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Sentilhes L, Sénat MV, Bouchghoul H, Delorme P, Gallot D, Garabedian C, Madar H, Sananès N, Perrotin F, Schmitz T. [Intrahepatic cholestasis of pregnancy: French College of Obstetricians and Gynecologists guidelines for clinical practice]. Gynecol Obstet Fertil Senol 2023; 51:493-510. [PMID: 37806861 DOI: 10.1016/j.gofs.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To identify strategies for reducing neonatal and maternal morbidity associated with intrahepatic cholestasis pregnancy (ICP). MATERIAL AND METHODS The quality of evidence of the literature was assessed following the GRADE methodology with questions formulated in the PICO format (Patients, Intervention, Comparison, Outcome) and outcomes defined a priori and classified according to their importance. An extensive bibliographic search was performed on PubMed, Cochrane, EMBASE and Google Scholar databases. The quality of the evidence was assessed (high, moderate, low, very low) and a (i) strong or (ii) weak recommendations or (iii) no recommendation were formulated. The recommendations were reviewed in two rounds with external reviewers (Delphi survey) to select the consensus recommendations. RESULTS Of the 14 questions (from 12 PICO questions and one definition question outside the PICO format), there was agreement between the working group and the external reviewers on 14 (100%). The level of evidence of the literature was insufficient to provide a recommendation on two questions. ICP is defined by the occurrence of suggestive pruritus (palmoplantar, nocturnal) associated with a total bile acid level>10μmol/L or an alanine transaminase level above 2N after ruling out differential diagnoses. In the absence of suggestive symptoms of a differential diagnosis, it is recommended not to carry out additional biological or ultrasound tests. In women with CIP, ursodeoxycholic acid is recommended to reduce the intensity of maternal pruritus (Strong recommendation. Quality of the evidence moderate) and to decrease the level of total bile acids and alanine transaminases. (Strong recommendation. Quality of the evidence moderate). S-adenosyl-methionine, dexamethasone, guar gum or activated charcoal should not be used to reduce the intensity of maternal pruritus (Strong recommendation. Quality of evidence low), and there is insufficient data to recommend the use of antihistamines (No recommendation. Quality of evidence low). Rifampicin (Weak recommendation. Very low quality of evidence) or plasma exchange (Strong recommendation. Very low quality of evidence) should not be used to reduce maternal pruritus and perinatal morbidity. Serum monitoring of bile acids is recommended to reduce perinatal morbidity and mortality (stillbirth, prematurity) (Low recommendation. Quality of the evidence low). The level of evidence is insufficient to determine whether fetal heart rate or fetal ultrasound monitoring are useful to reduce perinatal morbidity (No recommendation). Birth is recommended when bile acid level is above 99μmol/L from 36 weeks gestation to reduce perinatal morbidity, in particular stillbirth. When bile acid level is above 99μmol/L is below 100μmol/L, women should be informed that induction of labor could be considered 37 and 39 weeks gestation to reduce perinatal morbidity. (Strong recommendation. Quality of evidence low). In postpartum, total bile acids and alanine transaminases level should be checked and normalized before prescribing estrogen-progestin contraception, ideally with a low estrogen dose (risk of recurrence of pruritus and cytolysis) (Low recommendation. Quality of evidence very low). CONCLUSION Although the quality of evidence regarding ICP gestational cholestasis remains low, there is a strong consensus in France, as shown by our Delphi study, on how to manage women with ICP. The reference first-line treatment is ursodeoxycholic acid.
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Affiliation(s)
- L Sentilhes
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France.
| | - M-V Sénat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - H Bouchghoul
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - P Delorme
- Service de gynécologie-obstétrique, hôpital Trousseau, AP-HP, Paris, France
| | - D Gallot
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - C Garabedian
- Service de gynécologie-obstétrique, CHU de Lille, université de Lille, ULR 2694-METRICS, 59000 Lille, France
| | - H Madar
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - N Sananès
- Service de gynécologie-obstétrique, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - F Perrotin
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Tours, Tours, France
| | - T Schmitz
- Service de gynécologie obstétrique, hôpital Robert-Debré, AP-HP, Paris, France
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Sentilhes L, Kayem G. [Routine ultrasound screening in pregnancy: How to improve its performance?]. Gynecol Obstet Fertil Senol 2023; 51:191-192. [PMID: 36649815 DOI: 10.1016/j.gofs.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Indexed: 01/15/2023]
Affiliation(s)
- L Sentilhes
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Place Amélie Raba-Léon, 33000 Bordeaux, France.
| | - G Kayem
- Université de Paris, CRESS, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, EPOPé, Inserm, INRA, DHU Risks in Pregnancy, Paris, France; Department of Obstetrics and Gynecology, Trousseau Hospital, Assistance publique-Hôpitaux de Paris, Paris, France
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Sentilhes L, Schmitz T, Madar H, Bouchghoul H, Fuchs F, Garabédian C, Korb D, Nouette-Gaulain K, Pécheux O, Sananès N, Sibiude J, Sénat MV, Goffinet F. [The cesarean procedure: Guidelines for clinical practice from the French College of Obstetricians and Gynecologists]. Gynecol Obstet Fertil Senol 2023; 51:7-34. [PMID: 36228999 DOI: 10.1016/j.gofs.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify procedures to reduce maternal morbidity during cesarean. MATERIAL AND METHODS The quality of evidence of the literature was assessed following the GRADE® method with questions formulated in the PICO format (Patients, Intervention, Comparison, Outcome) and outcomes defined a priori and classified according to their importance. An extensive bibliographic search was performed on PubMed, Cochrane and EMBASE databases. The quality of the evidence was assessed (high, moderate, low, very low) and a (i) strong or (ii) weak recommendations or (iii) no recommendation were formulated. The recommendations were reviewed in two rounds with external reviewers (Delphi survey) to select the consensus recommendations. RESULTS Of the 27 questions, there was agreement between the working group and the external reviewers on 26. The level of evidence of the literature was insufficient to provide a recommendation on 15 questions. Preventing hypothermia is recommended to increase maternal satisfaction and comfort (weak recommendation) and to reduce neonatal hypothermia (strong recommendation). The quality of the evidence of the literature did not allow to recommend the skin disinfectant to be used nor the relevance of a preoperative vaginal disinfection nor the choice between the use or nonuse of an indwelling bladder catheterization (if micturition takes place 1 hour before the cesarean section). The Misgav-Ladach technique or its analogues should be considered rather than the Pfannenstiel technique to reduce maternal morbidity (weak recommendation) bladder flap before uterine incision should not be performed routinely (weak recommendation), but a blunt (weak recommendation) and cephalad-caudad extension of uterine incision (weak recommendation) should be considered to reduce maternal morbidity. Antibiotic prophylaxis is recommended to reduce maternal infectious morbidity (strong recommendation) without recommendation on its type or the timing of administration (before incision or after cord clamping). The administration of carbetocin after cord clamping does not significantly decrease the incidence of blood loss>1000 ml, anemia, or blood transfusion compared with the administration of oxytocin. Thus, it is not recommended to use carbetocin rather than oxytocin in cesarean. It is recommended that systematic manual removal of the placenta not to be performed (weak recommendation). An antiemetic should be administered after cord clamping in women having a planned cesarean under locoregional anaesthesia to reduce intraoperative and postoperative nausea and vomiting (strong recommendation) with no recommendation regarding choice of use one or two antiemetics. The level of evidence of the literature was insufficient to provide any recommendation concerning single or double-layer closure of the uterine incision, or the uterine exteriorization. Closing the peritoneum (visceral or parietal) should not be considered (weak recommendation). The quality of the evidence of the literature was not sufficient to provide recommendation on systematic subcutaneous closure, including in obese or overweight patients, or the use of subcuticular suture in obese or overweight patients. The use of subcuticular suture in comparison with skin closure by staples was not considered as a recommendation due to the absence of a consensus in the external review rounds. CONCLUSION In case of cesarean, preventing hypothermia, administering antiemetic and antibiotic prophylaxis after cord clamping are the only strong recommendations. The Misgav-Ladach technique, the way of performing uterine incision (no systematic bladder flap, blunt cephalad-caudad extension), not performing routine manual removal of the placenta nor closure of the peritoneum are weak recommendations and may reduce maternal morbidity.
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Affiliation(s)
- L Sentilhes
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France.
| | - T Schmitz
- Service de gynécologie obstétrique, hôpital Robert-Debré, université Paris Diderot, AP-HP, Paris, France
| | - H Madar
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - H Bouchghoul
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - F Fuchs
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Montpellier, Montpellier, France
| | - C Garabédian
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Lille, Lille, France
| | - D Korb
- Service de gynécologie obstétrique, hôpital Robert-Debré, université Paris Diderot, AP-HP, Paris, France
| | - K Nouette-Gaulain
- Service d'anesthésie, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - O Pécheux
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Lille, Lille, France
| | - N Sananès
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Strasbourg, Strasbourg, France
| | - J Sibiude
- Service de gynécologie-obstétrique, hôpital Louis-Mourier, AP-HP Louis-Mourier, Colombes, France
| | - M-V Sénat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP Le Kremlin-Bicêtre, Paris, France
| | - F Goffinet
- Maternité Port-Royal, groupe hospitalier Cochin Broca, Hôtel-Dieu, université Paris-Descartes, AP-HP, Paris, France
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Deruelle P, Sentilhes L, Ghesquière L, Desbrière R, Ducarme G, Attali L, Jarnoux A, Artzner F, Tranchant A, Schmitz T, Sénat MV. [Expert consensus from the College of French Gynecologists and Obstetricians: Management of nausea and vomiting of pregnancy and hyperemesis gravidarum]. Gynecol Obstet Fertil Senol 2022; 50:700-711. [PMID: 36150647 DOI: 10.1016/j.gofs.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To determine the management of patients with 1st trimester nausea and vomiting and hyperemesis gravidarum. METHODS A panel of experts participated in a formal consensus process, including focus groups and two Delphi rounds. RESULTS Hyperemesis gravidarum is distinguished from nausea and vomiting during pregnancy by weight loss≥5 % or signs of dehydration or a PUQE score≥7. Hospitalization is proposed when there is, at least, one of the following criteria: weight loss≥10%, one or more clinical signs of dehydration, PUQE (Pregnancy Unique Quantification of Emesis and nausea) score≥13, hypokalemia<3.0mmol/L, hyponatremia<120mmol/L, elevated serum creatinine>100μmol/L or resistance to treatment. Prenatal vitamins and iron supplementation should be stopped without stopping folic acid supplementation. Diet and lifestyle should be adjusted according to symptoms. Aromatherapy is not to be used. If the PUQE score is<6, even in the absence of proof of their benefit, ginger, pyridoxine (B6 vitamin), acupuncture or electrostimulation can be used, even in the absence of proof of benefit. It is proposed that drugs or combinations of drugs associated with the least severe and least frequent side effects should always be chosen for uses in 1st, 2nd or 3rd intention, taking into account the absence of superiority of a class over another to reduce the symptoms of nausea and vomiting of pregnancy and hypermesis gravidarum. To prevent Gayet Wernicke encephalopathy, Vitamin B1 must systematically be administered for hyperemesis gravidarum needing parenteral rehydration. Patients hospitalized for hyperemesis gravidarum should not be placed in isolation (put in the dark, confiscation of the mobile phone or ban on visits, etc.). Psychological support should be offered to all patients with hyperemesis gravidarum as well as information on patient' associations involved in supporting these women and their families. When returning home after hospitalization, care will be organized around a referring doctor. CONCLUSION This work should contribute to improving the care of women with hyperemesis gravidarum. However, given the paucity in number and quality of the literature, researchers must invest in the field of nausea and vomiting in pregnancy, and HG to identify strategies to improve the quality of life of women with nausea and vomiting in pregnancy or hyperemesis gravidarum.
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Affiliation(s)
- P Deruelle
- UNISTRA, département de gynécologie-obstétrique, hôpitaux universitaires de Strasbourg, 67000 Strasbourg cedex, France.
| | - L Sentilhes
- Department of obstetrics and gynecology, Bordeaux university hospital, Bordeaux, France
| | - L Ghesquière
- ULR 2694 - METRICS - évaluation des technologies de santé et des pratiques médicales, university Lille, CHU Lille, 59000 Lille, France; Department of obstetrics, CHU Lille, 59000 Lille, France
| | | | - G Ducarme
- Service de gynécologie obstétrique, centre hospitalier départemental Vendée, 85000 La Roche-sur-Yon, France
| | - L Attali
- UNISTRA, département de gynécologie-obstétrique, hôpitaux universitaires de Strasbourg, 67000 Strasbourg cedex, France
| | | | - F Artzner
- Association 9mois avec ma bassine, France
| | - A Tranchant
- Association de lutte contre l'hyperémèse gravidique, France
| | - T Schmitz
- Université Paris Cité, 75006 Paris, France; Service de gynécologie obstétrique, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris, Paris, France
| | - M-V Sénat
- Department of obstetrics and gynecology, Bicêtre hospital, Assistance publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
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Bagou G, Sentilhes L, Mercier FJ, Berveiller P, Blanc J, Cesareo E, Dewandre PY, Douay B, Gloaguen A, Gonzalez M, Le Conte P, Le Gouez A, Madar H, Maissonneuve E, Morau E, Rackelboom T, Rossignol M, Sibiude J, Vaux J, Vivanti A, Goddet S, Rozenberg P, Garnier M, Chauvin A. Recommandations de pratiques professionnelles 2022 Prise en charge des urgences obstétricales en médecine d’urgence. Ann Fr Med Urgence 2022. [DOI: 10.3166/afmu-2022-0417] [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] [Indexed: 11/20/2022]
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Madar H, Deneux-Tharaux C, Sentilhes L. [What's new in obstetrics and gynecology ? About tranexamic acid for the prevention of postpartum hemorrhage]. Gynecol Obstet Fertil Senol 2022; 50:280-282. [PMID: 35123141 DOI: 10.1016/j.gofs.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Affiliation(s)
- H Madar
- Service de Gynécologie-Obstétrique, CHU de Bordeaux, Place Amélie- Raba-Léon, 33076 Bordeaux, France.
| | - C Deneux-Tharaux
- Université de Paris, CRESS, Équipe de recherche en épidémiologie obstétricale périnatale et pédiatrique, EPOPé, INSERM, INRA, FHU Préma, Paris, France
| | - L Sentilhes
- Service de Gynécologie-Obstétrique, CHU de Bordeaux, Place Amélie- Raba-Léon, 33076 Bordeaux, France
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Brun JL, Sentilhes L, Torre A, Huchon C, Garabedian C, Legendre G, Sibiude J, Sénat MV, Marret H, Schmitz T. [CNGOF clinical practice guidelines: Evaluation one year after revision of the methodology]. Gynecol Obstet Fertil Senol 2022; 50:130-135. [PMID: 34801762 DOI: 10.1016/j.gofs.2021.11.008] [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: 11/07/2021] [Accepted: 11/16/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To evaluate the revision of methodology of the clinical practice guidelines (CPG) of the French National College of Gynecologists and Obstetricians (CNGOF). METHOD Three CPGs were organized in 2020 on the topics of severe preeclampsia, menorrhagia, and prophylactic surgery according to AGREE II (Apraisal of Guidelines for Research & Evaluation). Questions were presented in PICO (Population, Intervention, Comparison, Outcome) format and the grading of scientific evidence was based on the GRADE (Grading of Recommendation Assessment, Development and Evaluation) method. RESULTS All three CPGs groups adhered to this new methodology. However, the presentation of the arguments, the formulation of the recommendations and the development of the GRADE tables were heterogeneous from one group to another. A homogenization of the presentation is proposed, as well as a guide to the critical analysis of the literature to help the experts to rate the evidence. CONCLUSION Adherence to these quality criteria should make it easier to apply the recommendations at the national level and improve international recognition of the work done by the CNGOF.
