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Grangier L, Martinez de Tejada B, Savoldelli G, Irion O, Haller G. Adverse side effects and route of administration of opioids in combined spinal-epidural analgesia for labour: a meta-analysis of randomised trials. Int J Obstet Anesth 2020; 41:83-103. [DOI: 10.1016/j.ijoa.2019.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/11/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
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Abstract
BACKGROUND Migrant mothers in developed countries often experience more complicated pregnancy outcomes and less fewer women access preventive gynecology services. To enlighten health care providers to potential barriers, the objective of this paper is to explore barriers to reproductive health services in Geneva described by migrant women from a qualitative perspective. METHODS In this qualitative study, thirteen focus groups (FG) involving 78 women aged 18 to 66 years were conducted in seven languages. All the FG discussions were audio-recorded and later transcribed. The data was classified, after which the main themes and sub-themes were manually extracted and analyzed. RESULTS Barriers were classified either into structural or personal barriers aiming to describe factors influencing the accessibility of reproductive health services vs. those influencing client satisfaction. The five main themes that emerged were financial accessibility, language barriers, real or perceived discrimination, lack of information and embarrassment. CONCLUSION Structural improvements which might meet the needs of the emergent extremely diverse population are the (1) provision of informative material that is easy to understand and available in multiple languages, (2) provision of sensitive cultural training including competence skill for all health professionals, (3) provision of specifically trained nurses or social assistance to guide migrants through the health system and (4) inclusion of monitoring and evaluation programs for the prevention of personal and systemic discrimination.
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Affiliation(s)
- N C Schmidt
- Department of Obstetrics and Gynecology, University Hospitals of Geneva, Geneva, Switzerland.
| | - V Fargnoli
- Department of Sociology, University of Geneva, Geneva, Switzerland
| | - M Epiney
- Department of Obstetrics and Gynecology, University Hospitals of Geneva, Geneva, Switzerland
| | - O Irion
- Department of Obstetrics and Gynecology, University Hospitals of Geneva, Geneva, Switzerland
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Schmidt NC, Fargnoli V, Epiney M, Irion O. Barriers to reproductive health care for migrant women in Geneva: a qualitative study. Reprod Health 2018; 15:43. [PMID: 29510718 PMCID: PMC5838955 DOI: 10.1186/s12978-018-0478-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 02/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background Migrant mothers in developed countries often experience more complicated pregnancy outcomes and less fewer women access preventive gynecology services. To enlighten health care providers to potential barriers, the objective of this paper is to explore barriers to reproductive health services in Geneva described by migrant women from a qualitative perspective. Methods In this qualitative study, thirteen focus groups (FG) involving 78 women aged 18 to 66 years were conducted in seven languages. All the FG discussions were audio-recorded and later transcribed. The data was classified, after which the main themes and sub-themes were manually extracted and analyzed. Results Barriers were classified either into structural or personal barriers aiming to describe factors influencing the accessibility of reproductive health services vs. those influencing client satisfaction. The five main themes that emerged were financial accessibility, language barriers, real or perceived discrimination, lack of information and embarrassment. Conclusion Structural improvements which might meet the needs of the emergent extremely diverse population are the (1) provision of informative material that is easy to understand and available in multiple languages, (2) provision of sensitive cultural training including competence skill for all health professionals, (3) provision of specifically trained nurses or social assistance to guide migrants through the health system and (4) inclusion of monitoring and evaluation programs for the prevention of personal and systemic discrimination.
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Affiliation(s)
- N C Schmidt
- Department of Obstetrics and Gynecology, University Hospitals of Geneva, Geneva, Switzerland.
| | - V Fargnoli
- Department of Sociology, University of Geneva, Geneva, Switzerland
| | - M Epiney
- Department of Obstetrics and Gynecology, University Hospitals of Geneva, Geneva, Switzerland
| | - O Irion
- Department of Obstetrics and Gynecology, University Hospitals of Geneva, Geneva, Switzerland
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Guittier MJ, Othenin-Girard V, de Gasquet B, Irion O, Boulvain M. Authors' reply re: Maternal positioning to correct occiput posterior fetal position during the fi rst stage of the labour: a randomised controlled trial. BJOG 2017; 124:1124. [PMID: 28544717 DOI: 10.1111/1471-0528.14541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2016] [Indexed: 11/28/2022]
Affiliation(s)
- M J Guittier
- Department of Gynaecology and Obstetrics, University of Applied Sciences Western Switzerland, Geneva, Switzerland.,Geneva University Hospitals, Geneva, Switzerland
| | - V Othenin-Girard
- Geneva University Hospitals, Geneva, Switzerland.,Department of Gynaecology and Obstetrics, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - O Irion
- Geneva University Hospitals, Geneva, Switzerland.,Department of Gynaecology and Obstetrics, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - M Boulvain
- Geneva University Hospitals, Geneva, Switzerland.,Department of Gynaecology and Obstetrics, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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Veit-Rubin N, Brossard P, Gayet-Ageron A, Montandon CY, Simon J, Irion O, Rutschmann OT, Martinez de Tejada B. Validation of an emergency triage scale for obstetrics and gynaecology: a prospective study. BJOG 2017; 124:1867-1873. [PMID: 28294509 DOI: 10.1111/1471-0528.14535] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the reliability of a four-level triage scale for obstetrics and gynaecology emergencies and to explore the factors associated with an optimal triage. DESIGN Thirty clinical vignettes presenting the most frequent indications for obstetrics and gynaecology emergency consultations were evaluated twice using a computerised simulator. SETTING The study was performed at the emergency unit of obstetrics and gynaecology at the Geneva University Hospitals. SAMPLE The vignettes were submitted to nurses and midwives. METHODS We assessed inter- and intra-rater reliability and agreement using a two-way mixed-effects intra-class correlation (ICC). We also performed a generalised linear mixed model to evaluate factors associated triage correctness. MAIN OUTCOME MEASURES Triage acuity. RESULTS We obtained a total of 1191 evaluations. Inter-rater reliability was good (ICC 0.748; 95% CI 0.633-0.858) and intra-rater reliability was almost perfect (ICC 0.812; 95% CI 0.726-0.889). We observed a wide variability: the mean number of questions varied from 6.9 to 18.9 across individuals and from 8.4 to 16.9 across vignettes. Triage acuity was underestimated in 12.4% of cases and overestimated in 9.3%. Undertriage occurred less frequently for gynaecology compared with obstetric vignettes [odds ratio (OR) 0.45; 95% CI 0.23-0.91; P = 0.035] and decreased with the number of questions asked (OR 0.94; 95% CI 0.88-0.99; P = 0.047). Certification in obstetrics and gynaecology emergencies was an independent factor for the avoidance of undertriage (OR 0.35; 95% CI 0.17-0.70; P = 0.003). CONCLUSION The four-level triage scale is a valid and reliable tool for the integrated emergency management of obstetrics and gynaecology patients. TWEETABLE ABSTRACT The Swiss Emergency Triage Scale is a valid and reliable tool for obstetrics and gynaecology emergency triage.
