermediates" (n=14) groups were statistically different, 1.87 (±0.75) and 3.31 (±0.83) (P=1.85-5), respectively and corresponded to the pre-existing experience (I). A lower ratio of reached skill allowed the identification of "documentation of the examination" item as a priority area of improvement for both groups (II). The relevance of the pass/fail score is consolidated, even if an overlap was observed between novices and intermediates groups (III). CONCLUSIONS The relevancy and feasibility of using OSAUS scoring method for fetal biometry are supported. In addition, the possibility of comparisons with generic OSAUS remains.
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Affiliation(s)
- G Ambroise Grandjean
- Département d'Obstétrique, CHRU de Nancy, 54000 Nancy, France; Inserm, Université de Lorraine, IADI, rue du Morvan, 54000 Vandoeuvre-les-Nancy, France; Département universitaire de Maïeutique, université de Lorraine, 54000 Nancy, France.
| | - P Berveiller
- Département d'Obstétrique, CHI de Poissy Saint-Germain-en-Laye, 78300 Poissy, France; Université Versailles Saint-Quentin, 78180 Montigny-le-Bretonneux, France
| | - G Hossu
- Inserm, CHRU de Nancy, université de Lorraine, CIC, 54000 Nancy, France
| | - C Bertholdt
- Département d'Obstétrique, CHRU de Nancy, 54000 Nancy, France; Inserm, Université de Lorraine, IADI, rue du Morvan, 54000 Vandoeuvre-les-Nancy, France
| | - P Judlin
- Département d'Obstétrique, CHRU de Nancy, 54000 Nancy, France
| | - O Morel
- Département d'Obstétrique, CHRU de Nancy, 54000 Nancy, France; Inserm, Université de Lorraine, IADI, rue du Morvan, 54000 Vandoeuvre-les-Nancy, France
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Affiliation(s)
- M Dap
- Pôle de gynécologie obstétrique, maternité universitaire, CHRU de Nancy, Nancy, France
| | - C Bertholdt
- Pôle de gynécologie obstétrique, maternité universitaire, CHRU de Nancy, Nancy, France
| | - J Belaisch-Allart
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier des 4 villes Saint-Cloud, Saint-Cloud, France
| | - C Huissoud
- Maternité de la Croix-Rousse, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France
| | - O Morel
- Pôle de gynécologie obstétrique, maternité universitaire, CHRU de Nancy, Nancy, France.
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Bertholdt C, Chen B, Dap M, Morel O, Beaumont M. Comments on "Placental vascular tree characterization based on ex-vivo MRI with a potential application for placental insufficiency assessment". Placenta 2020; 101:251. [PMID: 33092722 DOI: 10.1016/j.placenta.2020.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 11/26/2022]
Affiliation(s)
- C Bertholdt
- Université de Lorraine, CHRU-NANCY, Pôle de de Gynécologie-Obstétrique, F-54000, Nancy, France; Université de Lorraine, Inserm, IADI, F-54000, Nancy, France.
| | - B Chen
- Université de Lorraine, Inserm, IADI, F-54000, Nancy, France; CHRU-NANCY, Inserm, Université de Lorraine, CIC, Innovation Technologique, F-54000, Nancy, France
| | - M Dap
- Université de Lorraine, CHRU-NANCY, Pôle de de Gynécologie-Obstétrique, F-54000, Nancy, France; Université de Lorraine, Inserm, IADI, F-54000, Nancy, France
| | - O Morel
- Université de Lorraine, CHRU-NANCY, Pôle de de Gynécologie-Obstétrique, F-54000, Nancy, France; Université de Lorraine, Inserm, IADI, F-54000, Nancy, France
| | - M Beaumont
- Université de Lorraine, Inserm, IADI, F-54000, Nancy, France; CHRU-NANCY, Inserm, Université de Lorraine, CIC, Innovation Technologique, F-54000, Nancy, France
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Grangé G, Berlin I, Bretelle F, Bertholdt C, Berveiller P, Blanc J, DiGuisto C, Dochez V, Garabedian C, Guerby P, Koch A, Le Lous M, Perdriolle-Galet E, Peyronnet V, Rault E, Torchin H, Legendre G. [CNGOF-SFT Expert Report and Guidelines for Smoking Management during Pregnancy-Short Text]. Gynecol Obstet Fertil Senol 2020; 48:539-545. [PMID: 32289497 DOI: 10.1016/j.gofs.2020.04.005] [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] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To provide up-to-date evidence-based guidelines for the management of smoking cessation during pregnancy. METHODS Systematic review of the international literature. We identified papers published between January 2003 and April 2019 in Cochrane PubMed, and Embase databases with predefined keywords. All reports published in French and English relevant to the areas of focus were included and classified according the level of evidence ranging from 1 (highest) to 4 (lowest). The strength of the recommendations was classified according to the Haute Autorité de santé, France (ranging from A, highest to C, lowest). RESULTS "Counseling", involving globally all kind of non-pharmacological interventions, has a modest benefit on smoking cessation, birth weight and prematurity. Moderate physical activity did not show a significant effect on smoking cessation. The systematic use of feedback by measuring the expired air carbon monoxide concentration do not influence smoking abstinence but it may be used in establishing a therapeutic alliance. The use of self-help interventions and health education are recommended in helping pregnant smokers quit. The prescription of nicotine replacement therapies (NRT) may be offered to any pregnant woman who has failed stopping smoking without medication This prescription can be initiated by the health care professional taking care of the pregnant woman in early pregnancy. There is no scientific evidence to propose the electronic cigarette for smoking cessation to pregnant smokers; it is recommended to provide the same advice and to use methods that have already been evaluated. The use of waterpipe (shisha/narghile) during pregnancy is associated with decreased fetal growth. It is recommended not to use waterpipe during pregnancy. Breastfeeding is possible in smokers, but less often initiated by them. Although its benefit for the child's development is not demonstrated to date, breastfeeding allows the mother to reduce or stop smoking. The risk of postpartum relapse is high (up to 82% at 1 year). The main factors associated with postpartum abstinence are breastfeeding, not having a smoker at home, and having no symptoms of postpartum depression. CONCLUSIONS Smoking during pregnancy concerns more than hundred thousand women and their children per year in France. It is a major public health burden. Health care professionals should be mobilized for reducing or even eradicating it.