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Affiliation(s)
- J-L Brun
- Pôle d'obstétrique-reproduction-gynécologie, centre Aliénor d'Aquitaine, hôpital Pellegrin, CHU Bordeaux, place Amélie Raba Léon, 33076 Bordeaux, France; UMR 5234 (MFP), microbiologie fondamentale et pathogénicité, université de Bordeaux, 33076 Bordeaux, France.
| | - L Sentilhes
- Pôle d'obstétrique-reproduction-gynécologie, centre Aliénor d'Aquitaine, hôpital Pellegrin, CHU Bordeaux, place Amélie Raba Léon, 33076 Bordeaux, France
| | - A Torre
- Centre de procréation médicalement assistée, centre hospitalier Sud Francilien, 40, avenue Serge Dassault, 91106 Corbeil-Essonnes, France
| | - C Huchon
- Service de gynécologie-obstétrique, hôpital Lariboisière, AP-HP, 2, rue Ambroise Paré, 75010 Paris, France; UMR 1123 (ECEVE), épidémiologie clinique, évaluation économique, populations vulnérables, université de Paris, Paris, France
| | - C Garabedian
- Clinique d'obstétrique, hôpital Jeanne de Flandre, CHU de Lille, avenue Eugène Avinée, 59000 Lille, France; ULR 2694 (METRICS), évaluation des technologies de santé et des pratiques médicales, université de Lille, 59000 Lille, France
| | - G Legendre
- Service de gynécologie-obstétrique, CHU d'Angers, 4, rue Larrey, 49933 Angers, France; UMR 1018 (CESP), centre de recherche en épidémiologie et santé des populations, 94076 Villejuif, France
| | - J Sibiude
- Service de gynécologie-obstétrique, hôpital Louis Mourier, AP-HP, 92700 Colombes, France; UMR 1137 (IAME), centre de recherche infection-antimicrobiens-modélisation-évolution, université de Paris, 75018 Paris, France
| | - M-V Sénat
- UMR 1018 (CESP), centre de recherche en épidémiologie et santé des populations, 94076 Villejuif, France; Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - H Marret
- Service de chirurgie pelvienne gynécologique et oncologique, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; UMR 1253, Imagerie et cerveau, université de Tours, 37032 Tours, France
| | - T Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; INSERM U1153 (EPOPé), épidémiologie obstétricale périnatale et pédiatrique, université de Paris, 75006 Paris, France
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Kayem G, Sentilhes L. [Which validation of surgical skills in oncology for optimal patient management?]. Gynecol Obstet Fertil Senol 2022; 50:1. [PMID: 34748990 DOI: 10.1016/j.gofs.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Indexed: 06/13/2023]
Affiliation(s)
- G Kayem
- Service de gynécologie obstétrique, hôpital Trousseau, Sorbonne Université, AP-HP, Paris, France.
| | - L Sentilhes
- Service de gynécologie-obstétrique, CHU de Bordeaux, Bordeaux, France
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Bonnet MP, Garnier M, Keita H, Compere V, Arthuis C, Raia-Barjat T, Berveiller P, Burey J, Bouvet L, Bruyère M, Castel A, Clouqueur E, Estevez MG, Faitot V, Fischer C, Fuchs F, Lecarpentier E, Le Gouez A, Rigouzzo A, Rossignol M, Simon E, Vial F, Vivanti AJ, Zieleskewicz L, Sénat MV, Schmitz T, Sentilhes L. [Reprint of: Severe pre-eclampsia: guidelines for clinical practice from the French Society of anesthesiology and intensive care (SFAR) and the French College of gynaecologists and obstetricians (CNGOF)]. ACTA ACUST UNITED AC 2021; 50:2-25. [PMID: 34781016 DOI: 10.1016/j.gofs.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To provide national guidelines for the management of women with severe preeclampsia. DESIGN A consensus committee of 26 experts was formed. A formal conflict of interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding. The authors were advised to follow the principles 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 last SFAR and CNGOF guidelines on the management of women with severe preeclampsia was published in 2009. The literature is now sufficient for an update. The aim of this expert panel guidelines is to evaluate the impact of different aspects of the management of women with severe preeclampsia on maternal and neonatal morbidities separately. The experts studied questions within 7 domains. Each question was formulated according to the PICO (Patients Intervention Comparison Outcome) model and the evidence profiles were produced. An extensive literature review and recommendations were carried out and analyzed according to the GRADE® methodology. RESULTS The SFAR/CNGOF experts panel provided 25 recommendations: 8 have a high level of evidence (GRADE 1±), 9 have a moderate level of evidence (GRADE 2±), and for 7 recommendations, the GRADE method could not be applied, resulting in expert opinions. No recommendation was provided for 3 questions. After one scoring round, strong agreement was reached between the experts for all the recommendations. CONCLUSIONS There was strong agreement among experts who made 25 recommendations to improve practices for the management of women with severe preeclampsia.
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Affiliation(s)
- M-P Bonnet
- Sorbonne Université, GRC 29, DMU DREAM, Department of Anaesthesiology and Intensive Care, Armand Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Centre de Recherche épidémiologie et Statistiques Sorbonne Paris Cité (CRESS) U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France.
| | - M Garnier
- Sorbonne Université, APHP, GRC 29, DMU DREAM, Département d'Anesthesie-réanimation, CHU Tenon, Paris, France
| | - H Keita
- Département d'anesthésie-réanimation pédiatrique et obstétricale, hôpital Necker-Enfants malades, université de Paris, AP-HP, Paris, France
| | - V Compere
- Département d'anesthésie-réanimation, CHU de Rouen, Rouen, France
| | - C Arthuis
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Nantes, hôpital Mère-Enfant, Nantes, France
| | - T Raia-Barjat
- Inserm, U 1059 SainBioSE, département de gynécologie, obstétrique, et médecine de la reproduction, CHU de Saint-Étienne, université de Saint-Étienne Jean-Monnet, 42023 Saint-Étienne, France
| | - P Berveiller
- Service de gynécologie-obstétrique, école nationale vétérinaire d'Alfort, CHI Poissy Saint-Germain, UVSQ, INRAE, BREED, Jouy-en-Josas, BREED, Poissy université Paris-Saclay, Maisons-Alfort, France
| | - J Burey
- Service d'anesthésie-réanimation chirurgicale, hôpital Tenon, AP-HP, Paris, France
| | - L Bouvet
- Service d'anesthésie-réanimation, groupement hospitalier Est, hospices civils de Lyon, Bron, Claude-Bernard Lyon 1, hôpital Femme Mère-Enfant, université de Lyon, Villeurbanne, France
| | - M Bruyère
- Service d'anesthésie-réanimation médecine périopératoire, hôpital Bicêtre, AP-HP, université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - A Castel
- Département d'anesthésie-réanimation, hôpital Paule-de-Viguier, Toulouse, France
| | - E Clouqueur
- Service de gynécologie-obstétrique, centre hospitalier de Tourcoing, Tourcoing, France
| | - M Gonzalez Estevez
- Service d'anesthésie-réanimation et de médecine périopératoire, hôpital Jeanne-de-Flandre, CHU de Lille, Lille, France
| | - V Faitot
- Département d'anesthésie-réanimation, hôpital de Hautepierre, CHU de Strasbourg, Strasbourg, France
| | - C Fischer
- Département d'anesthésie-réanimation chirurgicale, hôpital Cochin, Paris, France
| | - F Fuchs
- UMR Inserm, service de gynécologie-obstétrique, institut Desbrest d'épidémiologie et de santé publique (IDESP), IURC, CHU de Montpellier, hôpital Arnaud-de-Villeneuve, université de Montpellier, Campus Santé, Montpellier, France
| | - E Lecarpentier
- Inserm U955, département de gynécologie-obstétrique et médecine de la reproduction, CHIC de Créteil, institut biomédical Henri-Mondor, université Paris Est Créteil, Créteil, France
| | - A Le Gouez
- Département d'anesthésie-réanimation, hôpital Antoine-Béclère, AP-HP, Clamart, France
| | - A Rigouzzo
- Service d'anesthésie-réanimation chirurgicale, hôpital Armand Trousseau, AP-HP, Paris, France
| | - M Rossignol
- Département d'anesthésie-réanimation et SMUR, hôpital Lariboisière, AP-HP, université de Paris, Paris, France
| | - E Simon
- Pôle de gynécologie-obstétrique et biologie de la reproduction, CHU de Dijon-Bourgogne, UFR Sciences de santé Dijon, université de Bourgogne, Bourgogne, France
| | - F Vial
- Service d'anesthésie-réanimation, maternité régionale universitaire-CHRU de Nancy, Nancy, France
| | - A J Vivanti
- Université Paris Saclay, service de gynécologie-obstétrique, hôpital Antoine Béclère, AP-HP, Paris, France
| | - L Zieleskewicz
- Inserm, INRA, département d'anesthésie-réanimation, centre de recherche cardiovasculaire et de nutrition (C2VN), hôpital Nord, université d'Aix-Marseille, université Aix-Marseille, Marseille, France
| | - M-V Sénat
- Inserm, service de gynécologie-obstétrique, UVSQ, CESP, hôpital Bicêtre, université Paris-Saclay, AP-HP, Villejuif, France
| | - T Schmitz
- Inserm, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), service de gynécologie-obstétrique, centre de recherche épidémiologie et statistique Sorbonne Paris Cité (CRESS), hôpital Robert-Debré, université de Paris, AP-HP, 75004 Paris, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, maternité Aliénor d'Aquitaine, CHU de Bordeaux, Bordeaux, France
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10
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Shander A, Javidroozi M, Sentilhes L. Reply to: Prophylactic tranexamic acid at delivery: if not now, when? Int J Obstet Anesth 2021; 49:103234. [PMID: 34810054 DOI: 10.1016/j.ijoa.2021.103234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/14/2021] [Accepted: 10/24/2021] [Indexed: 11/19/2022]
Affiliation(s)
- A Shander
- Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, NJ, USA.
| | - M Javidroozi
- Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, NJ, USA
| | - L Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
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11
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Shander A, Javidroozi M, Sentilhes L. Tranexamic acid and obstetric hemorrhage: give empirically or selectively? Int J Obstet Anesth 2021; 48:103206. [PMID: 34343820 DOI: 10.1016/j.ijoa.2021.103206] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 06/09/2021] [Accepted: 06/26/2021] [Indexed: 11/30/2022]
Abstract
Antifibrinolytic agents such as tranexamic acid (TXA) inhibit the fibrinolytic pathway and protect blood clots from being degraded, thereby promoting hemostasis. They have been used to reduce blood loss in various settings including obstetrics. Based on current evidence, TXA can be considered as a therapeutic adjunct to control postpartum hemorrhage (PPH) after vaginal and cesarean deliveries, with earlier administration preferred. This strategy has been demonstrated to reduce mortality due to bleeding (but not the incidence of transfusion) in developing countries. On the other hand, the benefit-risk ratio of TXA has not been fully assessed in developed countries which have much lower PPH-related mortality rates and better access to other management modalities. As a proposed prophylactic agent to prevent PPH, the level of evidence is currently insufficient to recommend the routine use of TXA to prevent blood loss after vaginal and cesarean deliveries. The results of large new multicenter studies assessing the impact of TXA on maternal blood loss-related outcomes after cesarean delivery are awaited. While most studies to date have focused on empirical and one-size-fit-all dosing of TXA, more selective and individualized treatment protocols (possibly guided by functional coagulation assays) are needed to pave the way for safer and more effective use of this inexpensive and widely used medication.
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Affiliation(s)
- A Shander
- Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, NJ, USA.