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Affiliation(s)
- N Veit-Rubin
- Department of Gynaecology and Obstetrics, Lausanne University Hospital and Faculty of Medicine, Lausanne, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Obstetrics and Gynaecology, Medical University Vienna, Vienna, Austria
| | - P Brossard
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - A Gayet-Ageron
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,CRC & Division of Clinical Epidemiology, Department of Health and Community Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - C-Y Montandon
- Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - J Simon
- Nursing Department, Geneva University Hospitals, Geneva, Switzerland
| | - O Irion
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - O T Rutschmann
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Primary Care, Community and Emergency Medicine, Division of Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - B Martinez de Tejada
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
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Schmidt N, Quack K, Fargnoli V, Epiney M, Irion O. Exploring barriers to reproductive health services for migrant women in Geneva using a community-based approach. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1598145] [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: 10/20/2022] Open
Affiliation(s)
- N Schmidt
- Departement d'obstétrique et gynécologie (HUG), Genf, Schweiz
| | - K Quack
- FrauenSpital Zürich, Zürich, Schweiz
| | - V Fargnoli
- Département de Sociologie (UNIGE), Genf, Schweiz
| | - M Epiney
- Departement d'obstétrique (HUG), Genf, Schweiz
| | - O Irion
- Departement d'obstétrique et gynécologie (HUG), Genf, Schweiz
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Schmidt N, Fargnoli V, Epiney M, Irion O. Barriers to reproductive health services for migrant women in Geneva using a qualitative, community-based approach. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593055] [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: 10/20/2022] Open
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Jastrow N, Vikhareva O, Gauthier RJ, Irion O, Boulvain M, Bujold E. Can third-trimester assessment of uterine scar in women with prior Cesarean section predict uterine rupture? Ultrasound Obstet Gynecol 2016; 47:410-414. [PMID: 26483275 DOI: 10.1002/uog.15786] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/28/2015] [Accepted: 10/06/2015] [Indexed: 06/05/2023]
Affiliation(s)
- N Jastrow
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Hôpitaux Universitaires de Genève, Université de Genève, Genève, Switzerland
| | - O Vikhareva
- Department of Obstetrics and Gynaecology, Skane University Hospital Malmö, Lund University, Malmö, Sweden
| | - R J Gauthier
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Hôpital Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - O Irion
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Hôpitaux Universitaires de Genève, Université de Genève, Genève, Switzerland
| | - M Boulvain
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Hôpitaux Universitaires de Genève, Université de Genève, Genève, Switzerland
| | - E Bujold
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Centre de Recherche du Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
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Ryser Rüetschi J, Jornayvaz FR, Rivest R, Huhn EA, Irion O, Boulvain M. Fasting glycaemia to simplify screening for gestational diabetes. BJOG 2016; 123:2219-2222. [PMID: 26810795 DOI: 10.1111/1471-0528.13857] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 11/12/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Recommendations in Switzerland on screening for gestational diabetes endorse the International Association of Diabetes in Pregnancy Study Group consensus. As universal testing is time consuming and glucose loading is unpleasant, the recommendations include a simplification, not performing the glucose loading in women with fasting glycaemia <4.4 mmol/l. Our objective was to evaluate the diagnostic performance of this simplified strategy, compared with the complete test, in our population with a low prevalence of gestational diabetes. DESIGN We collected 2298 complete 75-g glucose tolerance tests. We simulated stopping the test, so avoiding the glucose loading and further glycaemia, if fasting glycaemia was <4.4 or ≥5.1 mmol/l. SETTING AND POPULATION Unselected pregnant women from Geneva and Basel, at 24-28 weeks of gestation. METHODS We calculated the sensitivity, and the percentage of women who would avoid the complete test with the strategy based on fasting glycaemia. RESULTS The prevalence of gestational diabetes was 10.9% in our population. Among 251 women with gestational diabetes, fasting glycaemia was ≥5.1 mmol/l in 119 women (47.4%), between 4.4 and <5.1 mmol/l in 78 women (31.1%) and <4.4 mmol/l in 54 women (21.5%). Proceeding with the complete test only in women with fasting glycaemia between 4.4 and <5.1 mmol/l will result in a sensitivity of 78.5%. This strategy would avoid glucose loading in 63.8% of women. CONCLUSIONS Screening with fasting glycaemia is an attractive alternative to universal screening with the complete 75-g glucose tolerance test. This strategy is, however, slightly less sensitive than previously reported in higher-risk populations. TWEETABLE ABSTRACT Fasting glycaemia can be considered as an alternative to the complete test for gestational diabetes screening.