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Affiliation(s)
- G Grangé
- Maternité Port-Royal, université de Paris, AP-HP, 75014 Paris, France.
| | - I Berlin
- Département de pharmacologie, AP-HP, 75000 Paris, France; Centre universitaire de médecine générale et de santé publique, 1000 Lausanne, Suisse
| | - F Bretelle
- Department of obstetrics and gynecology, conception hospital, Aix Marseille université, prenatal diagnosis Timone Conception, IHU, IRD, Assistance publique des Hôpitaux de Marseille (AP-HM), 13005 Marseille, France
| | - C Bertholdt
- Pôle de la femme, maternité régionale du CHRU de Nancy, 10, rue Dr-Heydenreich, 54000 Nancy, France; IADI, Inserm U1254, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - P Berveiller
- Service de gynécologie-obstétrique, CHI Poissy-St-Germain-en-Laye, 78300 Poissy, France
| | - J Blanc
- Service de gynécologie obstétrique, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France; EA3279, CEReSS, health service research and quality of life center, université Aix-Marseille, 13284 Marseille, France
| | - C DiGuisto
- Université de Paris, epidemiology and statistics research center/CRESS, Inserm (U1153 - Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRA, hôpital Tenon, bâtiment Recherche, rue de la Chine, 75020 Paris, France; Maternité Olympe de Gouges, centre hospitalier régional universitaire Tours, Tours, France; Université François-Rabelais, 37000 Tours, France
| | - V Dochez
- Service de gynécologie-obstétrique, CHU de Nantes, 44093 Nantes, France
| | - C Garabedian
- EA 4489 - Perinatal Environment and Health, université de Lille, hôpital Jeanne-de-Flandre, clinique d'obstétrique, CHU de Lille, 59000 Lille, France
| | - P Guerby
- Service de gynécologie obstétrique, hôpital Paule-de-Viguier, CHU de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - A Koch
- Service de gynécologie-obstétrique, CHU de Strasbourg, 67000 Strasbourg, France
| | - M Le Lous
- Département de gynécologie obstétrique et médecine de la reproduction, CHU de Rennes, Rennes, France; LTSI-Inserm, université de Rennes 1, UMR 1099, 35000 Rennes, France
| | - E Perdriolle-Galet
- Pôle de la femme, maternité régionale du CHRU de Nancy, 10, rue Dr-Heydenreich, 54000 Nancy, France
| | - V Peyronnet
- Service de gynécologie obstétrique, hôpital L.-Mourier, AP-HP, 92700 Colombes, France
| | - E Rault
- Hôpital Femme-Mère-Enfant, 69500 Bron, France
| | - H Torchin
- Service de médecine et réanimation néonatales de Port-Royal, AP-HP, 75014 Paris, France; Université de Paris, epidemiology and statistics research center/CRESS, Inserm, INRA, 75004 Paris, France
| | - G Legendre
- CESP-Inserm, U1018, Team 7, Genre, Sexual and Reproductive Health, Paris-Sud University, Paris-Saclay University, UVSQ, Inserm, 94800 Villejuif, France; Department of obstetrics and gynecology, Angers university hospital, 49000 Angers, France
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Peyronnet V, Koch A, Rault E, Perdriolle-Galet E, Bertholdt C. [N on-pharmacological management of smoking cessation during pregnancy- CNGOF-SFT Expert Report and Guidelines for Smoking Management during Pregnancy]. Gynecol Obstet Fertil Senol 2020; 48:590-603. [PMID: 32247854 DOI: 10.1016/j.gofs.2020.03.029] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To assess the benefit of non-pharmacological intervention promoting on smoking cessation, obstetric and neonatal outcomes, to offer pregnant women who smoke (PWS) optimal care. METHODS We searched Medline Database, Cochrane Library and consulted international guidelines. RESULTS "Counselling" involving globally all kind of non-pharmacological interventions has a benefit on smoking cessation (NP1) and a moderate benefit on birth weight and prematurity (NP2). The brief intervention seems ineffective on smoking cessation (NP2). The effects of motivational interviewing have not been demonstrated during pregnancy (NP2). Cognitive-behavioral interventions do not show superiority (NP2). Financial incentives have a benefit for smoking cessation and possibly for neonatal outcomes (NP1). Feedback interventions (Co tester) provide heterogeneous results (NP2). Self-help interventions (NP2) and health education (NP2) seem effective on smoking cessation. Hypnotherapy and acupuncture have been little or not studied in PWS. Moderate physical activity did not show a significant effect (NP2) on smoking cessation but seem to reduce craving for tobacco (NP3). CONCLUSIONS We recommend asking all PWS about their smoking consumption and detailing their smoking history, offering them different types of counselling according to their preferences and involving them multidisciplinary (grade A). The systematic use of feedback is not recommended (grade C) but experience suggests that the CO tester is important in establishing a therapeutic alliance (professional consensus). The use of self-help interventions (grade C) and health education (grade B) are recommended.