| | - M Javidroozi
- Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, NJ, USA
| | - L Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
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12
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Schmitz T, Korb D, Azria E, Garabédian C, Rozenberg P, Sénat MV, Sentilhes L, Vayssière C, Winer N, Goffinet F. Perinatal outcome after planned vaginal delivery in monochorionic compared with dichorionic twin pregnancy. Ultrasound Obstet Gynecol 2021; 57:592-599. [PMID: 33078466 DOI: 10.1002/uog.23518] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/19/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To assess, according to chorionicity, the perinatal outcome of twin pregnancy in which vaginal delivery is planned. METHODS JUMODA (JUmeaux MODe d'Accouchement) was a national prospective population-based cohort study of twin pregnancies, delivered in 176 maternity units in France, from February 2014 to March 2015. In this planned secondary analysis, we assessed, according to chorionicity, the perinatal outcome of twin pregnancies, in which vaginal delivery was planned, that delivered at or after 32 weeks of gestation with the first twin in cephalic presentation. In order to select a population with well-recognized indications for planned vaginal delivery, we applied the same exclusion criteria as those in the Twin Birth Study, an international randomized trial. Monochorionic twin pregnancies with twin-to-twin transfusion syndrome or twin anemia-polycythemia sequence were defined as complicated and were excluded. The primary outcome was a composite of intrapartum mortality and neonatal morbidity and mortality. Multivariable logistic regression models were used to control for potential confounders. Subgroup analyses were conducted according to birth order (first or second twin) and gestational age at delivery (< 37 or ≥ 37 weeks of gestation). RESULTS Among 3873 twin pregnancies, in which vaginal delivery was planned, that delivered at ≥ 32 weeks' gestation with the first twin in cephalic presentation, meeting the inclusion criteria of the Twin Birth Study, 729 (18.8%) were uncomplicated monochorionic twin pregnancies and 3144 (81.2%) were dichorionic twin pregnancies. The rate of composite intrapartum mortality and neonatal morbidity and mortality did not differ between uncomplicated monochorionic (27/1458 (1.9%)) and dichorionic (107/6288 (1.7%)) twin pregnancies when adjusting for conception by assisted reproductive technologies (adjusted relative risk, 1.07 (95% CI, 0.66-1.75)). No significant difference in the primary outcome was found between the groups on subgroup analyses according to birth order and gestational age at delivery. CONCLUSION When vaginal delivery is planned, and delivery occurs at ≥ 32 weeks of gestation with the first twin in cephalic presentation, uncomplicated monochorionic twin pregnancy is not associated with a higher rate of composite intrapartum mortality and neonatal morbidity and mortality compared with dichorionic twin pregnancy. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- T Schmitz
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Service de Gynécologie Obstétrique, Paris, France
- Université de Paris, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - D Korb
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Service de Gynécologie Obstétrique, Paris, France
- Université de Paris, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - E Azria
- Université de Paris, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
- Maternité Notre Dame de Bon Secours, Groupe Hospitalier Saint-Joseph, Paris, France
| | - C Garabédian
- CHRU de Lille, Maternité Jeanne de Flandre, Lille, France
- Université de Lille 2, Lille, France
| | - P Rozenberg
- Centre Hospitalier Intercommunal de Poissy, Service de Gynécologie Obstétrique, Poissy, France
- Université de Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - M V Sénat
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service de Gynécologie Obstétrique, Le Kremlin-Bicêtre, Paris, France
- Université Paris Sud, Le Kremlin-Bicêtre, Paris, France
| | - L Sentilhes
- CHU de Bordeaux, Service de Gynécologie Obstétrique, Bordeaux, France
- Université de Bordeaux, Bordeaux, France
| | - C Vayssière
- CHU de Toulouse, Service de Gynécologie Obstétrique, Toulouse, France
- Université Toulouse III Paul Sabatier, Toulouse, France
| | - N Winer
- CHU de Nantes, Service de Gynécologie Obstétrique, Nantes, France
- Université de Nantes, Nantes, France
| | - F Goffinet
- Université de Paris, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
- Assistance Publique-Hôpitaux de Paris, Maternité Port-Royal, Paris, France
- DHU Risques et Grossesse, Paris, France
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13
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Blondeel J, Mattuizzi A, Delmas Y, Skopinski S, Richez C, Blanco P, Sentilhes L, Lazaro E. [Prospective assessment of a multidisciplinary meeting dedicated to inflammatory and vascular diseases during pregnancy]. Gynecol Obstet Fertil Senol 2021; 49:159-165. [PMID: 32987176 DOI: 10.1016/j.gofs.2020.09.008] [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: 06/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The pluridisciplinary meeting "PREGNANT - Pregnancy and Auto-immunity, Nephropathy, Thrombophilic Disorders" at the university hospital of Bordeaux is dedicated to inflammatory and thrombophilic disorders during pregnancy. The objective of our study was to evaluate the quality of this meeting in terms of: compliance with the mandatory criteria, adequacy with standard care, homogeneity of care, becoming of proposals issued. METHODS We conducted a prospective observational study including patients whose files were submitted to the meeting from January 2018 to June 2019. RESULTS In all, 16 meeting were conducted with 152 cases presented. Sixty-two patients were pregnant and 90 were in preconception. The most common reasons for presentation were vasculo-placentary diseases (22.3%), systemic lupus (16.4%), venous thromboembolic diseases (15.1%) and chronic intervillositis of unknown etiology (9.8%). Other reasons were antiphospholipid antibody syndrome and repeated spontaneous miscarriages. The mandatory criteria for multidisciplinary meeting were met. For 89 cases (58.5%), the problem was dictated by recommendations. Decisions made were consistent with recommendations in 89.8% of cases. Among the 63 cases without any published recommendations (41.5%), there was some homogeneity of the proposals. In all, 92.8% of the proposals issued by the meeting were implemented. CONCLUSIONS Multidisciplinary meeting "PREGNANT" has a prominent locoregional role in the management of patients with autoimmune, inflammatory or thrombophilic disorders in a pregnancy context.
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Affiliation(s)
- J Blondeel
- Service de gynécologie, centre hospitalier de Dax, 40100 Dax, France
| | - A Mattuizzi
- Service de gynécologie-obstétrique, hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France; Centre de référence des maladies auto-immunes systémiques rares de l'Est et du Sud-Ouest, CHU de Bordeaux, 33000 Bordeaux, France
| | - Y Delmas
- Service de néphrologie, hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France; Centre de référence des maladies auto-immunes systémiques rares de l'Est et du Sud-Ouest, CHU de Bordeaux, 33000 Bordeaux, France; Centre de compétence des microangiopathies thrombotiques, CHU de Bordeaux, 33000 Bordeaux, France
| | - S Skopinski
- Service de médecine vasculaire, hôpital Saint-André, CHU de Bordeaux, 33000 Bordeaux, France; Centre de référence des maladies auto-immunes systémiques rares de l'Est et du Sud-Ouest, CHU de Bordeaux, 33000 Bordeaux, France
| | - C Richez
- Service de rhumatologie, hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France; Centre de référence des maladies auto-immunes systémiques rares de l'Est et du Sud-Ouest, CHU de Bordeaux, 33000 Bordeaux, France
| | - P Blanco
- Laboratoire d'immunologie, hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France; Centre de référence des maladies auto-immunes systémiques rares de l'Est et du Sud-Ouest, CHU de Bordeaux, 33000 Bordeaux, France; Centre de compétence des microangiopathies thrombotiques, CHU de Bordeaux, 33000 Bordeaux, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France; Centre de référence des maladies auto-immunes systémiques rares de l'Est et du Sud-Ouest, CHU de Bordeaux, 33000 Bordeaux, France; Centre de compétence des microangiopathies thrombotiques, CHU de Bordeaux, 33000 Bordeaux, France
| | - E Lazaro
- Service de médecine interne, hôpital du Haut-Lévêque, CHU de Bordeaux, 33000 Bordeaux, France; Centre de référence des maladies auto-immunes systémiques rares de l'Est et du Sud-Ouest, CHU de Bordeaux, 33000 Bordeaux, France; Centre de compétence des microangiopathies thrombotiques, CHU de Bordeaux, 33000 Bordeaux, France.
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14
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Kayem G, Seco A, Beucher G, Dupont C, Branger B, Crenn Hebert C, Huissoud C, Fresson J, Winer N, Langer B, Rozenberg P, Morel O, Bonnet MP, Perrotin F, Azria E, Carbillon L, Chiesa C, Raynal P, Rudigoz RC, Dreyfus M, Vendittelli F, Patrier S, Deneux-Tharaux C, Sentilhes L. Clinical profiles of placenta accreta spectrum: the PACCRETA population-based study. BJOG 2021; 128:1646-1655. [PMID: 33393174 DOI: 10.1111/1471-0528.16647] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe and compare the characteristics of women with placenta accreta spectrum (PAS) and their pregnancy outcomes according to the presence of placenta praevia and a prior caesarean section. DESIGN Prospective population-based study. SETTING All 176 maternity hospitals of eight French regions. POPULATION Two hundred and forty-nine women with PAS, from a source population of 520 114 deliveries. METHODS Women with PAS were classified into two risk-profile groups, with or without the high-risk combination of placenta praevia (or an anterior low-lying placenta) and at least one prior caesarean. These two groups were described and compared. MAIN OUTCOME MEASURES Population-based incidence of PAS, characteristics of women, pregnancies, deliveries and pregnancy outcomes. RESULTS The PAS population-based incidence was 4.8/10 000 (95% CI 4.2-5.4/10 000). After exclusion of women lost to follow up from the analysis, the group with placenta praevia and a prior caesarean included 115 (48%) women and the group without this combination included 127 (52%). In the group with both factors, PAS was more often suspected antenatally (77% versus 17%; P < 0.001) and more often percreta (38% versus 5%; P < 0.001). This group also had more hysterectomies (53% versus 21%, P < 0.001) and higher rates of blood product transfusions, maternal complications, preterm births and neonatal intensive care unit admissions. Sensitivity analysis showed similar results after exclusion of women who delivered vaginally. CONCLUSION More than half the cases of PAS occurred in women without the combination of placenta praevia and a prior caesarean delivery, and these women had better maternal and neonatal outcomes. We cannot completely rule out that some of the women who delivered vaginally had placental retention rather than PAS; however, we found similar results among women who delivered by caesarean. TWEETABLE ABSTRACT Half the women with PAS do not have both placenta praevia and a prior caesarean delivery, and they have better maternal outcomes.
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Affiliation(s)
- G Kayem
- Trousseau Hospital, APHP, Sorbonne University, Paris, France.,CRESS U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France
| | - A Seco
- CRESS U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France.,Clinical Research Unit Necker Cochin, APHP, Paris, France
| | - G Beucher
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, CHU de Caen, Caen Cedex, France
| | - C Dupont
- Réseau Périnatal Aurore, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon, France.,Health Services and Performance Research HESPER EA 7425, Université de Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - B Branger
- Réseau « Sécurité Naissance - Naître ensemble » des Pays-de-la-Loire, France
| | - C Crenn Hebert
- Louis Mourier University Hospital, APHP, Colombes, France.,Réseau Périnatal des Hauts de Seine, PERINAT92, Issy-les-Moulineaux, France
| | - C Huissoud
- Health Services and Performance Research HESPER EA 7425, Université de Lyon, University Claude Bernard Lyon 1, Lyon, France.,Maternité de la Croix Rousse, Lyon, France
| | - J Fresson
- CRESS U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France.,CHRU Nancy, Réseau Périnatal Lorrain, France
| | - N Winer
- Service de Gynécologie Obstétrique HME Université de Nantes, NUN, INRA, UMR 1280, Phan, Université de Nantes, Nantes, France
| | - B Langer
- CHU de Strasbourg, Strasbourg, France
| | | | - O Morel
- CHRU de Nancy, Nancy, France
| | - M P Bonnet
- Anaesthesia and Critical Care department, Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | | | - E Azria
- CRESS U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France.,Maternity Unit, Paris Saint Joseph Hospital, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - L Carbillon
- Réseau Périnatal NEF Naître dans l'Est Francilien, Paris 13 University, France
| | - C Chiesa
- CRESS U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France
| | - P Raynal
- CH de Versailles, Site Andre Mignot, Versailles, France
| | - R C Rudigoz
- Health Services and Performance Research HESPER EA 7425, Université de Lyon, University Claude Bernard Lyon 1, Lyon, France.,Maternité de la Croix Rousse, Lyon, France
| | - M Dreyfus
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, CHU de Caen, Caen Cedex, France
| | - F Vendittelli
- Réseau de Santé en Périnatalité d'Auvergne, CHU de Clermont-Ferrand, France.,CNRS, SIGMA Clermont, Institut Pascal, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | | | - C Deneux-Tharaux
- CRESS U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France
| | - L Sentilhes
- Department of Obstetrics and Gynaecology, Bordeaux University Hospital, Bordeaux, France
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15
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Petitprez K, Guillaume S, Hédon B, Sentilhes L. [Normal childbirth: physiologic labor support and medical procedures. Guidelines of the French National Authority for Health (HAS) with the collaboration of the French College of Gynaecologists and Obstetricians (CNGOF) and the French College of Midwives (CNSF) - Guidelines of the Haute Autorité de Santé - Introduction]. Gynecol Obstet Fertil Senol 2020; 48:871-872. [PMID: 33011383 DOI: 10.1016/j.gofs.2020.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- K Petitprez
- Service des bonnes pratiques professionnelles, Haute Autorité de santé, 93218 Saint-Denis La Plaine, France.
| | - S Guillaume
- Service de gynécologie-obstétrique, hôpital Necker-Enfants-Malades, Assistance publique des Hôpitaux de Paris, 75015 Paris, France
| | - B Hédon
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Montpellier, 34295 Montpellier, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, maternité Aliénor d'Aquitaine, centre hospitalier universitaire de Bordeaux, 33000 Bordeaux, France
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16
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Lejeune-Sadaa V, Mattuizzi A, Sentilhes L. [Normal childbirth: physiologic labor support and medical procedures. Guidelines of the French National Authority for Health (HAS) with the collaboration of the French College of Gynaecologists and Obstetricians (CNGOF) and the French College of Midwives (CNSF) - - When and how to take medical action during labor?]. Gynecol Obstet Fertil Senol 2020; 48:917-930. [PMID: 33011382 DOI: 10.1016/j.gofs.2020.09.017] [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] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this chapter is to provide recommendations for good practice regarding drug and technical interventions that may be considered during normal delivery. METHODS These recommendations were established by an expert consensus based on an analysis of the scientific literature and the French and international recommendations available on the subject. RESULTS Interventions during latent phase of the first stage of labor (up to 5-6cm) must be performed according to the fetal and maternal contraction tolerance (consensus agreement). In the active phase (from 5-6cm to full dilatation), dilation speed under 1cm/4h between 5 and 7cm or under 1cm/2h beyond 7cm is considered abnormal, it is then recommended to propose: an amniotomy if the membranes are intact and administration of oxytocin if membranes are already ruptured and uterine contractions are considered insufficient (consensus agreement). Intravenous (IV) antibiotic prophylaxis (at least four hours before birth) is recommended during labor in women at risk for group B streptococcal (GBS) maternofetal infection (GBS vaginal portage or GBS bacteriuria during pregnancy or history of maternofetal GBS infection) (grade B). In case of rupture of membranes after 37weeks of gestation without spontaneous labor, it is recommended: if the patient has GBS, to begin antibiotic prophylaxis immediately (consensus agreement); if delivery did not occur after 12hours, to start antibiotic prophylaxis (grade A), to set up dedicated patient monitoring (consensus agreement), to screen for an infection (at least a full blood count, a vaginal sample and a dipstick test) (consensus agreement). It is recommended not to start expulsive efforts as soon as a complete dilation is identified but to let the fetal presentation go down (grade A). The administration of oxytocin is recommended if the patient does not feel inclined to push and the presentation has not reached low-pelvic station after two hours of complete dilation in case of insufficient uterine activity (AE). There is no argument for recommending a push technique over another (grade B). It is recommended to inform the gynecologist-obstetrician in case of non-progression of the fetus after two hours of complete dilation with sufficient uterine activity (AE). Prophylactic administration of oxytocin at 5 or 10 IU is recommended to prevent postpartum hemorrhage after vaginal delivery (grade A). Administration could be performed intravenously (slow injection over about a minute) or intramuscularly (AE). In case of placental retention, manual removal of the placenta is recommended (grade A). In absence of bleeding, it must be performed after 30mins after birth, without exceeding 60mins (AE). CONCLUSION These recommendations define indications and methods for drug and technical interventions during a normal delivery to prevent poor obstetrical outcomes.