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Affiliation(s)
- J Ryser Rüetschi
- Department of Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
| | - F R Jornayvaz
- Department of Endocrinology, Diabetes, Hypertension and Nutrition, University Hospitals of Geneva, Geneva, Switzerland
| | | | - E A Huhn
- Department of Obstetrics and Gynaecology, University Hospital of Basel, Basel, Switzerland
| | - O Irion
- Department of Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
| | - M Boulvain
- Department of Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
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Guittier MJ, Othenin-Girard V, de Gasquet B, Irion O, Boulvain M. Maternal positioning to correct occiput posterior fetal position during the first stage of labour: a randomised controlled trial. BJOG 2016; 123:2199-2207. [PMID: 26806596 PMCID: PMC5132127 DOI: 10.1111/1471-0528.13855] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the efficacy of the hands and knees position during the first stage of labour to facilitate the rotation of the fetal head to the occiput anterior position. DESIGN Randomised controlled trial. SETTING Geneva University Hospitals, Switzerland. POPULATION A total of 439 women with a fetus in the occiput posterior position during the first stage of labour. METHODS The women in the intervention group were invited to take a hands and knees position for at least for 10 minutes. Women allocated to the control group received the usual care. For both groups, 15 minutes after randomisation, women completed a short questionnaire to report their perceived pain and the comfort of their position. MAIN OUTCOME MEASURES The rotation of the fetal head in occiput anterior position confirmed by ultrasonography 1 hour after randomisation. RESULTS One hour after the randomisation, 35 of 203 (17%) fetuses were diagnosed as being in the occiput anterior position in the intervention group compared with 24 of 209 (12%) in the control group. This difference was not statistically significant (relative risk 1.50; 95% CI 0.93-2.43; P = 0.13). The change in the evaluation of comfort between the randomisation and 15 minutes after showed an improvement in 70 and 39 women, no change in 82 and 78 women and a decrease in 56 and 86 women in the intervention and control groups, respectively (P = 0.02). CONCLUSIONS This study could not demonstrate a benefit of the hands and knees position to correct the occiput posterior position of the fetus during the first stage of labour, but the women reported an increase in their comfort level. TWEETABLE ABSTRACT Hands and knees position does not facilitate rotation into occiput anterior but increases the comfort level of women.
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Affiliation(s)
- M J Guittier
- University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland.,Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - V Othenin-Girard
- Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | | | - O Irion
- Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - M Boulvain
- Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
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Delaloye JF, Irion O. [Will bilateral mastectomy replace conservative surgery?]. Rev Med Suisse 2015; 11:1983-1984. [PMID: 26672175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Martinez de Tejada B, Othenin-Girard V, Irion O. [Prevention of preterm birth with vaginal progesterone in women with preterm labor: which are the evidences?]. Rev Med Suisse 2015; 11:2004-2010. [PMID: 26672179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The presence of uterine contractions and a short cervix at less than 37 weeks of gestation (preterm labor) is an important risk factor for a preterm birth. Currently, there is not treatment able to reduce the risk of preterm birth in this high risk group of women. Vaginal progesterone has been shown to be effective in reducing the risk of preterm birth in asymptomatic women with a prior preterm birth and in women with a short cervix, measured by vaginal ultrasound before 24 weeks of gestation. Unfortunately, vaginal progesterone has not been shown to be efficacious in women with preterm labor. A recent clinical trial has shown that it can even be deleterious in this group of women.
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Ditisheim A, Boulvain M, Irion O, Pechère-Bertschi A. [Atypical presentation of preeclampsia]. Rev Med Suisse 2015; 11:1655-1658. [PMID: 26540995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Preeclampsia is a pregnancy-related syndrome, which still represents one of the major causes of maternal-fetal mortality and morbidity. Diagnosis can be made difficult due to the complexity of the disorder and its wide spectrum of clinical manifestations. In order to provide an efficient diagnostic tool to the clinician, medical societies regularly rethink the definition criteria. However, there are still clinical presentations of preeclampsia that escape the frame of the definition. The present review will address atypical forms of preeclampsia, such as preeclampsia without proteinuria, normotensive preeclampsia, preeclampsia before 20 weeks of gestation and post-partum preeclampsia.
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Martinez de Tejada B, Karolinski A, Ocampo MC, Laterra C, Hösli I, Fernández D, Surbek D, Huespe M, Drack G, Bunader A, Rouillier S, López de Degani G, Seidenstein E, Prentl E, Antón J, Krähenmann F, Nowacki D, Poncelas M, Nassif JC, Papera R, Tuma C, Espoile R, Tiberio O, Breccia G, Messina A, Peker B, Schinner E, Mol BW, Kanterewicz L, Wainer V, Boulvain M, Othenin-Girard V, Bertolino MV, Irion O. Prevention of preterm delivery with vaginal progesterone in women with preterm labour (4P): randomised double-blind placebo-controlled trial. BJOG 2014; 122:80-91. [DOI: 10.1111/1471-0528.13061] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2014] [Indexed: 02/01/2023]
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Pichon M, Guittier MJ, Irion O, Boulvain M. [External cephalic version in case of persisting breech presentation at term: motivations and women's experience of the intervention]. Gynecol Obstet Fertil 2013; 41:427-432. [PMID: 23102577 DOI: 10.1016/j.gyobfe.2012.09.029] [Citation(s) in RCA: 3] [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] [Received: 11/04/2011] [Accepted: 04/10/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To evaluate the efficacy and acceptability of external cephalic version (ECV). MATERIALS AND METHOD From 2004 to 2008, 212 pregnant women between 34-37 weeks of gestation with fetus in breech presentation were included in a randomized clinical trial and 125 externals cephalic versions were studied. RESULTS A success rate of 37.6%t was recorded. At 34 weeks of gestation, 80.6% of women were considering an ECV in the event of persistent breech position at 37 weeks. These women expressed the desire to give birth vaginally (52% versus 24.4%, P<0.001). In contrast, others women preferred an elective cesarean section to avoid the risk of a breech vaginal delivery. Women felt pain during the ECV and scored 60 on average using the analogical visual scale. Women rated on a verbal rating scale the ECV as severely painful to unbearable (68%), and as stressful (70%). Despite this, the majority of women would recommend ECV to their friends or would be willing to repeat it for themselves. DISCUSSION AND CONCLUSION ECV remains a scary and painful medical procedure. More research is needed to reduce the impact. The use of analgesic medication for this indication is controversial. Hypnosis could be an alternative to evaluate.