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Affiliation(s)
- V Peyronnet
- Service de gynécologie-obstétrique, hôpital Louis-Mourier, Université de Paris, 178 rue des Renouillers, 92700 Colombes, France.
| | - A Koch
- Pôle de gynécologie-obstétrique, CHU de Strasbourg, 67000 Strasbourg, France
| | - E Rault
- Service d'obstétrique, hospices civils de Lyon, hôpital Femme-Mère-Enfant Lyon, 69500 Bron, France
| | - E Perdriolle-Galet
- Service d'obstétrique et de médecine fœtale, maternité régionale, CHRU de Nancy, 54035 Nancy, France
| | - C Bertholdt
- Service d'obstétrique et de médecine fœtale, maternité régionale du CHRU de Nancy, 10, rue du Dr-Heydenreich, 54000 Nancy, France; IADI, Inserm U1254, rue du Morvan, 54500 Vandœuvre-les-Nancy, France
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Perdriolle-Galet E, Peyronnet V, Bertholdt C. [Management of Resumption Risk in Postpartum for Women who Quit Smoking During Pregnancy - CNGOF-SFT Expert Report and Guidelines for Smoking Management During Pregnancy]. Gynecol Obstet Fertil Senol 2020; 48:619-624. [PMID: 32247855 DOI: 10.1016/j.gofs.2020.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
According to the 2016 National Perinatal Survey, 30.0 % of women smoked before pregnancy, 45.8 % quit smoking in the 1st or 2nd trimester. Many do this only for pregnancy and the risk of postpartum relapse is high (up to 82 % at 1 year). The main factors associated with postpartum abstinence are breastfeeding, not having a smoker at home, and having no symptoms of postpartum depression. No drug treatment can be recommended to prevent the smoking postpartum relapse. Only global counseling can prevent this risk.
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Affiliation(s)
- E Perdriolle-Galet
- Service d'obstétrique et de médecine fœtale, maternité régionale du CHRU de Nancy, 10, rue du Dr-Heydenreich, 54000 Nancy, France.
| | - V Peyronnet
- Service de gynécologie-obstétrique, université de Paris, hôpital Louis Mourier, 92700 Colombes, France
| | - C Bertholdt
- Service d'obstétrique et de médecine fœtale, maternité régionale du CHRU de Nancy, 10, rue du Dr-Heydenreich, 54000 Nancy, France; IADI, Inserm U1254, rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France
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Grangé G, Berlin I, Bretelle F, Bertholdt C, Berveiller P, Blanc J, DiGuisto C, Dochez V, Garabedian C, Guerby P, Koch A, Le Lous M, Perdriolle-Galet E, Peyronnet V, Rault E, Torchin H, Legendre G. Smoking and smoking cessation in pregnancy. Synthesis of a systematic review. J Gynecol Obstet Hum Reprod 2020; 49:101847. [PMID: 32619725 DOI: 10.1016/j.jogoh.2020.101847] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To provide up-to-date evidence-based guidelines for the management of smoking cessation during pregnancy and the post-partum period. STUDY DESIGN A systematic review of the international literature was undertaken between January 2003 and April 2019. MEDLINE, EMBASE databases and the Cochrane library were searched for a range of predefined key words. All relevant reports in English and French were classified according to their level of evidence ranging from 1(highest) to 4(lowest). The strength of each recommendation was classified according to the Haute Autorité de Santé (French National Authority for Health) ranging from A (highest) to C (lowest). RESULTS "Counselling", including all types of non-pharmacological interventions, has a moderate benefit on smoking cessation, birth weight and prematurity. The systematic use of measuring expired air CO concentration does not influence smoking abstinence, however, it may be useful in assessing smoked tobacco exposure prior to and after quitting. The use of self-help therapies and health education are recommended in helping pregnant smokers quit and should be advised by healthcare professionals. Nicotine replacement therapies (NRT) may be prescribed to pregnant women who have failed to stop smoking after trying non-pharmacological interventions. Different modes of delivery and dosages can be used in optimizing their efficacy. Smoking in the postpartum period is essential to consider. The same treatment options as during pregnancy can be used. CONCLUSION Smoking during pregnancy concerns more than a hundred thousand women each year in France resulting in a major public health burden. Healthcare professionals should be mobilised to employ a range of methods to reduce or even eradicate it.