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Affiliation(s)
- V Lejeune-Sadaa
- Service de gynécologie-obstétrique, centre hospitalier d'Auch, allée Marie-Clarac, 32008 Auch, France.
| | - A Mattuizzi
- Service de gynécologie-obstétrique, CHU de Bordeaux, 33000 Bordeaux, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, CHU de Bordeaux, 33000 Bordeaux, France
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17
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Petitprez K, Guillaume S, Mattuizzi A, Morin S, Hédon B, Sentilhes L. [Normal childbirth: physiologic labor support and medical procedures. Guidelines of the French National Authority for Health (HAS) with the collaboration of the French College of Gynaecologists and Obstetricians (CNGOF) and the French College of Midwives (CNSF) - Method and organization]. Gynécologie Obstétrique Fertilité & Sénologie 2020; 48:953-956. [PMID: 33011377 DOI: 10.1016/j.gofs.2020.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- K Petitprez
- Service des bonnes pratiques professionnelles, Haute Autorité de santé, 5, avenue du Stade-de-France, 93218 Saint-Denis La Plaine, France.
| | - S Guillaume
- Service de gynécologie-obstétrique, hôpital Necker-Enfants-Malades, Assistance publique des Hôpitaux de Paris, 75015 Paris, France
| | - A Mattuizzi
- Service de gynécologie-obstétrique, maternité Aliénor d'Aquitaine, centre hospitalier universitaire de Bordeaux, 33000 Bordeaux, France
| | - S Morin
- Service des indicateurs pour l'amélioration de la qualité et la sécurité des soins, Haute Autorité de santé, 93218 Saint-Denis, France
| | - B Hédon
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Montpellier, 34000 Montpellier, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, maternité Aliénor d'Aquitaine, centre hospitalier universitaire de Bordeaux, 33000 Bordeaux, France
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Petitprez K, Guillaume S, Mattuizzi A, Arnal M, Artzner F, Bernard C, Bonnin M, Bouvet L, Caron FM, Chevalier I, Daussy-Urvoy C, Ducloy-Bouthorsc AS, Garnier JM, Keita-Meyer H, Lavillonnière J, Lejeune-Sadaa V, Leray C, Morandeau A, Morau E, Nadjafizade M, Pizzagalli F, Schantz C, Schmitz T, Shojai R, Hédon B, Sentilhes L. [Normal childbirth: physiologic labor support and medical procedures. Guidelines of the French National Authority for Health (HAS) with the collaboration of the French College of Gynaecologists and Obstetricians (CNGOF) and the French College of Midwives (CNSF) -- Text of the Guidelines (short text)]. Gynecol Obstet Fertil Senol 2020; 48:873-882. [PMID: 33011381 DOI: 10.1016/j.gofs.2020.09.013] [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: 11/24/2022]
Abstract
OBJECTIVE The objective of these guidelines is to define for women at low obstetric risk modalities that respect the physiology of delivery and guarantee the quality and safety of maternal and newborn care. METHODS These guidelines were made by a consensus of experts based on an analysis of the scientific literature and the French and international recommendations available on the subject. RESULTS It is recommended to conduct a complete initial examination of the woman in labor at admission (consensus agreement). The labor will be monitored using a partogram that is a useful traceability tool (consensus agreement). A transvaginal examination may be offered every two to four hours during the first stage of labor and every hour during the second stage of labor or before if the patient requests it, or in case of a warning sign. It is recommended that if anesthesia is required, epidural or spinal anesthesia should be used to prevent bronchial inhalation (grade A). The consumption of clear fluids is permitted throughout labor in patients with a low risk of general anesthesia (grade B). It is recommended to carry out a "low dose" epidural analgesia that respects the experience of delivery (grade A). It is recommended to maintain the epidural analgesia through a woman's self-administration pump (grade A). It is recommended to give the woman the choice of continuous (by cardiotocography) or discontinuous (by cardiotocography or intermittent auscultation) monitoring if the conditions of maternity organization and the permanent availability of staff allow it and, after having informed the woman of the benefits and risks of each technique (consensus agreement). In the active phase of the first stage of labor, the dilation rate is considered abnormal if it is less than 1cm/4h between 5 and 7cm or less than 1cm/2h above 7cm (level of Evidence 2). It is then recommended to propose an amniotomy if the membranes are intact or an oxytocin administration if the membranes are already ruptured, and the uterine contractions considered insufficient (consensus agreement). It is recommended not to start expulsive efforts as soon as complete dilation is identified, but to let the presentation of the fetus drop (grade A). It is recommended to inform the gynecologist-obstetrician in case of nonprogression of the fetus after two hours of complete dilation with sufficient uterine dynamics (consensus agreement). It is recommended not to use abdominal expression (grade B). It is recommended to carry out preventive administration of oxytocin at 5 or 10 IU to prevent PPH after vaginal delivery (grade A). In the case of placental retention, it is recommended to perform a manual removal of the placenta (grade A). In the absence of bleeding, it should be performed 30minutes but not more than 60minutes after delivery (consensus agreement). It is recommended to assess at birth the breathing or screaming, and tone of the newborn to quickly determine if resuscitation is required (consensus agreement). If the parameters are satisfactory (breathing present, screaming frankly, and normal tonicity), it is recommended to propose to the mother that she immediately place the newborn skin-to-skin with her mother if she wishes, with a monitoring protocol (grade B). Delayed cord clamping is recommended beyond the first 30seconds in neonates, not requiring resuscitation (grade C). It is recommended that the first oral dose (2mg) of vitamin K (consensus agreement) be given systematically within two hours of birth. CONCLUSION These guidelines allow women at low obstetric risk to benefit from a better quality of care and optimal safety conditions while respecting the physiology of delivery.
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Affiliation(s)
- K Petitprez
- Service des bonnes pratiques professionnelles, Haute Autorité de santé, 93218 Saint-Denis, France
| | - S Guillaume
- Service de gynécologie-obstétrique, hôpital Necker-Enfants-Malades, Assistance publique des Hôpitaux de Paris, 75015 Paris, France
| | - A Mattuizzi
- Service de gynécologie-obstétrique, maternité Aliénor d'Aquitaine, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | | | - F Artzner
- Collectif inter-associatif autour de la naissance (CIANE), 93100 Montreuil, France
| | - C Bernard
- Collectif inter-associatif autour de la naissance (CIANE), 75011 Paris, France
| | - M Bonnin
- Service d'anesthésie-réanimation, hôpital d'Estaing, centre hospitalier universitaire de Clermont-Ferrand, 63100 Clermont-Ferrand, France
| | - L Bouvet
- Service d'anesthésie-réanimation, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69000 Lyon, France
| | - F-M Caron
- Pôle femme enfant Victor-Pauchet, centre hospitalier universitaire d'Amiens, 80080 Amiens, France
| | | | | | - A-S Ducloy-Bouthorsc
- Service d'anesthésie-réanimation, maternité Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, 59000 Lille, France
| | | | - H Keita-Meyer
- Service d'anesthésie-réanimation, hôpital Necker-Enfants-Malades, Assistance publique des Hôpitaux de Paris, 75015 Paris, France
| | | | - V Lejeune-Sadaa
- Service de gynécologie-obstétrique, centre hospitalier d'Auch, 32008 Auch, France
| | - C Leray
- Service de gynécologie-obstétrique, hôpital Cochin, maternité Port-Royal, Assistance publique des Hôpitaux de Paris, 75014 Paris, France
| | | | - E Morau
- Service d'anesthésie-réanimation, centre hospitalier de Narbonne, 11100 Narbonne, France
| | - M Nadjafizade
- École de sages-femmes, centre hospitalier régional universitaire de Nancy, 54035 Nancy, France
| | - F Pizzagalli
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, 92140 Clamart, France
| | - C Schantz
- CEPED, IRD, université Paris Descartes, Inserm, équipe SAGESUD, 75006 Paris, France
| | - T Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, Assistance publique des Hôpitaux de Paris, 75019 Paris, France
| | - R Shojai
- Service de gynécologie-obstétrique, clinique de l'étoile, 13100 Aix-en-Provence, France
| | - B Hédon
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Montpellier, 34295 Montpellier, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, maternité Aliénor d'Aquitaine, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
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19
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Casta N, Sentilhes L, Brochard P, Bonneterre V, Dewitte J, Gehanno J, Gonzalez M, Pairon J, Descatha A, Verdun-Esquer C, Deruelle P, Delva F. Impact de l’infection par le SARS-CoV2 chez la femme enceinte et ses conséquences en santé au travail. ARCH MAL PROF ENVIRO 2020. [PMCID: PMC7834344 DOI: 10.1016/j.admp.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
L’objectif de cette recommandation est de présenter à travers une revue narrative l’impact de l’infection par le SARS-CoV2 chez la femme enceinte et ses conséquences en santé au travail.
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20
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Blanc J, Rességuier N, Lorthe E, Goffinet F, Sentilhes L, Auquier P, Tosello B, d'Ercole C. Association between extremely preterm caesarean delivery and maternal depressive and anxious symptoms: a national population-based cohort study. BJOG 2020; 128:594-602. [PMID: 32931138 DOI: 10.1111/1471-0528.16499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate whether caesarean delivery before 26 weeks of gestation was associated with symptoms of depression and anxiety in mothers in comparison with deliveries between 26 and 34 weeks. DESIGN Prospective national population-based EPIPAGE-2 cohort study. SETTING 268 neonatology departments in France, March to December 2011. POPULATION Mothers who delivered between 22 and 34 weeks and whose self-reported symptoms of depression (Center for Epidemiologic Studies Depression Scale: CES-D) and anxiety (State-Trait Anxiety Inventory: STAI) were assessed at the moment of neonatal discharge. METHODS The association of caesarean delivery before 26 weeks with severe symptoms of depression (CES-D ≥16) and anxiety (STAI ≥45) was assessed by weighted and design-based log-linear regression model. MAIN OUTCOME MEASURES Severe symptoms of depression and anxiety in mothers of preterm infants. RESULTS Among the 2270 women completing CES-D and STAI questionnaires at the time of neonatal discharge, severe symptoms of depression occurred in 25 (65.8%) women having a caesarean before 26 weeks versus in 748 (50.6%) women having a caesarean after 26 weeks. Caesarean delivery before 26 weeks was associated with severe symptoms of depression compared with caesarean delivery after 26 weeks (adjusted relative risk [aRR] 1.42, 95% CI 1.12-1.81) adjusted to neonatal birthweight and severe neonatal morbidity among other factors. There was no evidence of an association between mode of delivery and symptoms of anxiety. CONCLUSIONS Mothers having a caesarean delivery before 26 weeks' gestation are at high risk of symptoms of depression and may benefit from specific preventive care. TWEETABLE ABSTRACT Mothers having caesarean delivery before 26 weeks' gestation are at high risk of symptoms of depression.
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Affiliation(s)
- J Blanc
- Department of Obstetrics and Gynaecology, APHM, Nord Hospital, Marseille, France.,EA3279, CEReSS, Health Service Research and Quality of Life Centre, Aix-Marseille University, Marseille, France
| | - N Rességuier
- EA3279, CEReSS, Health Service Research and Quality of Life Centre, Aix-Marseille University, Marseille, France
| | - E Lorthe
- INSERM, INRA, Epidemiology and Statistics Research Centre/CRESS, Université de Paris, Paris, France.,EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal
| | - F Goffinet
- INSERM, INRA, Epidemiology and Statistics Research Centre/CRESS, Université de Paris, Paris, France.,Maternité Port-Royal, AP-HP, AP-HP Centre-Université de Paris, Paris, France
| | - L Sentilhes
- Department of Obstetrics and Gynaecology, Bordeaux University Hospital, Bordeaux, France
| | - P Auquier
- EA3279, CEReSS, Health Service Research and Quality of Life Centre, Aix-Marseille University, Marseille, France
| | - B Tosello
- Department of Neonatology, Assistance Publique des Hôpitaux de Marseille, North Hospital, France.,CNRS, EFS, ADES, Aix-Marseille University, Marseille, France
| | - C d'Ercole
- Department of Obstetrics and Gynaecology, APHM, Nord Hospital, Marseille, France.,EA3279, CEReSS, Health Service Research and Quality of Life Centre, Aix-Marseille University, Marseille, France
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21
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Delorme P, Kayem G, Lorthe E, Sentilhes L, Zeitlin J, Subtil D, Rozé JC, Vayssière C, Durox M, Ancel PY, Pierrat V, Goffinet F. Neurodevelopment at 2 years and umbilical artery Doppler in cases of very preterm birth after prenatal hypertensive disorder or suspected fetal growth restriction: EPIPAGE-2 prospective population-based cohort study. Ultrasound Obstet Gynecol 2020; 56:557-565. [PMID: 32212388 DOI: 10.1002/uog.22025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/26/2020] [Accepted: 03/13/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the association between absent or reversed end-diastolic flow (ARED) on umbilical artery Doppler ultrasound and poor neurological outcome at 2 years of age after very preterm birth associated with suspected fetal growth restriction (FGR) or maternal hypertensive disorders. METHODS The study population comprised all very preterm (22-31 completed weeks) singleton pregnancies delivered because of suspected FGR and/or maternal hypertensive disorders that had umbilical artery Doppler and 2-year follow-up available included in EPIPAGE-2, a prospective, nationwide, population-based cohort of preterm births in France in 2011. Univariate and two-level multivariable logistic regression analyses were used to assess the association of ARED in the umbilical artery, as compared with normal or reduced end-diastolic flow, with severe or moderate neuromotor and/or sensory disability and with an Ages and Stages Questionnaire (ASQ) score below a threshold. This was defined as a score more than 2 SD below the mean in any of the five domains, at age 2, adjusting for gestational age at delivery. ASQ is used to identify children at risk of developmental delay requiring reinforced follow-up and further evaluation. Descriptive statistics and bivariate tests were weighted according to the duration of the inclusion periods. RESULTS The analysis included 484 children followed up at 2 years of age, for whom prenatal umbilical artery Doppler ultrasound was available. Among them, 8/484 (1.6%) had severe or moderate neuromotor and/or sensory disability, and 156/342 (45.4%) had an ASQ score below the threshold. Compared with normal or reduced end-diastolic flow in the umbilical artery (n = 305), ARED (n = 179) was associated with severe or moderate neuromotor and/or sensory disability (adjusted odds ratio (OR), 11.3; 95% CI, 1.4-93.2) but not with an ASQ score below the threshold (adjusted OR, 1.2; 95% CI, 0.8-1.9). CONCLUSION Among children delivered before 32 weeks of gestation due to suspected FGR and/or maternal hypertensive disorder who survived until 2 years of age, prenatal ARED in the umbilical artery was associated with a higher incidence of severe or moderate neuromotor and/or sensory disability. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- P Delorme
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA Paris Descartes University, Paris, France
- Sorbonne Université, AP-HP, Department of Gynaecology and Obstetrics, Trousseau Hospital, Paris, France
| | - G Kayem
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA Paris Descartes University, Paris, France
- Sorbonne Université, AP-HP, Department of Gynaecology and Obstetrics, Trousseau Hospital, Paris, France
| | - E Lorthe
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA Paris Descartes University, Paris, France
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - L Sentilhes
- Department of Obstetrics and Gynaecology, Bordeaux University Hospital, Bordeaux, France
| | - J Zeitlin
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA Paris Descartes University, Paris, France
| | - D Subtil
- Université de Lille, CHU Lille, Hop Jeanne de Flandre, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, Lille, France
| | - J C Rozé
- CHU, Centre Hospitalo-Universitaire Hôtel-Dieu, Nantes, France
| | - C Vayssière
- UMR 1027 INSERM, Team SPHERE, Université Toulouse III Paul Sabatier, Toulouse, France
- CHU de Toulouse, Service de Gynécologie Obstétrique, Toulouse, France
| | - M Durox
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA Paris Descartes University, Paris, France
| | - P Y Ancel
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA Paris Descartes University, Paris, France
- URC-CIC P1419, HUPC, Assistance Publique Hôpitaux de Paris, Paris, France
| | - V Pierrat
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA Paris Descartes University, Paris, France
- CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France
| | - F Goffinet
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), FHU PREMA Paris Descartes University, Paris, France
- Department of Obstetrics and Gynaecology, AP-HP Cochin Port Royal, FHU PREMA Paris, France
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Durand-Zaleski I, Deneux-Tharaux C, Seco A, Malki M, Frenkiel J, Sentilhes L. An economic evaluation of tranexamic acid to prevent postpartum haemorrhage in women with vaginal delivery: the randomised controlled TRAAP trial. BJOG 2020; 128:114-120. [PMID: 32770781 DOI: 10.1111/1471-0528.16456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To estimate the cost-effectiveness of tranexamic acid (TXA) use to prevent postpartum haemorrhage. DESIGN A trial-based economic evaluation. SETTING Fifteen French university maternity hospitals. POPULATION Women enrolled in the TRAAP randomised controlled trial comparing TXA versus placebo in women with vaginal delivery. TRAAP failed to show a reduction in postpartum haemorrhage of at least 500 ml in the intervention arm but evidenced significant lower rates of secondary outcomes related to blood loss. METHODS & MAIN OUTCOME MEASURES We estimated direct medical costs from within-trial hospital resources collected prospectively from the study report form. All resources were costed at their value to the hospital. We estimated incremental cost per incremental haemorrhage averted. RESULTS Among the 4079 women in the TRAAP trial, data necessary to calculate costs were available for 3836 (94.0%). The average total costs in the TXA and control groups were €2278 ± 388 and €2288 ± 409 per woman, respectively (P = 0.79). In women with postpartum haemorrhage of at least 500 ml (trial primary endpoint), costs were €2359 ± 354 and €2409 ± 525 (P = 0.14); for provider-assessed clinically significant postpartum haemorrhage and postpartum haemorrhage of at least 1000 ml, costs were respectively €2316 ± 347 versus €2381 ± 521 (P = 0.22) and €2321 ± 318 versus €2411 ± 590 (P = 0.35) in the tranexamic and placebo groups, respectively. The probabilistic sensitivity analysis showed that the use of TXA had a 65-73% probability of saving costs and improving outcome. CONCLUSIONS Our findings support the use of TXA, as both bleeding events and cost may be reduced three out of four times. TWEETABLE ABSTRACT Tranexamic acid at vaginal delivery reduces both costs and bleeding events 3 times out of 4.