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Affiliation(s)
- M Pichon
- HEdS, 47, avenue de Champel, Genève, Suisse.
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Affiliation(s)
- I Eperon
- Department of Obstetrics and Gynecology, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland.
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Andrey Urias A, Martinez De Tejada B, Monnier S, Streuli I, Irion O. [What's new in gynecology and obstetrics in 2012?]. Rev Med Suisse 2013; 9:44-47. [PMID: 23367703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Intraoperative radiotherapy (IORT) has been shown to be as effective as traditional radiotherapy in the management of early stage breast cancer. IORT is performed in a single session and consists in a single irradiation in the tumorectomy cavity. Medically assisted procreation does not seem to favor neither gynecological nor non-gynecological cancers. Nevertheless medically assisted procreation technique ICSI (intracytoplasmic sperm injection) is associated with an increased risk of birth defect. This is not the case of IVF (in vitro fertilization). The causality of the treatment or of the infertility itself is unclear. During pregnancy, nicotine-replacement patches at usual dosage do not seem to increase abstinence smoking rates. A selective, and not a systematic thyroid screening strategy, is now recommended during first trimester of pregnancy.
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Affiliation(s)
- A Andrey Urias
- Service de gynécologie, Département de gynécologie et d'obstétrique, HUG et Faculté de médecine, Genève.
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Abdulcadir J, Margairaz C, Boulvain M, Irion O. O005 HEALTH PROMOTION FOR WOMEN WITH FEMALE GENITAL MUTILATION/CUTTING (FGM/C). Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)60435-4] [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: 11/26/2022]
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Saudan P, Billieux MH, Pechere A, Irion O, Savoldelli G, Boulvain M. OS014. Which first-line drug to control severe hypertension in pregnancy? A pilot study. Pregnancy Hypertens 2012; 2:182. [DOI: 10.1016/j.preghy.2012.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Martinez de Tejada B, Gayet-Ageron A, Combescure C, Irion O, Baehni P. Association between early preterm birth and periodontitis according to USA and European consensus definitions. J Matern Fetal Neonatal Med 2012; 25:2160-6. [PMID: 22548257 DOI: 10.3109/14767058.2012.663827] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Prospective case-control study assessing the association between maternal periodontitis according to the recently issued USA and European consensus definitions and early preterm delivery (<35 weeks gestation). Cases were women delivering between 22 and 34(6/7) weeks of gestation (n = 84) and controls were women delivering at term (≥ 37 weeks) (n = 345). METHODS Periodontal examination at the immediate postpartum period identified periodontitis according to both consensus definitions. A multivariate logistic model was used to assess the association between early preterm delivery and the presence of periodontitis adjusted for confounders. RESULTS All women had periodontitis by the European consensus definitions. When using the USA definitions, more cases had severe periodontitis than controls (34.5% vs. 17.72%); p = 0.003. After adjustment for main confounders, the association between severe (OR: 2.38; 95% CI: 1.36-4.14) periodontitis and early preterm delivery persisted. The only other independent factor associated with early preterm delivery was vaginal bleeding during pregnancy. CONCLUSIONS Early preterm delivery is associated with periodontitis when the USA consensus definitions are used. The European definitions revealed inadequate for the study population because of the lack of discrimination power.
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Affiliation(s)
- B Martinez de Tejada
- Department of Obstetrics and Gynaecology, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland.
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de Tejada BM, Pfister R, Renzi G, François P, Irion O, Boulvain M, Schrenzel J. Intrapartum Group B streptococcus detection by rapid polymerase chain reaction assay for the prevention of neonatal sepsis. Clin Microbiol Infect 2011; 17:1786-91. [DOI: 10.1111/j.1469-0691.2010.03378.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jastrow N, Meyer P, Bouchardy J, Savoldelli GL, Irion O. [Maternal heart disease and pregnancy: a multidisciplinary approach]. Rev Med Suisse 2011; 7:2070-2077. [PMID: 22141305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In developed countries, cardiovascular diseases are becoming one of the first causes of maternal death. Myocardial infarction, dissection of the thoracic aorta and cardiomyopathies are the leading causes. However, preexisting maternal cardiac diseases, such as congenital heart diseases, are more commonly encountered and may be associated with significant maternal and perinatal morbidity. This article reviews hemodynamic changes occurring during pregnancy, proposes a risk stratification according to pre-existing cardiac diseases, and discusses the monitoring and overall management of these patients. Finally, two pregnancy-triggered cardiac diseases are discussed: coronary artery disease and peripartum cardiomyopathy.
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Affiliation(s)
- N Jastrow
- Service d'obstétrique, Département de gynécologie et obstétrique, HUG, 1211 Genève.
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23
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Epiney M, Boulvain M, Irion O. [Psychosocial risk factors and preterm delivery]. Rev Med Suisse 2011; 7:2066-2069. [PMID: 22141304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Delivery before term (at less than 37 weeks of gestation) represents 5 to 10% of the deliveries and is an important cause of perinatal mortality and morbidity. Few improvements in prevention have been made. Difficulties include the multiplicity of medical risk factors, the absence of reliable diagnostic tests and the limited effectiveness of medical treatment. Several studies have shown that psychosocial risk factors are associated with preterm labour. The identification and management of these risk factors and of unfavorable social environment may potentially reduce the risk of preterm delivery. We describe and discuss the studies evaluating psychosocial interventions aiming at reducing the risk of prematurity.