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Affiliation(s)
- G Grangé
- Maternité Port-Royal, Université de Paris, AP-HP.Centre, FHU Prema, 75014, Paris, France.
| | - I Berlin
- Département de Pharmacologie, AP-HP, 75000, Paris, France; Centre Universitaire de Médecine Générale et de Santé Publique, 1011 Lausanne, Switzerland
| | - F Bretelle
- Department of Obstetrics and Gynecology, Conception Hospital, Aix Marseille Université, Prenatal Diagnosis Timone Conception, IHU, IRD, Assistance Publique des Hôpitaux de Marseille (AP-HM), 13005, Marseille, France
| | - C Bertholdt
- Pôle de la Femme, Maternité Régionale du CHRU de Nancy, 10, Rue Dr-Heydenreich, 54000, Nancy, France; IADI, Inserm U1254, Rue du Morvan, 54500, Vandœuvre-lès-Nancy, France
| | - P Berveiller
- Service de Gynécologie-Obstétrique, CHI Poissy-St-Germain-en-Laye, 78300, Poissy, France
| | - J Blanc
- Service de Gynécologie Obstétrique, Hôpital Nord, AP-HM, Chemin des Bourrely, 13015, Marseille, France; EA3279, CEReSS, Health Service Research and Quality of Life Center, Université Aix-Marseille, 13284, Marseille, France
| | - C DiGuisto
- Centre Universitaire de Médecine Générale et de Santé Publique, 1011 Lausanne, Switzerland; Université de Paris, Epidemiology and Statistics Research center/CRESS, Inserm (U1153 - Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRA, Hôpital Tenon, Bâtiment Recherche, Rue de la Chine, 75020, Paris, France; Maternité Olympe de Gouges, Centre Hospitalier Régional Universitaire Tours, Tours, France; Université François-Rabelais, 37000, Tours, France
| | - V Dochez
- Service de Gynécologie-Obstétrique, CHU de Nantes, 44093, Nantes, France
| | - C Garabedian
- CHU Lille Clinique d'obstetrique Univ. LILLE ULR 2694 Évaluation des technologies de santé. F-59000 Lille, France
| | - P Guerby
- Service de Gynécologie Obstétrique, Hôpital Paule-de-Viguier, CHU de Toulouse, 330, Avenue de Grande-Bretagne, 31059, Toulouse, France
| | - A Koch
- Service de Gynécologie-Obstétrique, CHU de Strasbourg, 67000, Strasbourg, France
| | - M Le Lous
- Département de Gynécologie Obstétrique et Médecine de la Reproduction, CHU de Rennes, Rennes, France; LTSI-Inserm, Université de Rennes 1, UMR 1099, 35000, Rennes, France
| | - E Perdriolle-Galet
- Pôle de la Femme, Maternité Régionale du CHRU de Nancy, 10, Rue Dr-Heydenreich, 54000 Nancy, France
| | - V Peyronnet
- Service de Gynécologie Obstétrique, Hôpital L.-Mourier, AP-HP, 92700 Colombes, France; Université de Paris, Paris, France
| | - E Rault
- Hôpital Femme-Mère-Enfant, 69500, Bron, France
| | - H Torchin
- Service de Médecine et Réanimation Néonatales de Port-Royal, AP-HP, 75014 Paris, France; Université de Paris, Epidemiology and Statistics Research center/CRESS, Inserm, INRA, 75004, Paris, France
| | - G Legendre
- CESP-Inserm, U1018, Team 7, Genre, Sexual and Reproductive Health, Paris-Sud University, Paris-Saclay University, UVSQ, Inserm, 94800, Villejuif, France; Department of Obstetrics and Gynecology, Angers University Hospital, 49000, Angers, France
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Pouypoudat L, Tomczyk L, Gauchotte E, Morel O, Bertholdt C. [Intrauterine tamponade: Practices and training assessment]. Gynecol Obstet Fertil Senol 2020; 48:409-413. [PMID: 32084572 DOI: 10.1016/j.gofs.2020.02.007] [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: 11/25/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The main objective was to describe the practices of a French center regarding the use of intrauterine tamponade. The secondary objective was to describe the training of residents in the use of intrauterine tamponade (IUT). METHODS This was a practice survey conducted through an anonymous quiz sent to residents in France between May 1, 2018 and July 1, 2019. Responses from first year residents were excluded. The data concerned the practices of the centers (mode of delivery, mode of insertion, ultrasound control, use of vaginal gauze or antibiotic prophylaxis) as well as the feeling of the residents concerning their training in using of the intrauterine tamponade (frequency, training sessions, learning difficulties). RESULTS We obtained 145 responses to represent all regions of France. Responses from 27/28 centres were obtained. All the centres use it during cesarean section and after vaginal delivery. Vaginal gauze is used in 74% of cases and 65% use antibiotic prophylaxis. A specific training during the residentship is described in only 26% of cases and 21% of residents say they have never used an IUT. CONCLUSION Intrauterine tamponade is a technique widely used in France, regardless of the mode of delivery. The training of residents is essential, especially since the simulation is perfectly adapted to the learning for using intrauterine tamponade.