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Affiliation(s)
- I Durand-Zaleski
- AP-HP Health Economics Research Unit, Hotel Dieu Hospital, Paris, France.,INSERM UMR 1153 CRESS, Clinical Epidemiology(Methods) & Obstetrical, Perinatal and Pediatric Epidemiology (Epopé) Research Team, Paris Descartes University, Paris, France
| | - C Deneux-Tharaux
- INSERM UMR 1153 CRESS, Clinical Epidemiology(Methods) & Obstetrical, Perinatal and Pediatric Epidemiology (Epopé) Research Team, Paris Descartes University, Paris, France
| | - A Seco
- INSERM UMR 1153 CRESS, Clinical Epidemiology(Methods) & Obstetrical, Perinatal and Pediatric Epidemiology (Epopé) Research Team, Paris Descartes University, Paris, France.,APHP Paris Centre Clinical Research Unit, Paris, France
| | - M Malki
- AP-HP Health Economics Research Unit, Hotel Dieu Hospital, Paris, France
| | - J Frenkiel
- AP-HP Health Economics Research Unit, Hotel Dieu Hospital, Paris, France
| | - L Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
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Kayem G, Sentilhes L. [What direction will we be taking with our new Editors-in-Chief for the journal?]. Gynecol Obstet Fertil Senol 2020; 48:342-343. [PMID: 32147249 DOI: 10.1016/j.gofs.2020.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- G Kayem
- Service de gynécologie-obstétrique, hôpital Trousseau AP-HP, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France; Sorbonne université 91, 105, boulevard de l'Hôpital, 75013 Paris, France.
| | - L Sentilhes
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
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Madar H, Sentilhes L. [Elective induction of labor at 39 weeks of gestation: A reasonable option?]. ACTA ACUST UNITED AC 2020; 48:344-345. [PMID: 32045718 DOI: 10.1016/j.gofs.2020.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Indexed: 10/25/2022]
Affiliation(s)
- H Madar
- Service de gynécologie-obstétrique, CHU de Bordeaux, place Amélie Raba-Léon, 33000 Bordeaux, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, CHU de Bordeaux, place Amélie Raba-Léon, 33000 Bordeaux, France.
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Sentilhes L, Senat MV, Schmitz T, Fauconnier A, Fritel X. [CNGOF Guidelines: Time to Change!]. ACTA ACUST UNITED AC 2020; 48:1-2. [PMID: 31901335 DOI: 10.1016/j.gofs.2019.11.002] [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] [Indexed: 11/17/2022]
Affiliation(s)
- L Sentilhes
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - M-V Senat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Inserm, centre de recherche en épidémiologie et santé des populations, UVSQ, université Paris-Saclay, université Paris-Sud, hôpital Paul Brousse, 16, avenue Paul Vaillant-Couturier, 94800 Villejuif, France
| | - T Schmitz
- Service de gynécologie-obstétrique, hôpital Robert Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Inserm, Inra, epidemiology and statistics research center (CRESS), université de Paris, 75004 Paris, France
| | - A Fauconnier
- Service de gynécologie-obstétrique, CHI Poissy-Saint-Germain, 10, rue du Champ-Gaillard, 78300 Poissy, France; Unité de recherche EA 7285 (RISCQ), université Versailles Saint-Quentin (UVSQ), 78180 Montigny-le-Bretonneux, France
| | - X Fritel
- CIC 1402 Inserm, CHU de Poitiers, université de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
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Certenais T, Manangama G, Coelho J, Brochard P, Sentilhes L, Teysseire R, Delva F. Expositions à des facteurs de risque sur la reproduction en milieu professionnel. ARCH MAL PROF ENVIRO 2019. [DOI: 10.1016/j.admp.2019.09.004] [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] [Indexed: 10/25/2022]
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Verspyck É, Schmitz T, Rozenberg P, Senat MV, Sentilhes L. [Breech Presentation: CNGOF Guidelines for Clinical Practice - Introduction]. ACTA ACUST UNITED AC 2019; 48:59-60. [PMID: 31678564 DOI: 10.1016/j.gofs.2019.10.021] [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: 10/24/2019] [Indexed: 10/25/2022]
Affiliation(s)
- É Verspyck
- Service de gynécologie-obstétrique, CHU Rouen, 1, rue de Germont, 76031 Rouen, France
| | - T Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France
| | - P Rozenberg
- Département de gynécologie-obstétrique, hôpital Poissy-Saint-Germain, 10, rue du Champ-Gaillard, 78300 Poissy, France; Université Versailles-St Quentin, 55, avenue de Paris, 78000 Versailles, France
| | - M-V Senat
- Service de gynécologie-obstétrique, hôpital Kremlin-Bicêtre, faculté Paris-Sud, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; INSERM, centre de recherche en épidémiologie et santé des populations, hôpital Paul-Brousse, université Paris-Saclay, université Paris-Sud, UVSQ, 16, avenue Paul-Vaillant-Couturier, 94800 Villejuif, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, CHU Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
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Sentilhes L, Schmitz T, Rozenberg P, Verspyck E, Senat MV. [Breech Presentation: CNGOF Guidelines for Clinical Practice - Methods and Organization]. ACTA ACUST UNITED AC 2019; 48:61-62. [PMID: 31678565 DOI: 10.1016/j.gofs.2019.10.020] [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: 10/24/2019] [Indexed: 11/27/2022]
Affiliation(s)
- L Sentilhes
- Service de gynécologie-obstétrique, CHU Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - T Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France
| | - P Rozenberg
- Service de gynécologie-obstétrique, centre hospitalier intercommunal de Poissy, 10, rue du Champ-Gaillard, 78300 Poissy, France; Université Versailles-St Quentin, 55, avenue de Paris, 78000 Versailles, France
| | - E Verspyck
- Service de gynécologie-obstétrique, CHU Rouen, 1, rue de Germont, 76031 Rouen, France
| | - M-V Senat
- Service de gynécologie-obstétrique, hôpital Kremlin-Bicêtre, faculté Paris-Sud, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; INSERM, centre de recherche en épidémiologie et santé des populations, hôpital Paul-Brousse, université Paris-Saclay, université Paris-Sud, UVSQ, 16, avenue Paul-Vaillant-Couturier, 98000 Villejuif, France
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Schmitz T, Senat MV, Sentilhes L, Azria É, Deneux-Tharaux C, Huchon C, Bourdel N, Fritel X, Fauconnier A. [CNGOF Guidelines for Clinical Practice: Revision of the Methodology]. ACTA ACUST UNITED AC 2019; 48:3-11. [PMID: 31678506 DOI: 10.1016/j.gofs.2019.10.028] [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] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To revise the organization and the methodology of the Practice Clinical Guidelines (PCG) of the French College of Gynecologists and Obstetricians (CNGOF). METHODS The different available methods of PCG organization and of scientific evidence grading have been consulted after searching in the Medline database. RESULTS The PCG group of the CNGOF has decided to adopt the AGREE II (for Appraisal of Guidelines for REsearch and Evaluation) methology for PCG organization and the GRADE (for Grading of Recommendation Assessment, Development, and Evaluation) system for grading scientific evidence. CONCLUSION By adopting the AGREE II consortium criteria and grading scientific evidence according to the GRADE system, the CNGOF will increase the quality of the overall process, will deliver more targeted and easy to assimilate recommendations, to facilitate professional decision making.
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Affiliation(s)
- T Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Epidemiology and Statistics Research Center/CRESS, Inserm, Inra, université de Paris, 75004 Paris, France.
| | - M-V Senat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Inserm, université Paris-Saclay, University Paris-Sud, UVSQ, Centre de recherche en épidémiologie et santé des populations, hôpital Paul-Brousse, 16, avenue Paul-Vaillant-Couturier, 94076 Villejuif, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - É Azria
- Epidemiology and Statistics Research Center/CRESS, Inserm, Inra, université de Paris, 75004 Paris, France; Maternité Notre-Dame-de-Bon-Secours, groupe hospitalier Paris Saint-Joseph, DHU risques et grossesse, 185, rue Raymond-Losserad, 75014 Paris, France
| | - C Deneux-Tharaux
- Epidemiology and Statistics Research Center/CRESS, Inserm, Inra, université de Paris, 75004 Paris, France
| | - C Huchon
- Service de gynécologie-obstétrique, CHI Poissy-St-Germain, 10, rue du Champ-Gaillard, 78300 Poissy, France; Unité de recherche EA 7285 (RISCQ), université Versailles St-Quentin (UVSQ), 78180 Montigny-le-Bretonneux, France
| | - N Bourdel
- Service de gynécologie-obstétrique, CHU Estaing, CHU Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France
| | - X Fritel
- CIC 1402 Inserm, université de Poitiers, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - A Fauconnier
- Service de gynécologie-obstétrique, CHI Poissy-St-Germain, 10, rue du Champ-Gaillard, 78300 Poissy, France; Unité de recherche EA 7285 (RISCQ), université Versailles St-Quentin (UVSQ), 78180 Montigny-le-Bretonneux, France
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Sunyach C, Perrin J, Bretelle F, Paris C, Garlantezec R, Belacel M, Pairon JC, Sentilhes L, Delva F, Brochard P. A French network for prevention and reduction of reproductive risk in couples and pregnant women. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.186] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Since 2013, several international (ASRM, FIGO, ACOG) and French (ANSES) learned societies and the French National Health and Environment Plan (2015-2019) urged to take into account exposures to environmental reprotoxic substances during standard care of infertile couples and pregnant women. However perinatal health professionals hardly incorporate this recommendation into practice.
Objectives
To create a network of platforms to addressing the environmental aspects that can impact the pregnancy chances of infertile couples after ART and pregnancy outcomes.
We asked regional health authorities in France to provide funding for multidisciplinary hospital structures, in conjunction with clinical-biological reproductive health and gynecology-obstetric centers. Expertise, as well as information leaflets and risk detection tools have been shared.
Results
Platforms of counselling and prevention have been set up in the University Hospitals of Bordeaux, Marseille, Rennes, Créteil and Paris Fernand-Widal. Infertile couples and pregnant women, referred by reproductive physicians, benefit from personalized management of their domestic/professional reprotoxic exposures by addictology/tobacco, dietetics, occupational health and environmental pathology professionals. The network organizes an annual scientific day and a common database of exposure is being set up.
Conclusions
The PREVENIR (PREVENTION - ENVIRONMENT - Reproduction) network of platforms allows perinatal health professionals to refer their patients in order to optimize their chance of pregnancy through personalized and multidisciplinary care. The lifestyle changes initiated through this approach will also improve pregnancy outcomes and child health.
Key messages
A French network for the prevention and reduction of reproductive risk in infertile couples and pregnant women: the PREVENIR platforms (PREVENTION - ENVIRONMENT - Reproduction) is being established. Perinatal health professionals of multidisciplinary platforms engage into preventive actions to limit the exposure to environmental hazards during preconception and pregnancy.