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Affiliation(s)
- M Epiney
- Service d'obstétrique, Département de gynécologie et d'obstétrique, HUG, 1211 Genève 4.
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Söhnchen N, Melzer K, Tejada BMD, Jastrow-Meyer N, Othenin-Girard V, Irion O, Boulvain M, Kayser B. Maternal heart rate changes during labour. Eur J Obstet Gynecol Reprod Biol 2011; 158:173-8. [DOI: 10.1016/j.ejogrb.2011.04.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 03/21/2011] [Accepted: 04/29/2011] [Indexed: 01/12/2023]
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Abou M, Capanna F, Pellegrinelli JM, Meyer P, Irion O, Martinez de Tejada B. Maternal bilateral adrenal necrosis in the 3rd trimester of pregnancy. J OBSTET GYNAECOL 2011; 31:264-5. [PMID: 21417657 DOI: 10.3109/01443615.2010.546903] [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: 11/13/2022]
Affiliation(s)
- M Abou
- Department of Obstetrics and Gynaecology, University Hospital of Geneva and Faculty of Medicine, Geneva, Switzerland
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Jastrow N, Cantero P, Boulvain M, Irion O. [Vaginal birth after cesarean delivery: update 2010]. Rev Med Suisse 2010; 6:2000-2004. [PMID: 21137458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Uterine rupture is a rare, but potentially catastrophic complication of a trial of vaginal birth after cesarean (VBAC). In part because of concerns about this complication, the rate of cesarean deliveries continue to raise in developed countries. However, multiple repeat cesarean deliveries are associated with a greater risk of complications during surgery and of abnormal placentation in a subsequent pregnancy. VBAC should be proposed to women with good prognosis of VBAC success and low risk of uterine rupture. We aimed to review antepartum and intrapartum factors that are required for a safe VBAC.
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Affiliation(s)
- N Jastrow
- Service d'obstétrique, Département de gynécologie et obstétrique HUG, 1211 Genève 14. Nicole.JastrowMeyer@.hcuge.ch
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Haller G, Camparini-Righini N, Kern C, Pfister R, Morales M, Berner M, Clergue F, Irion O. Indicateurs sécurité en obstétrique : une étude Delphi. ACTA ACUST UNITED AC 2010; 39:371-8. [DOI: 10.1016/j.jgyn.2010.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 05/18/2010] [Accepted: 05/26/2010] [Indexed: 11/28/2022]
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Martinez de Tejada B, Jackson Y, Paccolat C, Irion O. [Congenital Chagas disease in Geneva: diagnostic and clinical aspects]. Rev Med Suisse 2009; 5:2091-2096. [PMID: 19947451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Chagas disease, a parasitic infection with Trypanosoma cruzi, recently emerged in Europe and in Switzerland. Mother-to-child infection represents a major mode of transmission in non endemic areas. In 2008, 305 Latin American pregnant women consulting at the Geneva University Hospitals were screened by serology. Overall prevalence was 2% and 8.8% in Bolivian women. All infected women were in the indeterminate form of the chronic phase. Two newborns were congenitally infected. Considering the potential for vertical transmission and the risk of long-term complications, screening programs for persons at risk need to be implemented.
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Irion O. [Long-term risks of cesarean section]. Rev Med Suisse 2009; 5:2097-2101. [PMID: 19947452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Long-term risks of cesarean section are underappreciated. Uterine rupture is a rare, but dramatic complication. Maternal anemia and infection, hysterectomy, perinatal death or cerebral palsy are frequent in case of rupture of the uterus during delivery. Vaginal birth after cesarean section is sharply declining in developed countries. Women with previous cesarean sections have also a higher risk of placenta praevia accreta. Hysterectomy is almost always nessessary in unstable hemodynamic conditions. The rising rate of cesarean sections may lead politicians to put obstetricians under supervision. Because of these risks, we have to aim at avoiding the first cesarean section.
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Affiliation(s)
- O Irion
- Service d'obstétrique, Département de gynécologie-obstétrique, HUG, Genevè
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Razurel C, Bruchon-Schweitzer M, Dupanloup A, Irion O, Epiney M. Stressful events, social support and coping strategies of primiparous women during the postpartum period: a qualitative study. Midwifery 2009; 27:237-42. [PMID: 19783333 DOI: 10.1016/j.midw.2009.06.005] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2009] [Revised: 05/27/2009] [Accepted: 06/07/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE to identify problems and events perceived as stressful by primiparous mothers during the postpartum period, and to explore the social support and coping strategies they used to face these situations. DESIGN a qualitative study. Data were collected via semi-structured interviews and analysed using a content-analysis method. SETTING Geneva University Hospitals, Geneva, Switzerland from October 2006 to March 2007. PARTICIPANTS 60 women interviewed six weeks after the birth at term of their first child. FINDINGS during the early postpartum period, interaction with caregivers was an important source of perceived stress. Upon returning home, the partner was considered as the primary source of social support, but the first need expressed was for material support. Breast feeding was perceived negatively by the new mothers, and this may be due to the difference between the actual problems encountered and the idealised expectations conveyed by prenatal information. Educational information dispensed by medical staff during the prenatal period was not put into practice during the postpartum period. Mothers expressed the need to be accompanied and counselled when problems arose and regretted the lack of long-term postpartum support. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE both the prenatal education and postpartum social support seem to mismatch women's needs and expectations. Concerted efforts are required by health professionals at the maternity unit and in the community to provide mothers with more adequate postpartum assistance.
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Affiliation(s)
- C Razurel
- Haute Ecole de Santé/Hautes Ecoles Spécialisées de Suisse Occidentale, 47 Avenue de Champel, Geneva, Switzerland.