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Affiliation(s)
- L Pouypoudat
- Service d'obstétrique et de médecine fœtale, maternité régionale, CHRU de Nancy, 10, rue du Docteur Heydenreich, 54000 Nancy, France
| | - L Tomczyk
- Service d'obstétrique et de médecine fœtale, maternité régionale, CHRU de Nancy, 10, rue du Docteur Heydenreich, 54000 Nancy, France
| | - E Gauchotte
- Service d'obstétrique et de médecine fœtale, maternité régionale, CHRU de Nancy, 10, rue du Docteur Heydenreich, 54000 Nancy, France
| | - O Morel
- Service d'obstétrique et de médecine fœtale, maternité régionale, CHRU de Nancy, 10, rue du Docteur Heydenreich, 54000 Nancy, France; Inserm U1254, IADI, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - C Bertholdt
- Service d'obstétrique et de médecine fœtale, maternité régionale, CHRU de Nancy, 10, rue du Docteur Heydenreich, 54000 Nancy, France; Inserm U1254, IADI, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
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Abstract
OBJECTIVES To assess adverse outcome of polyhydramnios without morphological abnormalities and to determine the factors associated with an adverse outcome. METHODS This is a retrospective observational cohort study conducted in a French tertiary care unit between 2008 and 2018 including all women with singleton pregnancy complicated by polyhydramnios. Presence of morphological abnormality was an exclusion criteria. The primary outcome was the rate of adverse outcome, defined by a composite criterion including death or postnatal discovery of malformation or chronic pathology. Maternal, obstetrical, paediatric and polyhydramnios characteristics were collected. RESULTS Ninety-one women with polyhydramnios were included. The rate of adverse outcome was 24.2% (22/91). This rate was 20,3% in case of idiopathic polyhydramnios and 33,3% in case of maternal diabetes associated. The postnatal mortality rate was 5.5%. The rate of malformations not diagnosed in antenatal was 11%. Obesity (50% vs. 18,8%; P=0,004), early diagnosis (72,7% before 32 WG vs. 44,9%; P=0,02), and severity of polyhydramnios (22,7% vs. 4,3% in severe polyhydramnios; P=0,01) were associated significantly with an adverse outcome. In these cases, the incidence of preterm delivery was higher. CONCLUSION Polyhydramnios must have second-line ultrasound, including isolated maternal diabetes. A systematic genetic assessment can be discussed.
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Affiliation(s)
- C Bertholdt
- Service d'obstétrique et de médecine fœtale, maternité régionale du CHRU de Nancy, 10, rue du Dr Heydenreich, 54000 Nancy, France; IADI, Inserm U1254, rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France.
| | - A-L Fijean
- Service d'obstétrique et de médecine fœtale, maternité régionale du CHRU de Nancy, 10, rue du Dr Heydenreich, 54000 Nancy, France
| | - O Morel
- Service d'obstétrique et de médecine fœtale, maternité régionale du CHRU de Nancy, 10, rue du Dr Heydenreich, 54000 Nancy, France; IADI, Inserm U1254, rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France
| | - C Zuily-Lamy
- Service d'obstétrique et de médecine fœtale, maternité régionale du CHRU de Nancy, 10, rue du Dr Heydenreich, 54000 Nancy, France
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Bertholdt C, Andre L, Germain J, Soussoko M, Morel O, Mezan de Malartic C. [Antibiotics in first-line in case of bartholinitis: Retrospective Study of 33 Cases]. ACTA ACUST UNITED AC 2019; 47:713-717. [PMID: 31356891 DOI: 10.1016/j.gofs.2019.07.011] [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: 01/27/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Acute Bartholinitis is a common pathology affecting nearly 2% of women in their lifetime. Many treatments are used, although their effectiveness is not demonstrated in the literature. The main objective was to evaluate the success rate of first-line antibiotic therapy. The secondary objective was to identify factors associated with successful treatment. METHODS We conducted a retrospective unicentric study between January 2014 and June 2018 at the University Hospital Center of Nancy. Inclusion criteria were the presence of acute bartholinitis treated with first-line antibiotic therapy. Exclusion criteria were patients lost to follow-up after initiation of treatment. The primary endpoint was the absence of surgical treatment within 30 days of initiation of antibiotic therapy. Factors associated with successful medical treatment were sought. RESULTS Thirty-three patients were included. The success rate of medical treatment was 48.5% at 30 days. In the case of symptoms that had been evolving for less than 3 days, the success of medical treatment was more frequent (75% vs. 35.3%, P=0.02). Medical treatment was more effective in lesions of less than 2cm (68.7% vs. 23.5%, P=0.01). After adjustment, the only factor associated with successful medical treatment was lesion size≤2cm [ORa=5.31 (1.05-26.81)]. CONCLUSION First-line antibiotic therapy for acute bartholinitis seems effective but should be targeted according to certain eligibility criteria.