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Affiliation(s)
| | - J Perrin
- Conception Hospital, Marseille, France
- Mediterranean Institute of Marine and Terrestrial Biodiversity and Ecology, Marseille, France
| | - F Bretelle
- Timone Hospital, Marseille, France
- Mediterranean Network (PACA CORSE MONACO Perinatal Network), Marseille, France
- Mediterranee Infection, Marseille, France
| | - C Paris
- University Hospital, Rennes, France
| | | | - M Belacel
- Intercomunal Center Hospital, Creteil, France
| | - J-C Pairon
- Intercomunal Center Hospital, Creteil, France
| | | | - F Delva
- University Hospital, Bordeaux, France
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Sentilhes L, Schmitz T, Azria E, Gallot D, Ducarme G, Korb D, Mattuizzi A, Parant O, Sananès N, Baumann S, Rozenberg P, Senat MV, Verspyck É. [Breech Presentation: CNGOF Guidelines for Clinical Practice - Short Text]. ACTA ACUST UNITED AC 2019; 48:63-69. [PMID: 31678505 DOI: 10.1016/j.gofs.2019.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To determine the optimal management of singleton breech presentation. MATERIALS AND METHODS The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. RESULTS In France, 5% of women have breech deliveries (Level of Evidence [LE3]). One third of them have a planned vaginal delivery (LE3) of whom 70% deliver vaginally (LE3). External cephalic version (ECV) is associated with a reduced rate of breech presentation at birth (LE2), and with a lower rate of cesarean section (LE3) without increases in severe maternal (LE3) and perinatal morbidity (LE3). It is therefore recommended to inform women with a breech presentation at term that ECV could be attempted from 36 weeks of gestation (Professional consensus). In case of breech presentation, planned vaginal compared with planned cesarean delivery might be associated with an increased risk of composite perinatal mortality or serious neonatal morbidity (LE2). No difference has been found between planned vaginal and planned cesarean delivery for neurodevelopmental outcomes at two years (LE2), cognitive and psychomotor outcomes between 5 and 8 years (LE3), and adult intellectual performances (LE4). Short and long term maternal complications appear similar in case of planned vaginal compared with planned cesarean delivery in the absence of subsequent pregnancies. A previous cesarean delivery results for subsequent pregnancies in higher risks of uterine rupture, placenta accreta spectrum and hysterectomy (LE2). It is recommended to offer women who wish a planned vaginal delivery a pelvimetry at term (Grade C) and to check the absence of hyperextension of the fetal head by ultrasonography (Professional consensus) to plan their mode of delivery. Complete breech presentation, previous cesarean, nulliparity, term prelabor rupture of membranes do not contraindicate planned vaginal delivery (Professionnal consensus). Term breech presentation is not a contraindication to labor induction when the criteria for acceptance of vaginal delivery are met (Grade C). CONCLUSION In case of breech presentation at term, the risks of severe morbidity for the child and the mother are low after both planned vaginal and planned cesarean delivery. For the French College of Obstetricians and Gynecologists (CNGOF), planned vaginal delivery is a reasonable option in most cases (Professional consensus). The choice of the planned route of delivery should be shared by the woman and her caregiver, respecting the right to woman's autonomy.
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Affiliation(s)
- L Sentilhes
- Service de gynécologie-obstétrique, université de Bordeaux, CHU Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - T Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Serrurier, 75019 Paris, France; Inserm, Inra, Epidemiology and Statistics Research Center/CRESS, université de Paris, 75004 Paris, France
| | - E Azria
- Inserm, Inra, Epidemiology and Statistics Research Center/CRESS, université de Paris, 75004 Paris, France; Maternité Notre-Dame-de-Bon-Secours, groupe hospitalier Paris Saint-Joseph, DHU risques et grossesse, 185, rue Raymond-Losserand, 75014 Paris, France
| | - D Gallot
- Pôle Femme et Enfant, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France; R2D2-EA7281, faculté de médecine, université d'Auvergne, place Henri-Dunant, 63000 Clermont-Ferrand, France
| | - G Ducarme
- Service de gynécologie-obstétrique, centre hospitalier départemental, 85000 La Roche-sur-Yon, France
| | - D Korb
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Serrurier, 75019 Paris, France; Inserm, Inra, Epidemiology and Statistics Research Center/CRESS, université de Paris, 75004 Paris, France
| | - A Mattuizzi
- Service de gynécologie-obstétrique, université de Bordeaux, CHU Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - O Parant
- Inserm, UMR1027, équipe SPHERE, 31073 Toulouse, France; UMR1027, université de Toulouse III, 31073 Toulouse, France; Pôle de gynécologie obstétrique, hôpital Paule-de-Viguier, CHU Toulouse, 31059 Toulouse, France
| | - N Sananès
- Service de gynécologie-obstétrique, hôpitaux universitaires de Strasbourg, avenue Molière, BP 426, 67091 Strasbourg cedex, France; Unité Inserm UMR-S 1121 « Biomatériaux et Bioingénierie », 11, rue Humann, 67000 Strasbourg, France
| | - S Baumann
- Collège national des sages-femmes de France, 136, avenue Émile-Zola, 75015 Paris, France
| | - P Rozenberg
- Département de gynécologie-obstétrique, hôpital Poissy-Saint-Germain, 10, rue du Champ-Gaillard, 78300 Poissy, France; Université Versailles-St Quentin, 55, avenue de Paris, 78000 Versailles, France
| | - M-V Senat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Inserm, Centre de recherche en épidémiologie et santé des populations, hôpital Paul-Brousse, université Paris-Saclay, university Paris-Sud, UVSQ, 16, avenue Paul Vaillant Couturier, 94800 Villejuif, France
| | - É Verspyck
- Service de gynécologie-obstétrique, université de Rouen, CHU de Rouen, 76000 Rouen, France
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Senat MV, Schmitz T, Bouchghoul H, Diguisto C, Girault A, Paysant S, Sibiude J, Lassel L, Sentilhes L. [Term Prelabor Rupture of Membranes: CNGOF Guidelines for Clinical Practice - Short Text]. ACTA ACUST UNITED AC 2019; 48:15-18. [PMID: 31669527 DOI: 10.1016/j.gofs.2019.10.017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the management of patients with term prelabor rupture of membranes. METHODS Synthesis of the literature from the PubMed and Cochrane databases and the recommendations of French and foreign societies and colleges. RESULTS Term prelabor rupture of membranes is considered a physiological process up to 12hours of rupture (Professional consensus). In case of expectant management and with a low rate of antibiotic prophylaxis, home care compared to hospitalization could be associated with an increase in neonatal infections (LE3), especially in case of group B streptococcus colonization (LE3). Home care is therefore not recommended (Grade C). In the absence of spontaneous labor within 12hours of rupture, antibiotic prophylaxis could reduce the risk of maternal intrauterine infection but not of neonatal infection (LE3). Its use after 12hours of rupture in term prelabor rupture of the membranes is therefore recommended (Grade C). When antibiotic prophylaxis is indicated, intravenous beta-lactams are recommended (Grade C). Induction of labor with oxytocin (LE1), prostaglandin E2 (LE1) or misoprostol (LE1), is associated with shorter rupture of membranes to delivery intervals when compared to expectant management. Compared with expectant management, immediate induction of labor is not associated with lower rates of neonatal infection (LE1), even among women with a positive streptococcus B vaginal swab (LE2). Thus, expectant management can be offered without increasing the risk of neonatal infection (Grade B). Induction of labor is not associated with an increase or decrease in the cesarean delivery rate (LE2), whatever parity (LE2) or Bishop score at admission (LE3). Induction can thus be proposed without increasing the risk of cesarean delivery (Grade B). No induction method (oxytocin, dinoprostone, misoprostol or Foley® catheter) has demonstrated superiority over another, whether to reduce rate of intrauterine or neonatal infection, rate of cesarean delivery or to shorten rupture of membranes to delivery intervals regardless of Bishop's score and parity. CONCLUSION Term prelabor rupture of membranes is a frequent event. A 12-hour delay without onset of spontaneous labor was chosen to differentiate a physiological condition from a potentially unsafe situation justifying an antibiotic prophylaxis. Expectant management or induction of labor can both be proposed, even in case of positive screening for streptococcus B, depending on the patient's wishes and maternity units' organization (Professional consensus).
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Affiliation(s)
- M-V Senat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Université Paris-Sud, université de médecine Paris-Saclay, 94270 Le Kremlin-Bicêtre, France; Inserm, centre de recherche en épidémiologie et en santé en population, université Paris-Saclay, université Paris-Sud, université de Versailles Saint-Quentin-en-Yvelines, 94800 Villejuif, France.
| | - T Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Université de Paris, 75014 Paris, France; Université de Paris, epidemiology and statistics research Center/CRESS, Inserm, INRA, 75004 Paris, France
| | - H Bouchghoul
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Université Paris-Sud, université de médecine Paris-Saclay, 94270 Le Kremlin-Bicêtre, France; Inserm, centre de recherche en épidémiologie et en santé en population, université Paris-Saclay, université Paris-Sud, université de Versailles Saint-Quentin-en-Yvelines, 94800 Villejuif, France
| | - C Diguisto
- Université de Paris, epidemiology and statistics research Center/CRESS, Inserm, INRA, 75004 Paris, France; Service de gynécologie-obstétrique, CHU Bretonneau, Maternité Olympe de Gouges, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Université François-Rabelais, 37044 Tours, France
| | - A Girault
- Université de Paris, epidemiology and statistics research Center/CRESS, Inserm, INRA, 75004 Paris, France; Service de gynécologie-obstétrique, maternité Port-Royal, université de Paris, DHU risques et grossesse, AP-HP, 123, boulevard de Port-Royal, 75014 Paris, France
| | - S Paysant
- Collège national des sages-femmes de France, 136, avenue Emile-Zola, 75015 Paris, France
| | - J Sibiude
- Service de gynécologie-obstétrique, maternité Louis-Mourier, université de Paris, DHU risques et grossesse, AP-HP, 178, rue des Renouillers, 92701 Colombes cedex, France
| | - L Lassel
- Département de gynécologie-obstétrique et reproduction humaine, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35203 Rennes, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, hôpital Pellegrin, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
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Lassel L, Schmitz T, Sentilhes L, Senat MV. [Term Prelabor Rupture of Membranes: CNGOF Guidelines for Clinical Practice - Introduction]. ACTA ACUST UNITED AC 2019; 48:12. [PMID: 31669524 DOI: 10.1016/j.gofs.2019.10.013] [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: 10/22/2019] [Indexed: 11/18/2022]
Affiliation(s)
- L Lassel
- Département de gynécologie-obstétrique et reproduction humaine, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35203 Rennes, France
| | - T Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, 48, bd Sérurier, 75019 Paris, France; Université de Paris, 75014 Paris, France; Université de Paris, Epidemiology and Statistics Research Centre/CRESS, INSERM, INRA, 75004 Paris, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, hôpital Pellegrin, Centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - M-V Senat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Université Paris-Sud, université de médecine Paris-Saclay, 94270 Le Kremlin-Bicêtre, France; INSERM, centre de recherche en épidémiologie et en santé en population, université Paris-Saclay, université Paris-Sud, université de Versailles Saint-Quentin-en-Yvelines, 94076 Villejuif, France.
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Lebrun-Grandié V, Mattuizzi A, Martin A, Chabanier P, Merlot B, Elleboode B, Longaygues E, Saillour F, Sentilhes L. [Retrospective study of the impact of training on the management of immediate post-partum hemorrhage]. Gynecol Obstet Fertil Senol 2019; 47:465-470. [PMID: 30872188 DOI: 10.1016/j.gofs.2019.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The aim of the study was to assess the impact of the introduction of training workshops on the quality of prevention and management of Post-Partum Hemorrhage (PPH) in a type III university center. METHODS A clinical audit was carried out in our type III university center before and after the introduction of training workshops on the prevention and management of PPH, in two periods between January 1st to December 31st 2011 and March 1st and August 1st, 2015. Training workshops were according to the recommendations for clinical practice of the National College of Gynecologists-Obstetricians French published in 2014, and included a theoretical portion and a simulation of low fidelity manikin. Data on the management of patients presenting with PPH after vaginal birth of a singleton were retrospectively collected consecutively from medical records. Data were collected using a standardized analytical grid. Between the two data collections, some improvement actions were implemented. RESULTS After implementation of training workshops, the proportion of patients with active management of the third stage of labor (prophylactic uterotonic after delivery) has significantly improved (72% before, vs. 92% after, P=0.001); time to PPH diagnosis has been significantly higher notified (40% before, vs. 94% after, P<0.001), as well as the quantification of bleeding at diagnosis (46% before, vs. 72% after, P<0.003) and total bleeding (68% before, vs. 92%, P<0.001). PPH-specific monitoring sheet was found to be used significantly more frequently (3 before, vs. 30 after, P=0.00015). Additionally, the Physician Anesthesiologist has been contacted significantly more often (34% before, vs. 53% after, P=0.002). CONCLUSION Our study highlights a significant improvement in professional practices between 2011 and 2015 on PPH prevention and management in our type III university center.