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Laverriere A, Landau R, Charvet I, Irion O, Bischof P, Morales M, Cohen M. GRP78 as a marker of pre-eclampsia: an exploratory study. Mol Hum Reprod 2009; 15:569-74. [DOI: 10.1093/molehr/gap037] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Meyer-Monard S, Passweg J, Troeger C, Eberhard HP, Roosnek E, de Faveri GN, Chalandon Y, Rovo A, Kindler V, Irion O, Holzgreve W, Gratwohl A, Müller C, Tichelli A, Tiercy JM. Cord blood banks collect units with different HLA alleles and haplotypes to volunteer donor banks: a comparative report from Swiss Blood stem cells. Bone Marrow Transplant 2009; 43:771-8. [PMID: 19060930 DOI: 10.1038/bmt.2008.391] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 08/19/2008] [Accepted: 08/22/2008] [Indexed: 11/09/2022]
Abstract
Allogeneic haematopoietic SCT is a standard therapy for many patients with haematological diseases. A major aim of public umbilical cord blood (UCB) banking is to establish an inventory with a large HLA diversity. Few studies have compared HLA diversity between UCB banks and volunteer unrelated donor (VUD) registries and examined whether UCB banks indeed collect more units with rare alleles and haplotypes. This study compares HLA-A/B/DRB1 allele frequencies and inferred A/B/DRB1-haplotypes in 1602 UCB units and 3093 VUD from two centres in distinct recruitment areas in Switzerland. The results show that the frequencies of HLA-DRB1 alleles as well as of the HLA-A/B/DRB1 haplotypes differ between UCB and VUD. Ten DRB1 alleles occurred at a 2- to 12-fold higher relative frequency in UCB than in VUD and 27 rare alleles were identified in UCB. Out of these 27 alleles, 15 were absent in the entire VUD data set of the national registry. This difference in allele frequencies was found only by intermediate/high-resolution typing. Targeted recruitment of UCB units from non-Caucasian donors could further increase HLA allele and haplotype diversity of available donors. Intermediate or high-resolution DNA typing is essential to identify rare alleles or allele groups.
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Affiliation(s)
- S Meyer-Monard
- Division of Hematology, Basel Stem Cell Transplant Team, University Hospital Basel, Basel, Switzerland.
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Irion O, Delaloye JF. [Gynecologist, obstetrician, sub-specialist or technician? Gynecologist-obstetrician!]. Rev Med Suisse 2008; 4:2243. [PMID: 19025173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Abstract
BACKGROUND The matrix metalloproteinase (MMP) family is known to play a key role in tissue remodelling during embryonic development and in pathological conditions, such as cardiovascular disease, arthritis and cancer metastasis. It has been shown previously that p53 regulates positively or negatively the expression of different MMPs. Because of p53 overexpression in trophoblastic cells, and its potential role in regulating MMP-2 and MMP-9 expression in different cell lines, we hypothesized that the expression of MMP-9 could also be regulated by p53 in first trimester cytotrophoblasts (CTB). METHODS and RESULTS Transfection experiments in CTB demonstrated that wild-type p53 down-regulates the −670 (P < 0.001) but not the −531 and −90 human MMP-9 promoter/CAT reporter plasmid activity, whereas p53 mutants partially lost this repressive activity. However, endogenous p53 is not able to regulate MMP-9 expression in CTB. The presence of high molecular weight complexes of p53 in CTB suggests a potential mechanism of inactivation of p53 transcriptional activity towards MMPs in these cells. CONCLUSIONS Although p53 is mutated in trophoblast, it is functionally incompetent towards MMPs in these cells.
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Affiliation(s)
- M Cohen
- Department of Obstetrics and Gynaecology, Laboratory of Hormonology, University of Geneva, Geneva, Switzerland.
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36
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Abstract
BACKGROUND Prostaglandins have been used for cervical ripening and induction of labour since the 1970s. The goal of the administration of prostaglandins in the process of induction of labour is to achieve cervical ripening before the onset of contractions. One of the routes of administration that was proposed is intracervical. Using this route, prostaglandins are less easy to administer and the need for exposing the cervix may cause discomfort to the woman. OBJECTIVES To determine the effects of intracervical prostaglandins for third trimester cervical ripening or induction of labour compared with placebo/no treatment and with vaginal prostaglandins (except misoprostol). SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (August 2007) and bibliographies of relevant papers. SELECTION CRITERIA Clinical trials comparing intracervical prostaglandins used for third trimester cervical ripening or labour induction with placebo/no treatment or other methods listed above it on a predefined list of labour induction methods (vaginal prostaglandins, except misoprostol). DATA COLLECTION AND ANALYSIS A strategy was developed to deal with the large volume and complexity of trial data relating to labour induction. This involved a two-stage method of data extraction. MAIN RESULTS Fifty-six trials (7738 women) are included. INTRACERVICAL PGE2 WITH PLACEBO/NO TREATMENT: 28 TRIALS, 3764 WOMEN: Four studies reported the number of women who did not achieve vaginal delivery within 24 hours, showing a decreased risk with PGE2 (relative risk (RR) 0.61; 95% confidence interval (CI) 0.47 to 0.79). There was a small, and statistically non-significant, reduction of the risk of caesarean section when PGE2 was used (RR 0.88; 95% CI 0.77 to 1.00). The finding was statistically significant in a subgroup of women with intact membranes and unfavourable cervix only (RR 0.82; 95% CI 0.68 to 0.98). The risk of hyperstimulation with fetal heart rate (FHR) changes was not significantly increased (RR 1.21; 95% CI 0.72 to 2.05). However, the risk of hyperstimulation without FHR changes was significantly increased (RR 1.59; 95% CI 1.09 to 2.33. INTRACERVICAL PGE2 WITH INTRAVAGINAL PGE2: 29 TRIALS, 3881 WOMEN: The risk of not achieving vaginal delivery within 24 hours was increased with intracervical PGE2 (RR 1.26; 95% CI 1.12 to 1.41). There was no change in the risk of caesarean section (RR 1.07; 95% CI 0.93 to 1.22). The risks of hyperstimulation with FHR changes (RR 0.76; 95% CI 0.39 to 1.49) and without FHR changes (RR 0.80; 95% CI 0.56 to 1.15) were non-significantly different with the two methods of PGE2 administration. Only one trial with small sample size reported on women's views, with no difference between groups. INTRACERVICAL PGE2 LOW DOSE WITH INTRACERVICAL PGE2 HIGH DOSE: TWO TRIALS, 102 WOMEN: The trials are too small to provide any useful information. AUTHORS' CONCLUSIONS Intracervical prostaglandins are effective compared to placebo, but appear inferior when compared to intravaginal prostaglandins.