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Affiliation(s)
- C Bertholdt
- Pôle de gynécologie-obstétrique, maternité régionale universitaire, CHRU de Nancy, 10, rue du Docteur Heydenreich, 54000 Nancy, France; Unité Inserm U1254, CHRU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
| | - L Andre
- Pôle de gynécologie-obstétrique, maternité régionale universitaire, CHRU de Nancy, 10, rue du Docteur Heydenreich, 54000 Nancy, France
| | - J Germain
- Pôle de gynécologie-obstétrique, maternité régionale universitaire, CHRU de Nancy, 10, rue du Docteur Heydenreich, 54000 Nancy, France
| | - M Soussoko
- Pôle de gynécologie-obstétrique, maternité régionale universitaire, CHRU de Nancy, 10, rue du Docteur Heydenreich, 54000 Nancy, France
| | - O Morel
- Pôle de gynécologie-obstétrique, maternité régionale universitaire, CHRU de Nancy, 10, rue du Docteur Heydenreich, 54000 Nancy, France; Unité Inserm U1254, CHRU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - C Mezan de Malartic
- Pôle de gynécologie-obstétrique, maternité régionale universitaire, CHRU de Nancy, 10, rue du Docteur Heydenreich, 54000 Nancy, France
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Bertholdt C, Poujois J, Pouypoudat L, Gisbert S, Morel O. [Perineal risk and obstetrical protection: A survey with birth professionals]. ACTA ACUST UNITED AC 2019; 47:504-509. [PMID: 31003014 DOI: 10.1016/j.gofs.2019.04.012] [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: 01/28/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The main objective was to evaluate the practices declared by birth professionals in the Lorraine region about perineal obstetric protection (any perineal tear combined). The secondary objective was to evaluate prevention measures performed in practice by birth professionals according to the perineal risk subjectively estimated for each obstetric situation. METHODS This is a practice survey conducted through an anonymous questionnaire distributed to birth professionals (gynecologists, interns, midwife and midwife student) in October 2016. Topics covered concerned maternal, obstetric and fetal risk factors associated with perineal (1st to 4th degrees) lesions and the associated protective measures. A descriptive analysis of the data collected was conducted. RESULTS One hundred and five professionals answered the questionnaire. The identified risk factors were consistent with those highlighted in the literature. Other factors, not known as associated with perineal risk, were cited by professionals (smoking, phototype). If the professional perceived a significant perineal risk, they more frequently practiced an episiotomy (15% vs. 0%, P<0.001) or considered that the delivery should be performed by an obstetrician (34% vs 8%, P<0.001). CONCLUSION This evaluation shows that birth professionals know the main risk factors for perineal injury. On the other hand, they easily use perineal protection maneuvers (episiotomy for example) without real demonstrated effectiveness.
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Affiliation(s)
- C Bertholdt
- Pôle de gynécologie-obstétrique, CHRU de Nancy, 10, rue du Docteur-Heydenreich, 54000 Nancy, France; Inserm U1254, CHRU de Nancy, rue du Morvan, 54000 Vandœuvre-lès-Nancy, France.
| | - J Poujois
- Pôle de gynécologie-obstétrique, CHRU de Nancy, 10, rue du Docteur-Heydenreich, 54000 Nancy, France
| | - L Pouypoudat
- Pôle de gynécologie-obstétrique, CHRU de Nancy, 10, rue du Docteur-Heydenreich, 54000 Nancy, France
| | - S Gisbert
- Pôle de gynécologie-obstétrique, CHRU de Nancy, 10, rue du Docteur-Heydenreich, 54000 Nancy, France
| | - O Morel
- Pôle de gynécologie-obstétrique, CHRU de Nancy, 10, rue du Docteur-Heydenreich, 54000 Nancy, France; Inserm U1254, CHRU de Nancy, rue du Morvan, 54000 Vandœuvre-lès-Nancy, France
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Ambroise Grandjean G, Hossu G, Bertholdt C, Noble P, Morel O, Grangé G. Artificial intelligence assistance for fetal head biometry: Assessment of automated measurement software. Diagn Interv Imaging 2018; 99:709-716. [DOI: 10.1016/j.diii.2018.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/04/2018] [Accepted: 08/06/2018] [Indexed: 12/31/2022]
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Grondin-Depraetre L, Soussoko M, Gisbert S, Morel O, Bertholdt C. [Maternal outcomes in case of cesarean before 32weeks of gestation: A retrospective observational study]. ACTA ACUST UNITED AC 2018; 46:653-657. [PMID: 30174174 DOI: 10.1016/j.gofs.2018.08.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In recent years, active neonatal care in case of prematurity leads to an increase of cesarean delivery rate. Data remains sparse on maternal morbidity induced by preterm cesareans and especially before 32 weeks of gestation. The main aim of this study was to evaluate per-partum maternal morbidity in case of cesarean performed before 32 week of gestation. As secondary objectives, we assessed post-partum maternal morbidity and factors associated with maternal morbidity. METHODS This is a retrospective single-center study conducted in a tertiary care unit between 2014 and 2016 including cesareans performed before 32 week of gestation in the study period. The primary outcome was a composite criterion of per partum maternal morbidity including post-partum hemorrhage, blood transfusion, general anesthesia, surgical wounds and maternal death. The secondary outcome was the post-partum maternal morbidity, defined by a composite criterion including hospitalization more than 7 days, infectious disease, wall and digestive complication and venous thromboembolic disease. RESULTS Two hundred and eleven women were included. Maternal morbidity occurred in 21.3% in per partum and in 20.4% in post-partum. The factors associated with per partum morbidity were low-lying placenta (OR=4.40 [1.01-19.09]) and non-fetal indication of cesarean (OR=2.10[1.01-4.42]). The factors associated with post-partum morbidity were twin-pregnancy (OR=2.90 [1.12-7.54]), general anesthesia (OR=4.19 [1.68-10.49]) and non-cephalic fetal presentation (OR= 2.70 [1.23-5.93]). CONCLUSION The maternal morbidity of cesareans before 32 week of gestation is more than 20%. This study confirms the high maternal morbidity associated with caesareans performed before 32 weeks of gestation.