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Affiliation(s)
- V Lebrun-Grandié
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - A Mattuizzi
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - A Martin
- Pôle de santé publique, service d'information médicale, CHU de Bordeaux, 33000 Bordeaux, France
| | - P Chabanier
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - B Merlot
- Chirurgie gynécologique et sénologique, clinique Tivoli, 220, rue Mandron, 33000 Bordeaux, France
| | - B Elleboode
- ELSAN, 58bis, rue La Boétie, 75008 Paris, France
| | - E Longaygues
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - F Saillour
- Centre Inserm U1219-Bordeaux population health, university Bordeaux, ISPED, 33000 Bordeaux, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
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Sentilhes L, Galley-Raulin F, Boithias C, Sfez M, Goffinet F, Le Roux S, Benhamou D, Garnier JM, Paysant S, Bounan S, Michel C, Coudray J, Elleboode B, Rozé JC, Ducloy-Bouthors AS. [Not Available]. Gynecol Obstet Fertil Senol 2019; 47:393-394. [PMID: 30904141 DOI: 10.1016/j.gofs.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- L Sentilhes
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France; Société française de médecine périnatale (SFMP), 128, rue La Boétie, 75008 Paris, France; Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - F Galley-Raulin
- Collège national des sages-femmes de France (CNSF), 136, avenue Émile-Zola, 75015 Paris, France; Pôle mère-enfant, CHI Verdun St-Mihiel, 2, rue d'Anthouard, BP 20713, 55107 Verdun, France
| | - C Boithias
- Société française de médecine périnatale (SFMP), 128, rue La Boétie, 75008 Paris, France; Société française de néonatologie (SFN), 49, boulevard Béranger, 37044 Tours, France; Réanimation pédiatrique et néonatale, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris (AP-HP), 78, avenue du Général-Leclerc, 94270 Le Kremlin- Bicêtre, France
| | - M Sfez
- Société française d'anesthésie-réanimation (SFAR), 74, rue Raynouard, 75016 Paris, France; Clinique Oudinot, 2, rue Rousselet, 75007 Paris, France; Club d'anesthésie-réanimation en obstétrique (CARO), 23, boulevard de Port-Royal, 75014 Paris, France
| | - F Goffinet
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France; Société française de médecine périnatale (SFMP), 128, rue La Boétie, 75008 Paris, France; Maternité Port-Royal, université Paris Descartes, DHU risques et grossesse, hôpitaux universitaires Paris-centre, Assistance publique-Hôpitaux de Paris (AP-HP), 123, boulevard de Port-Royal, 75014 Paris, France
| | - S Le Roux
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France; Pôle femme-mère-enfant, centre hospitalier Annecy-Genevois, 74000 Annecy, France
| | - D Benhamou
- Société française d'anesthésie-réanimation (SFAR), 74, rue Raynouard, 75016 Paris, France; Club d'anesthésie-réanimation en obstétrique (CARO), 23, boulevard de Port-Royal, 75014 Paris, France; Pôle d'anesthésie-réanimation, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris (AP-HP), 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - J-M Garnier
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France; Polyclinique de l'Atlantique, avenue Claude-Bernard, 44819 Saint-Herblain, France
| | - S Paysant
- Collège national des sages-femmes de France (CNSF), 136, avenue Émile-Zola, 75015 Paris, France; Centre hospitalier du Cateau-Cambrésis, 28, boulevard Paturle, 59310 Le Cateau-Cambrésis, France
| | - S Bounan
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France; Centre hospitalier de Saint-Denis, 2, rue du Dr-Delafontaine, 93200 Saint-Denis, France
| | - C Michel
- Société française de néonatologie (SFN), 49, boulevard Béranger, 37044 Tours, France; Pôle santé Léonard-de-Vinci, 1, avenue du Professeur-Alexandre-Minkowski, 37170 Chambray-Lès-Tours, France
| | - J Coudray
- Fédération française des réseaux de soins en périnatalité (FFRSP), 6, rue Pétrarque, 31000 Toulouse, France
| | - B Elleboode
- ELSAN, 58 bis, rue La Boétie, 75008 Paris, France
| | - J-C Rozé
- Société française de médecine périnatale (SFMP), 128, rue La Boétie, 75008 Paris, France; Société française de néonatologie (SFN), 49, boulevard Béranger, 37044 Tours, France; Pôle de néonatologie, centre hospitalier universitaire de Nantes, 38, boulevard Jean-Monnet, 44000 Nantes, France
| | - A-S Ducloy-Bouthors
- Société française d'anesthésie-réanimation (SFAR), 74, rue Raynouard, 75016 Paris, France; Club d'anesthésie-réanimation en obstétrique (CARO), 23, boulevard de Port-Royal, 75014 Paris, France; Pôle d'anesthésie-réanimation, maternité Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, 1, avenue Eugène-Avinée, 59000 Lille, France
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Manangama G, Migault L, Audignon-Durand S, Gramond C, Zaros C, Bouvier G, Brochard P, Sentilhes L, Lacourt A, Delva F. Maternal occupational exposures to nanoscale particles and small for gestational age outcome in the French Longitudinal Study of Children. Environ Int 2019; 122:322-329. [PMID: 30459064 DOI: 10.1016/j.envint.2018.11.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 06/25/2018] [Revised: 10/19/2018] [Accepted: 11/12/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To investigate the association between maternal occupational exposures to nanoscale particles (NPs) during pregnancy and small for gestational age (SGA). METHODS This study included 11,224 mothers and singleton birth pairs from the French Longitudinal Study of Children (ELFE cohort), which included infants born after 33 weeks of gestation or more in continental France in 2011. Mothers who did not work during pregnancy were excluded from the analyses. Maternal occupational exposures to NPs was estimated using a job-exposure matrix for the probability (>50%: occupationally exposed group, n = 569; 0%: occupationally non-exposed group, n = 9113; between these two thresholds: uncertain group, n = 1542) and frequency of exposure. Associations were estimated from multivariate logistic regression models for occupationally exposed vs occupationally unexposed groups in a first analysis, and with the frequency-weighted duration of work for the occupationally exposed group only in a second analysis. RESULTS Among working mothers, 5.1% were occupationally exposed to NPs. Maternal occupational exposures to NPs was associated with SGA (ORa = 1.63, 95% CI: 1.22, 2.18). The frequency-weighted duration of work for the occupationally exposed group (n = 569) was not associated with SGA (ORa = 1.02, 95% CI: 0.97, 1.08) in adjusted analyses. CONCLUSIONS These results, showing a significant association between occupational exposures to NPs and SGA, should encourage further studies to examine the adverse effect of NPs exposure on fetal development.
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Affiliation(s)
- G Manangama
- Epicene, INSERM U1219 and University Bordeaux, France; Service de médecine du travail et de pathologies professionnelles, CHU Bordeaux, France.
| | - L Migault
- Epicene, INSERM U1219 and University Bordeaux, France
| | - S Audignon-Durand
- Epicene, INSERM U1219 and University Bordeaux, France; Service de médecine du travail et de pathologies professionnelles, CHU Bordeaux, France
| | - C Gramond
- Epicene, INSERM U1219 and University Bordeaux, France
| | - C Zaros
- Joint research unit ELFE, Ined-Inserm-EFS, France
| | - G Bouvier
- Epicene, INSERM U1219 and University Bordeaux, France
| | - P Brochard
- Epicene, INSERM U1219 and University Bordeaux, France; Service de médecine du travail et de pathologies professionnelles, CHU Bordeaux, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, CHU Bordeaux, France
| | - A Lacourt
- Epicene, INSERM U1219 and University Bordeaux, France
| | - F Delva
- Epicene, INSERM U1219 and University Bordeaux, France; Service de médecine du travail et de pathologies professionnelles, CHU Bordeaux, France
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Mattuizzi A, Sauvestre F, Andre G, Poingt M, Camberlein C, Carles D, Pelluard F, Blanco P, Sentilhes L, Lazaro E. Issues périnatales de 122 cas d’intervillite chronique d’étiologie indéterminée : une étude observationnelle multicentrique. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.363] [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] [Indexed: 10/27/2022]
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Schmitz T, Sentilhes L, Lorthe E, Gallot D, Madar H, Doret-Dion M, Beucher G, Charlier C, Cazanave C, Delorme P, Garabedian C, Azria É, Tessier V, Senat MV, Kayem G. [Preterm premature rupture of membranes: CNGOF Guidelines for clinical practice - Short version]. ACTA ACUST UNITED AC 2018; 46:998-1003. [PMID: 30392986 DOI: 10.1016/j.gofs.2018.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine management of women with preterm premature rupture of membranes (PPROM). METHODS Bibliographic search from the Medline and Cochrane Library databases and review of international clinical practice guidelines. RESULTS In France, PPROM rate is 2 to 3% before 37 weeks of gestation (level of evidence [LE] 2) and less than 1% before 34 weeks of gestation (LE2). Prematurity and intra-uterine infection are the two major complications of PPROM (LE2). Compared to other causes of prematurity, PPROM is not associated with an increased risk of neonatal mortality and morbidity, except in case of intra-uterine infection, which is associated with an augmentation of early-onset neonatal sepsis (LE2) and of necrotizing enterocolitis (LE2). PPROM diagnosis is mainly clinical (professional consensus). In doubtful cases, detection of IGFBP-1 or PAMG-1 is recommended (professional consensus). Hospitalization of women with PPROM is recommended (professional consensus). There is no sufficient evidence to recommend or not recommend tocolysis (grade C). If a tocolysis should be prescribed, it should not last more than 48hours (grade C). Antenatal corticosteroids before 34 weeks of gestation (grade A) and magnesium sulfate before 32 weeks of gestation (grade A) are recommended. Antibiotic prophylaxis is recommended (grade A) because it is associated with a reduction of neonatal mortality and morbidity (LE1). Amoxicillin, 3rd generation cephalosporins, and erythromycin in monotherapy or the association erythromycin-amoxicillin can be used (professional consensus), for 7 days (grade C). However, in case of negative vaginal culture, early cessation of antibiotic prophylaxis might be acceptable (professional consensus). Co-amoxiclav, aminosides, glycopetides, first and second generation cephalosporins, clindamycin, and metronidazole are not recommended for antibiotic prophylaxis (professional consensus). Outpatient management of women with clinically stable PPROM after 48hours of hospitalization is a possible (professional consensus). During monitoring, it is recommended to identify the clinical and biological elements suggesting intra-uterine infection (professional consensus). However, it not possible to make recommendation regarding the frequency of this monitoring. In case of isolated elevated C-reactive protein, leukocytosis, or positive vaginal culture in an asymptomatic patient, it is not recommended to systematically prescribe antibiotics (professional consensus). In case of intra-uterine infection, it is recommended to immediately administer an antibiotic therapy associating beta-lactamine and aminoside (grade B), intravenously (grade B), and to deliver the baby (grade A). Cesarean delivery should be performed according to the usual obstetrical indications (professional consensus). Expectative management is recommended before 37 weeks of gestation in case of uncomplicated PPROM (grade A), even in case of positive vaginal culture for B Streptococcus, provided that an antibiotic prophylaxis has been prescribed (professional consensus). Oxytocin and prostaglandins are two possible options to induce labor in case of PPROM (professional consensus). CONCLUSION Expectative management is recommended before 37 weeks of gestation in case of uncomplicated PPROM (grade A).
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Affiliation(s)
- T Schmitz
- Service de gynécologie obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Université Paris Diderot, 5, rue Thomas-Mann, 75013 Paris, France; Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, 75005 Paris, France.
| | - L Sentilhes
- Service de gynécologie-obstétrique, hôpital Pellegrin, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - E Lorthe
- Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, 75005 Paris, France; EPIUnit-Institute of Public Health, University of Porto, Rua das Taipas, n(o) 135, 4050-600 Porto, Portugal
| | - D Gallot
- Pôle femme et enfant, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France; R2D2-EA7281, faculté de médecine, université d'Auvergne, place Henri-Dunant, 63000 Clermont-Ferrand, France
| | - H Madar
- Service de gynécologie-obstétrique, hôpital Pellegrin, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - M Doret-Dion
- Service de gynécologie obstétrique, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 59, boulevard Pinel, 69500 Bron, France
| | - G Beucher
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France
| | - C Charlier
- Service des maladies infectieuses et tropicales, hôpital Necker-Enfants-Malades, AP-HP, Paris, France; Université Paris Descartes, 75005 Paris, France; Centre d'infectiologie Necker-Pasteur, Institut IMAGINE, 75015 Paris, France
| | - C Cazanave
- Service des maladies infectieuses et tropicales, groupe hospitalier Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France; Infections humaines à mycoplasmes et à chlamydiae, université de Bordeaux, USC EA 3671, 33000 Bordeaux, France
| | - P Delorme
- Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, 75005 Paris, France; Université Paris Descartes, 75005 Paris, France; DHU risques et grossesse, maternité Port-Royal, hôpital Cochin, hôpitaux universitaires Paris Centre, AP-HP, 75014 Paris, France
| | - C Garabedian
- Clinique d'obstétrique, hôpital Jeanne-de-Flandre, CHU de Lille, Lille, France; Université de Lille, EA 4489-environnement périnatal et croissance, 59000 Lille, France
| | - É Azria
- Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, 75005 Paris, France; Université Paris Descartes, 75005 Paris, France; Maternité Notre Dame de Bon Secours, DHU risques et grossesse, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - V Tessier
- DHU risques et grossesse, maternité Port-Royal, hôpital Cochin, hôpitaux universitaires Paris Centre, AP-HP, 75014 Paris, France; Collège national des sages-femmes de France, 136, avenue Emile-Zola, 75015 Paris, France
| | - M-V Senat
- Service de gynécologie obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Université Paris-Sud, université de médecine Paris-Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - G Kayem
- Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, 75005 Paris, France; Service de gynécologie obstétrique, hôpital Trousseau, AP-HP, 26, rue du Docteur-Arnold-Netter, 75012 Paris, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France
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Schmitz T, Kayem G, Senat MV, Sentilhes L. [Preterm Premature Rupture of Membranes: CNGOF Guidelines for Clinical Practice - Method and Organization]. ACTA ACUST UNITED AC 2018; 46:996-997. [PMID: 30385353 DOI: 10.1016/j.gofs.2018.10.018] [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: 09/27/2018] [Indexed: 11/19/2022]
Affiliation(s)
- T Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Inserm UMR 1153 équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique, Sorbonne Paris cité, 75005 Paris, France; Université Paris Diderot, 5, rue Thomas-Mann, 75013 Paris, France.
| | - G Kayem
- Inserm UMR 1153 équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique, Sorbonne Paris cité, 75005 Paris, France; Service de gynécologie-obstétrique, hôpital Trousseau, AP-HP, 26, rue du Docteur-Arnold-Netter, 75012 Paris, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France
| | - M-V Senat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Université Paris-Sud, université de médecine Paris-Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, CHU Bordeaux, hôpital Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France
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Kayem G, Sentilhes L, Senat MV, Schmitz T. [Preterm Premature Rupture of Membranes: CNGOF Guidelines for Clinical Practice - Introduction]. ACTA ACUST UNITED AC 2018; 46:994-995. [PMID: 30385354 DOI: 10.1016/j.gofs.2018.10.015] [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: 09/28/2018] [Indexed: 11/17/2022]
Affiliation(s)
- G Kayem
- Service de gynécologie-obstétrique, hôpital Trousseau, AP-HP, 26, rue du Docteur-Arnold-Netter, 75012 Paris, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France; Inserm UMR 1153 équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique, Sorbonne Paris cité, 75005 Paris, France.
| | - L Sentilhes
- Service de gynécologie-obstétrique, CHU Bordeaux, hôpital Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - M V Senat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Université Paris-Sud, université de médecine Paris-Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - T Schmitz
- Inserm UMR 1153 équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique, Sorbonne Paris cité, 75005 Paris, France; Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Université Paris Diderot, 5, rue Thomas-Mann, 75013 Paris, France
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Milpied B, Janier M, Timsit J, Spenatto N, Caumes E, Chosidow O, Sentilhes L, Senat MV. [Diagnostic and therapeutic recommendations for sexually transmitted diseases: Genital herpes]. Ann Dermatol Venereol 2018; 146:31-36. [PMID: 30366717 DOI: 10.1016/j.annder.2018.07.029] [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: 11/28/2017] [Accepted: 07/13/2018] [Indexed: 11/26/2022]
Abstract
TREATMENT OF THE INITIAL INFECTION OR FIRST CLINICAL EPISODE OF GENITAL HERPES: An initial infection or first clinical episode of genital herpes is treated with oral aciclovir 200mg×5/d for 5 to 10 days depending on clinical status. The recommended dosage for valaciclovir is 1g×2/d and treatment duration is identical to that for aciclovir. TREATMENT OF HERPES RECURRING DURING PREGNANCY: There are no studies of the efficacy of antiviral therapy on the symptoms of genital recurring during pregnancy. However, initial anti-viral treatment using aciclovir or valaciclovir may be given where warranted by symptoms (i.e. duration and severity of symptoms). Valaciclovir may be used instead (equivalent efficacy but better safety data for aciclovir). Valaciclovir may be given at a dosage of 1×500mg b.i.d. p.o. for 5 days. PROPHYLACTIC ANTI-VIRAL TREATMENT DURING PREGNANCY: In female patients presenting an initial infection or infection recurring during pregnancy, although there is no demonstrated benefit for prophylactic treatment in reducing the risk of neonatal herpes, anti-viral prophylaxis is recommended after 36 WA (weeks' amenorrhoea) to limit the need for Caesarean section due to herpetic lesions. The recommended antivirals are aciclovir at a dosage of 400mg t.i.d p.o. or valaciclovir at a dosage of 500mg b.i.d. p.o. until delivery.