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Affiliation(s)
- M Boulvain
- Hôpitaux Universitaires de Genève, Unite de Developpement en Obstetrique, CH-1211, Genève 14, Switzerland.
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Petignat P, de Tejada MB, Irion O, Boulvain M. [What's new in gynecology and obstetrics?]. Rev Med Suisse 2008; 4:24-27. [PMID: 18251211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Among the improvements in gynecology reported in 2007, we highlight those in the field of cervical cancer. A randomized trial showed that HPV testing has higher sensitivity compared to the screening based on Papanicolaou smears. The recent availability of a HPV vaccine is also an important event. In obstetrics, the results of several trials evaluating the administration of progesterone to prevent preterm birth were published. The benefit of the administration of progesterone is still controversial. Prevention of early onset groupe B Streptococcus sepsis might be improved by rapid PCR testing during labor.
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Affiliation(s)
- P Petignat
- Unité d'oncogynécologie et sénologie chirurgicales, Service de gynécologie, Département de gynécologie et d'obstétrique, HUG, 1211 Genève
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Feki A, Faltin DL, Lei T, Dubuisson JB, Jacob S, Irion O. Sphincter incontinence: is regenerative medicine the best alternative to restore urinary or anal sphincter function? Int J Biochem Cell Biol 2006; 39:678-84. [PMID: 17208507 DOI: 10.1016/j.biocel.2006.11.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Revised: 10/25/2006] [Accepted: 11/01/2006] [Indexed: 12/16/2022]
Abstract
Incontinence is a major public health concern in aging societies. It is caused by age-dependent spontaneous apoptosis of muscle cells in the urinary and fecal sphincters, and is aggravated in women due to birth trauma. Compared to other currently employed invasive surgical management techniques associated with morbidity and recurrence, replacement or regeneration of dysfunctional sphincter through stem cell therapy and tissue engineering techniques hold great promise. This review focuses on the pathophysiological analysis of urinary incontinence and the possible application of muscle-derived-stem cells, satellite cells, chondrocytes and adipose-derived-stem cells in restoring sphincter functions.
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Affiliation(s)
- A Feki
- Embryonic Stem Cell Research Laboratory, Switzerland.
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39
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Martinez de Tejada B, Boulvain M, Dumps P, Bischof P, Meisser A, Irion O. Short communication: Can we improve the diagnosis of rupture of membranes? The value of insulin-like growth factor binding protein-1. BJOG 2006; 113:1096-9. [PMID: 16903843 DOI: 10.1111/j.1471-0528.2006.01028.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Our objective was to assess the value of insulin-like growth factor binding protein-1 (IGFBP-1) and other tests for the diagnosis of rupture of the membranes (ROM). We included 49 women with suspected ROM. The gold standard for membranes status was defined based on clinical examination, ultrasonography, tests results (except IGFBP-1) and labour information. Sensitivity, specificity, positive predictive value and negative predictive value of each test were as follows, respectively: IGFBP-1 (86, 74, 73 and 87%); bromothymol (64, 100, 100 and 77%); fern test (62, 96, 93 and 75%) and ultrasonography (19, 100, 100 and 61%). The detection of IGFBP-1 in vaginal secretions has high sensitivity for the diagnosis of ROM.
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Affiliation(s)
- B Martinez de Tejada
- Division of Obstetrics, Department of Obstetrics and Gynaecology, University Hospitals of Geneva, Geneva, Switzerland
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40
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Affiliation(s)
- E Antonelli
- Department of Obstetrics and Gynecology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
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41
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Jastrow N, Antonelli E, Robyr R, Irion O, Boulvain M. Inter- and intraobserver variability in sonographic measurement of the lower uterine segment after a previous Cesarean section. Ultrasound Obstet Gynecol 2006; 27:420-424. [PMID: 16526096 DOI: 10.1002/uog.2718] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To evaluate the reproducibility of sonographic measurement of the lower uterine segment in pregnant women at term. METHODS Two independent observers performed transabdominal sonography on 129 women between 36 and 38 weeks of gestation who had had a previous Cesarean section. Sonography was performed when the patients had a full and a half-full bladder; in 100 patients, the measurements were also performed transvaginally, with the patients having an empty bladder. Agreement was quantified by the intraclass correlation coefficient and, using a cut-off of 3.5 mm, by the kappa coefficient. RESULTS The intraobserver agreement was generally high (intraclass correlation coefficient > 0.90). The interobserver agreement was higher on transvaginal (intraclass correlation coefficient, 0.94) compared with transabdominal (0.70 and 0.84, with full and half-full bladder, respectively) ultrasound. The kappa coefficient was 0.75 transvaginally, compared with 0.34 and 0.54 using the transabdominal approach, with full and half-full bladder, respectively. CONCLUSION The agreement between two observers for sonographic transvaginal measurement of the lower uterine segment can be considered good, compared with poor to moderate agreement using the transabdominal approach.
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Affiliation(s)
- N Jastrow
- Obstetrics and Gynecology Department, University Hospital of Geneva, Switzerland.