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Affiliation(s)
- L Grondin-Depraetre
- Pôle de gynécologie-obstétrique, maternité régionale universitaire, CHRU de Nancy, 10, rue du Docteur-Heydenreich, 54000 Nancy, France
| | - M Soussoko
- Pôle de gynécologie-obstétrique, maternité régionale universitaire, CHRU de Nancy, 10, rue du Docteur-Heydenreich, 54000 Nancy, France
| | - S Gisbert
- Pôle de gynécologie-obstétrique, maternité régionale universitaire, CHRU de Nancy, 10, rue du Docteur-Heydenreich, 54000 Nancy, France
| | - O Morel
- Pôle de gynécologie-obstétrique, maternité régionale universitaire, CHRU de Nancy, 10, rue du Docteur-Heydenreich, 54000 Nancy, France; Unité Inserm U1254, 1, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - C Bertholdt
- Pôle de gynécologie-obstétrique, maternité régionale universitaire, CHRU de Nancy, 10, rue du Docteur-Heydenreich, 54000 Nancy, France; Unité Inserm U1254, 1, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France.
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de Souza A, Minebois H, Luc A, Choserot M, Bertholdt C, Morel O, Callec R. [Stained amniotic fluid and meconium amniotic fluid: Should they change our obstetric management ?]. ACTA ACUST UNITED AC 2017; 46:28-33. [PMID: 29249650 DOI: 10.1016/j.gofs.2017.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To assess if a stained or meconial amniotic fluid during labor is correlated with a greater risk of neonatal metabolic acidosis. METHODS In a retrospective case-control study carried out in a level 3 maternity from 1st of January to 31st of December 2014, all patients who delivered a singleton eutrophic fetus in cephalic presentation after 37WG and with a stained or meconial amniotic fluid during labor were included. Obstetrical and neonatal outcomes were compared according to the amniotic fluid's color. RESULTS At all, 302 patients in the group « Abnormal amniotic fluid» (198 patients with stained amniotic fluid, 104 with meconial amniotic fluid) vs. 302 in the group « clear amniotic fluid» were included. No significant difference on the rate of neonatal severe acidosis between the two groups were found. Fetal heart rhythm abnormalities were more frequent in case of meconial amniotic fluid (11,3% vs. 31,7%, P<0,0001). The composite endpoint, defined by the association of umbilical arterial pH <7,0±base excess ≥12mmol/L±Apgar score at 5min <7, was more frequent in case of meconial amniotic fluid (4,0% vs. 12,5%, P=0,0018). CONCLUSION The occurrence of severe neonatal metabolic acidosis was not more frequent in case of stained or meconial amniotic fluid, but with an increase in the use of fetal scalp pH and cesaerian deliveries when the fluid was meconial.
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Affiliation(s)
- A de Souza
- Pôle d'obstétrique et de médecine fœtale, maternité régionale universitaire, CHRU de Nancy, 10, rue du Dr-Heydenreich, 54000 Nancy, France; Université de Lorraine, 34, cour Léopold, 54000 Nancy, France.