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Affiliation(s)
- B Milpied
- Service de dermatologie, hôpital Saint-André, CHU, 1, rue Jean-Burguet, 33000 Bordeaux, France
| | - M Janier
- Centre clinique et biologique des MST, hôpital Saint-Louis, 42, rue Bichat, 75010 Paris, France
| | - J Timsit
- Centre clinique et biologique des MST, hôpital Saint-Louis, 42, rue Bichat, 75010 Paris, France
| | - N Spenatto
- Pôle santé publique et médecine sociale, service de dermatologie et médecine sociale, hôpital La-Grave, place Lange, TSA 60033, 31059 Toulouse cedex 9, France
| | - E Caumes
- Service des maladies infectieuses et tropicales, hôpital Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - O Chosidow
- Service de dermatologie, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France.
| | - L Sentilhes
- Service de gynécologie-obstétrique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - M-V Senat
- Marie-Victoire Senat, service de gynécologie-obstétrique, Paris-Sud-université Paris-Saclay, hôpital Bicêtre, AP-HP, Le Kremlin Bicêtre, France
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Lorthe E, Sentilhes L, Quere M, Lebeaux C, Winer N, Torchin H, Goffinet F, Delorme P, Kayem G, Ancel P, Arnaud C, Blanc J, Boileau P, Debillon T, Delorme P, D'Ercole C, Desplanches T, Diguisto C, Foix‐L'Hélias L, Garbi A, Gascoin G, Gaudineau A, Gire C, Goffinet F, Kayem G, Langer B, Letouzey M, Lorthe E, Maisonneuve E, Marret S, Monier I, Morgan A, Rozé J, Schmitz T, Sentilhes L, Subtil D, Torchin H, Tosello B, Vayssière C, Winer N, Zeitlin J. Planned delivery route of preterm breech singletons, and neonatal and 2‐year outcomes: a population‐based cohort study. BJOG 2018; 126:73-82. [DOI: 10.1111/1471-0528.15466] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2018] [Indexed: 11/30/2022]
Affiliation(s)
- E Lorthe
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé) Center for Epidemiology and Statistics Sorbonne Paris Cité DHU Risks in pregnancy, Paris Descartes University Paris France
- EPIUnit – Institute of Public Health University of Porto Porto Portugal
| | - L Sentilhes
- Department of Obstetrics and Gynaecology Bordeaux University Hospital Bordeaux France
| | - M Quere
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé) Center for Epidemiology and Statistics Sorbonne Paris Cité DHU Risks in pregnancy, Paris Descartes University Paris France
| | - C Lebeaux
- Reference Centre on Teratogenic Agents Trousseau University Hospital Assistance Publique – Hôpitaux de Paris Paris France
| | - N Winer
- Department of Obstetrics and Gynecology CIC Mère Enfant University Hospital Nantes France
- INRA, UMR 1280 Physiologie des adaptations nutritionnelles Nantes France
| | - H Torchin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé) Center for Epidemiology and Statistics Sorbonne Paris Cité DHU Risks in pregnancy, Paris Descartes University Paris France
- Neonatal Medicine and Resuscitation Service Port‐Royal, Hôpital Cochin Assistance Publique – Hôpitaux de Paris Paris France
| | - F Goffinet
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé) Center for Epidemiology and Statistics Sorbonne Paris Cité DHU Risks in pregnancy, Paris Descartes University Paris France
- Department of Obstetrics and Gynaecology Cochin, Broca, Hôtel‐Dieu Assistance Publique – Hôpitaux de Paris Paris France
| | - P Delorme
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé) Center for Epidemiology and Statistics Sorbonne Paris Cité DHU Risks in pregnancy, Paris Descartes University Paris France
- Department of Obstetrics and Gynaecology Cochin, Broca, Hôtel‐Dieu Assistance Publique – Hôpitaux de Paris Paris France
| | - G Kayem
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé) Center for Epidemiology and Statistics Sorbonne Paris Cité DHU Risks in pregnancy, Paris Descartes University Paris France
- Department of Obstetrics and Gynaecology Trousseau University Hospital Assistance Publique – Hôpitaux de Paris Sorbonne Universités, Université Pierre and Marie Curie Paris 06 Paris France
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Jauniaux E, Alfirevic Z, Bhide AG, Belfort MA, Burton GJ, Collins SL, Dornan S, Jurkovic D, Kayem G, Kingdom J, Silver R, Sentilhes L. Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green-top Guideline No. 27a. BJOG 2018; 126:e1-e48. [PMID: 30260097 DOI: 10.1111/1471-0528.15306] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Manangama G, Migault L, Audignon-Durand S, Sentilhes L, Lacourt A, Delva F. Maternal occupational exposure to unintentional nanoscale particles and small for gestational age outcome in the ELFE cohort. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.05.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Sentilhes L, Azria E, Schmitz T. [Is universal first trimester screening for high risk of preterm preeclampsia clinically meaningful?]. ACTA ACUST UNITED AC 2018; 46:617-618. [PMID: 29656070 DOI: 10.1016/j.gofs.2018.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Indexed: 12/01/2022]
Affiliation(s)
- L Sentilhes
- Service de gynécologie-obstétrique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - E Azria
- Maternité Notre-Dame de Bon Secours, groupe hospitalier Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France; Université René-Descartes, 2, rue de l'École-de-Médecine, 75006 Paris, France; Inserm U1153, obstetrical, perinatal and pediatric epidemiology team, epidemiology and biostatistics, Sorbonne-Paris cité research center, 53, avenue de l'Observatoire, 75014 Paris, France
| | - T Schmitz
- Inserm U1153, obstetrical, perinatal and pediatric epidemiology team, epidemiology and biostatistics, Sorbonne-Paris cité research center, 53, avenue de l'Observatoire, 75014 Paris, France; Service de gynécologie obstétrique, hôpital Robert-Debré, Assistance publique-hôpitaux de Paris, boulevard Sérurier, 75019 Paris, France; Université Paris-Diderot, 16, rue Henri-Huchard, 75018 Paris, France
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Bardy-Evrard C, Mattuizzi A, Coatleven F, Nithart A, Evrard G, Benachi A, Nisand I, Sentilhes L. [Overview of feelings and practices of gynecologists and obstetricians for the noninvasive prenatal testing in France]. Gynecol Obstet Fertil Senol 2018; 46:34-40. [PMID: 29233528 DOI: 10.1016/j.gofs.2017.11.002] [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] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To evaluate the feelings and practices of French obstetrician-gynecologists in prescribing the noninvasive prenatal testing (NIPT) before the release of the French High Authority of Health recommendations. METHODS Descriptive, declarative and transversal study, analyzing the feelings and practices of obstetrician-gynecologists, members of the French College of Gynecologists and Obstetricians (CNGOF) between February and May 2017 using an online questionnaire. Practitioners' feedback was self-assessed for several clinical situations using a numerical scale ranging from 1 to 10. This experience was rated as "good" (grades 6 to 10) or "bad" (grades 1-5). RESULTS Overall, 529 practitioners (29.2%) of 1812 CNGOF members, answered the online questionnaire. A "good" feeling was found for more than 65% of the practitioners audited. Feelings were significantly better for obstetricians, sonographers (P<0.05) and CPDPN members (P=0.003) compared to other practitioners. Situations where the DPNI was proposed "systematically" were risks greater than 1/250 (70.9%), between 1/250 and 1/500 (59.4%), greater than 1/250 associated with history of spontaneous miscarriages and/or fetal death in utero (66%), greater than 1/250 associated with pregnancy resulting from PMA (68.3%), history of fetal aneuploidy (54%) and a parent carrying a Robertsonian translocation (51.6%). CONCLUSION This study highlights a good overall feeling of the practitioners with the NIPT.
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Affiliation(s)
- C Bardy-Evrard
- Service de gynécologie-obstétrique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
| | - A Mattuizzi
- Service de gynécologie-obstétrique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - F Coatleven
- Service de gynécologie-obstétrique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - A Nithart
- Service de gynécologie-obstétrique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - G Evrard
- Service des urgences adultes, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - A Benachi
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU Antoine-Béclère, AP-HP, 92140 Clamart, France; Collège national des gynécologues obstétriciens français, 75012 Paris, France
| | - I Nisand
- Collège national des gynécologues obstétriciens français, 75012 Paris, France; Service de gynécologie-obstétrique, CHU de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France; Collège national des gynécologues obstétriciens français, 75012 Paris, France
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Sénat MV, Laplace JP, Sentilhes L. [Herpes and pregnancy: Guidelines for clinical practice - method and organization]. ACTA ACUST UNITED AC 2017; 45:640-641. [PMID: 29146287 DOI: 10.1016/j.gofs.2017.10.010] [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: 09/21/2017] [Indexed: 11/25/2022]
Affiliation(s)
- M-V Sénat
- Service de gynécologie-obstétrique, hôpital Bicêtre, Le Kremlin-Bicêtre, faculté Paris-Sud, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
| | - J-P Laplace
- Gynerisq, 6, rue Pétrarque, 31000 Toulouse, France(1)
| | - L Sentilhes
- Service de gynécologie-obstétrique, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
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48
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Sénat MV, Anselem O, Picone O, Renesme L, Sananès N, Vauloup-Fellous C, Sellier Y, Laplace JP, Sentilhes L. Prévention et prise en charge de l’infection herpétique au cours de la grossesse et de l’accouchement : recommandations pour la pratique clinique – texte des recommandations (texte court). ACTA ACUST UNITED AC 2017; 45:705-714. [PMID: 29132768 DOI: 10.1016/j.gofs.2017.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/21/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Identify measures to diagnose, prevent and treat genital herpes infection during pregnancy and childbirth and neonatal infection. METHODS Bibliographic search from Medline, Cochrane Library databases and research of international clinical practice guidelines. RESULTS Genital herpes lesion is most often due to HSV2 (LE2). The risk of HSV seroconversion during pregnancy is 1 to 5% (LE2). Genital herpes ulceration during pregnancy in a woman with history of genital herpes corresponds with a recurrence. In this situation, there is no need for virologic confirmation (grade B). In case of genital lesions in a pregnant woman that do not report any genital herpes before, it is recommended to perform a virological confirmation by PCR and HSV type specific IgG (Professional consensus). In case of first episode genital herpes during pregnancy, antiviral treatment with acyclovir (200mg 5 times daily) or valacyclovir (1000mg twice daily) for 5 to 10 days is recommended (grade C). In case of recurrent herpes during pregnancy, antiviral therapy with acyclovir (200mg 5 times daily) or valacyclovir (500mg twice daily) can be administered (grade C). The risk of neonatal herpes is estimated between 25% and 44% in case of initial episode (LE2) and 1% in case of recurrence (LE3) at the time of delivery. Antiviral prophylaxis should be offered for women with first episode genital herpes or recurrent genital herpes during pregnancy from 36 weeks of gestation and until delivery (grade B). In case of a history of genital herpes without episode of recurrence during pregnancy, it is not recommended routinely offer a prophylactic treatment (professional consensus). A cesarean section should be performed if there is a suspicion of first episode genital herpes at the onset of labor (grade B), in the event of premature rupture of the membranes at term (professional consensus), or in case of first episode genital herpes less than 6 weeks before delivery (professional consensus). In case of recurrent genital herpes at the onset of labor, cesarean delivery will be all the more considered if the membranes are intact and vaginal delivery will be all the more considered in case of prolonged rupture of membranes (professional consensus). Neonatal herpes is rare and mainly due to HSV-1 (LE3). In most of the case of neonatal herpes, the mothers have no history of genital herpes (LE 3). In case of suspicion of neonatal herpes, different samples (blood and cerebrospinal fluid) for HSV PCR must be carried out to confirm the diagnosis (professional consensus). Any newborn suspected of neonatal herpes should be treated with intravenous acyclovir (60mg/kgs/day 3 times daily) (grade A) prior to the results of HSV PCR (professional consensus). The duration of the treatment depends on the clinical form (professional consensus) CONCLUSION: There is no formal evidence that it is possible to reduce the risk of neonatal herpes in genital herpes during pregnancy. However, appropriate care can reduce the symptoms associated with herpes, the risk of recurrence term and the cesarean rate performed to decrease the risk of neonatal herpes.
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Affiliation(s)
- M-V Sénat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Université Paris-Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France.
| | - O Anselem
- Maternité Port-Royal, université Paris-Descartes, groupe hospitalier Cochin-Broca Hôtel-Dieu, AP-HP, 12, rue de l'École-de-Médecine, 75006 Paris, France
| | - O Picone
- Service de gynécologie obstétrique, hôpital Louis-Mourier, hôpitaux universitaires Paris-Nord, 147, rue des Renouillers, 92700 Colombes, France; Université Paris-Diderot, 5, rue Thomas-Mann, 75013, Paris, France
| | - L Renesme
- Service de néonatalogie, soins intensifs, maternité, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - N Sananès
- Service de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - C Vauloup-Fellous
- Université Paris-Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Service de virologie, hôpitaux universitaires Paris-Sud, hôpital Paul-Brousse, AP-HP, 12, avenue Paul-Vaillant-Couturier, 94800 Villejuif, France
| | - Y Sellier
- Collège national des sages femmes de France, 136, avenue Émile-Zola, 75015 Paris, France
| | - J-P Laplace
- Gynerisq, 6, rue Pétrarque, 31000 Toulouse, France(1)
| | - L Sentilhes
- Service de gynécologie-obstétrique, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
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Sénat MV, Laplace JP, Sentilhes L. [Herpes and pregnancy: Guidelines for clinical practice - introduction]. ACTA ACUST UNITED AC 2017; 45:639. [PMID: 29132774 DOI: 10.1016/j.gofs.2017.10.009] [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: 09/21/2017] [Indexed: 11/15/2022]
Affiliation(s)
- M-V Sénat
- Service de gynécologie-obstétrique, hôpital Bicêtre, Le Kremlin-Bicêtre, université Paris-Sud, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
| | - J P Laplace
- Gynerisq, 6, rue Pétrarque, 31000 Toulouse, France(1)
| | - L Sentilhes
- Service de gynécologie-obstétrique, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
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50
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Madar H, Sentilhes L. [H. Madar and L. Sentilhes in response to J. Boujenah's correspondence on the article: For a targeted use of aspirin. Gynecol Obstet Fertil Senol 2017;45:224-30]. Gynecol Obstet Fertil Senol 2017; 45:448-449. [PMID: 28757107 DOI: 10.1016/j.gofs.2017.06.016] [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] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Indexed: 06/07/2023]
Affiliation(s)
- H Madar
- Service de gynécologie-obstétrique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - L Sentilhes
- Service de gynécologie-obstétrique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
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