| | - H Minebois
- Pôle d'obstétrique et de médecine fœtale, maternité régionale universitaire, CHRU de Nancy, 10, rue du Dr-Heydenreich, 54000 Nancy, France; Université de Lorraine, 34, cour Léopold, 54000 Nancy, France
| | - A Luc
- Plateforme d'aide à la recherche clinique PARC, unité MDS, CHRU de Nancy, 54500 Vandoeuvre-lès-Nancy, France
| | - M Choserot
- Pôle d'obstétrique et de médecine fœtale, maternité régionale universitaire, CHRU de Nancy, 10, rue du Dr-Heydenreich, 54000 Nancy, France; Université de Lorraine, 34, cour Léopold, 54000 Nancy, France
| | - C Bertholdt
- Pôle d'obstétrique et de médecine fœtale, maternité régionale universitaire, CHRU de Nancy, 10, rue du Dr-Heydenreich, 54000 Nancy, France; Université de Lorraine, 34, cour Léopold, 54000 Nancy, France
| | - O Morel
- Pôle d'obstétrique et de médecine fœtale, maternité régionale universitaire, CHRU de Nancy, 10, rue du Dr-Heydenreich, 54000 Nancy, France; Université de Lorraine, 34, cour Léopold, 54000 Nancy, France
| | - R Callec
- Pôle d'obstétrique et de médecine fœtale, maternité régionale universitaire, CHRU de Nancy, 10, rue du Dr-Heydenreich, 54000 Nancy, France; Université de Lorraine, 34, cour Léopold, 54000 Nancy, France
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Mourier E, Tarrade A, Duan J, Richard C, Bertholdt C, Beaumont M, Morel O, Chavatte-Palmer P. Non-invasive evaluation of placental blood flow: lessons from animal models. Reproduction 2016; 153:R85-R96. [PMID: 27845691 DOI: 10.1530/rep-16-0428] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/03/2016] [Accepted: 11/14/2016] [Indexed: 01/11/2023]
Abstract
In human obstetrics, placental vascularisation impairment is frequent as well as linked to severe pathological events (preeclampsia and intrauterine growth restriction), and there is a need for reliable methods allowing non-invasive evaluation of placental blood flow. Uteroplacental vascularisation is complex, and animal models are essential for the technical development and safety assessment of these imaging tools for human clinical use; however, these techniques can also be applied in the veterinary context. This paper reviews how ultrasound-based imaging methods such as 2D and 3D Doppler can provide valuable insight for the exploration of placental blood flow both in humans and animals and how new approaches such as the use of ultrasound contrast agents or ultrafast Doppler may allow to discriminate between maternal (non-pulsatile) and foetal (pulsatile) blood flow in the placenta. Finally, functional magnetic resonance imaging could also be used to evaluate placental blood flow, as indicated by studies in animal models, but its safety in human pregnancy still requires to be confirmed.
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Affiliation(s)
- E Mourier
- UMR BDRINRA, ENVA, Université Paris Saclay, Jouy en Josas, France .,PremUp FoundationParis, France
| | - A Tarrade
- UMR BDRINRA, ENVA, Université Paris Saclay, Jouy en Josas, France.,PremUp FoundationParis, France
| | - J Duan
- IADIInserm U947, University of Lorraine, CHRU of Brabois, Nancy, France.,CHRU of Nancypole de Gynécologie Obstétrique, Nancy, France
| | - C Richard
- UMR BDRINRA, ENVA, Université Paris Saclay, Jouy en Josas, France.,PremUp FoundationParis, France
| | - C Bertholdt
- IADIInserm U947, University of Lorraine, CHRU of Brabois, Nancy, France.,CHRU of Nancypole de Gynécologie Obstétrique, Nancy, France
| | - M Beaumont
- IADIInserm U947, University of Lorraine, CHRU of Brabois, Nancy, France.,CHRU of Nancypole de Gynécologie Obstétrique, Nancy, France
| | - O Morel
- IADIInserm U947, University of Lorraine, CHRU of Brabois, Nancy, France.,CHRU of Nancypole de Gynécologie Obstétrique, Nancy, France
| | - P Chavatte-Palmer
- UMR BDRINRA, ENVA, Université Paris Saclay, Jouy en Josas, France.,PremUp FoundationParis, France
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Bertholdt C, Vincent-Rohfritsch A, Tsatsaris V, Goffinet F. Placental Abruption Revealed by Hemoperitoneum: A Case Report. AJP Rep 2016; 6:e424-e426. [PMID: 27994944 PMCID: PMC5161361 DOI: 10.1055/s-0036-1597267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Background Hemoperitoneum is a life-threatening surgical emergency. Diagnosis of the cause is often difficult, in particular, during pregnancy when it may be either obstetric or nonobstetric. Case We report the case of a hemoperitoneum caused by the backflow of blood through a uterine tube, due to placental abruption. Conclusion Hemoperitoneum in pregnant women with no other signs can reveal placental abruption. The difficulty in identifying the cause may delay appropriate management.
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Affiliation(s)
- C Bertholdt
- Maternité Port-Royal, Université Paris Descartes, Groupe Hospitalier Cochin Broca, Hôtel-Dieu, Paris, France
| | - A Vincent-Rohfritsch
- Maternité Port-Royal, Université Paris Descartes, Groupe Hospitalier Cochin Broca, Hôtel-Dieu, Paris, France
| | - V Tsatsaris
- Maternité Port-Royal, Université Paris Descartes, Groupe Hospitalier Cochin Broca, Hôtel-Dieu, Paris, France
| | - F Goffinet
- Maternité Port-Royal, Université Paris Descartes, Groupe Hospitalier Cochin Broca, Hôtel-Dieu, Paris, France
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