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Irion O, Morales MA, Faltin D, Boulvain M. [The epidemic of cesarean sections: a necessary evil?]. Rev Med Suisse 2005; 1:2566-9. [PMID: 16353837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The proportion of cesarean deliveries has raised worldwide, to reach 29% in Switzerland, with important differences between public and private hospitals. There is no simple explanation to this. The emphasis on safety is no excuse, as cesarean sections have short and long-term risks. In this article, we try to understand the reason of this epidemic and we discuss the benefits and risks of cesarean section. This intervention should be performed for medical reasons only. Maternal demand is acceptable, only after a real informed consent. While simplification of surgical techniques and loco-regional anesthesia made cesarean safer, it should not become commonplace. To respect physiology is obstetrician's primary duty, corresponding to the wish of women. Hospitals and clinics have to publish their cesarean section rate.
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Affiliation(s)
- O Irion
- Service d'obstétrique HUG, 121 I Genève.
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Dällenbach P, Pelte MF, Irion O. Life-threatening third-trimester hemorrhage following a vanishing twin phenomenon in early pregnancy. Ultrasound Obstet Gynecol 2005; 26:196-7; discussion 197. [PMID: 15988734 DOI: 10.1002/uog.1946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Abstract
BACKGROUND D-dimer (DD) measurement has proved to be very useful to exclude venous thromboembolism (VTE) in outpatients. However, during pregnancy, the progressive increase as well as the interindividual variations of DD means that in this instance they are of poor value to rule out VTE. Only a few studies have reported measurements of DD levels in the postpartum. OBJECTIVES To measure DD sequentially in the puerperium in order to determine when DD levels return to values obtained in non-pregnant women and can again be used in the exclusion of VTE. PATIENTS AND METHODS After uncomplicated pregnancies, 150 women delivering at term either vaginally (n = 100) or by cesarean section (n = 50) were included. DD levels were measured immediately following delivery and next at days 1, 3, 10, 30 and 45. RESULTS There was a marked elevation of DD at delivery, especially when instrumental. All DD measurements were above 500 ng mL(-1) at delivery, at day 1 and at day 3 postpartum. A sharp decrease in DD was observed between day 1 and day 3, followed by a slight increase at day 10. At day 30 and day 45, respectively, 79% and 93% of women in the vaginal delivery group and 70% and 83% in the cesarean group had levels below 500 ng mL(-1). Bleeding, breastfeeding and heparin prophylaxis did not modify DD levels significantly. CONCLUSION Using the Vidas DD new assay, our study provides reference intervals for DD in the postpartum period. Using a cut-off at 500 ng mL(-1), DD measurement for ruling out VTE was found to be useful again 4 weeks after delivery.
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Affiliation(s)
- M Epiney
- Department of Obstetrics and Gynecology, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
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Boehlen F, Epiney M, Boulvain M, Irion O, de Moerloose P. [Changes in D-dimer levels during pregnancy and the postpartum period: results of two studies]. Rev Med Suisse 2005; 1:296-8. [PMID: 15771359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
In outpatients D-dimer (DD) measurement is included in most algorithms to exclude venous thromboembolism (VTE). We have recently performed two studies to evaluate the evolution of DD during pregnancy and the postpartum. During pregnancy, DD increase progressively and are of poor value to exclude VTE after 20 weeks of gestation. During labour, DD are usually very high and decrease quickly during the first 3 days post-delivery. Many weeks are necessary to obtain their normalisation and therefore their utility to rule out VTE is very limited until 4 weeks postpartum. This increase of DD values until 4 to 6 weeks after delivery correlates with the length of antithrombotic prophylaxis recommended for women at high risk of VTE.
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Affiliation(s)
- F Boehlen
- Unité d'hémostase, Service d'Angiologie et Hémostase.
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46
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Landau R, Irion O. [Recent data on the physiopathology of preeclampsia and recommendations for treatment]. Rev Med Suisse 2005; 1:290, 292-5. [PMID: 15771358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Maternal hypertension and proteinuria after 20 weeks gestation defines preeclampsia. Severe preeclampsia is defined by severe hypertension or massive proteinuria, with or without symptoms or altered laboratory tests. With an incidence of 4-7%, preeclampsia remains a major cause of maternal and neonatal morbidity and mortality. Admission into a hospital is crucial to monitor both mother and fetus. The only treatment is delivery. Management of blood pressure and prevention of eclampsia with magnesium sulfate is indicated in severe preeclampsia. Despite numerous studies attempting to elucidate the exact etiopathogenesis of this complex multifactorial disease, prediction or prevention of preeclampsia is not available. Preeclampsia has been named the "disease of theories" and remains to date a challenging enigma for the scientific community.
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Affiliation(s)
- R Landau
- Service d'Anesthésiologie, Département APSIC, HUG, 1211 Genève 4.
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Abstract
BACKGROUND Sweeping of the membranes, also named stripping of the membranes, is a relatively simple technique usually performed without admission to hospital. During vaginal examination, the clinician's finger is introduced into the cervical os. Then, the inferior pole of the membranes is detached from the lower uterine segment by a circular movement of the examining finger. This intervention has the potential to initiate labour by increasing local production of prostaglandins and, thus, reduce pregnancy duration or pre-empt formal induction of labour with either oxytocin, prostaglandins or amniotomy. This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology. OBJECTIVES To determine the effects of membrane sweeping for third trimester induction of labour. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group trials register (6 July 2004) and bibliographies of relevant papers. SELECTION CRITERIA Clinical trials comparing membrane sweeping used for third trimester cervical ripening or labour induction with placebo/no treatment or other methods listed above it on a predefined list of labour induction methods. DATA COLLECTION AND ANALYSIS A strategy was developed to deal with the large volume and complexity of trial data relating to labour induction. This involved a two-stage method of data extraction. MAIN RESULTS Twenty-two trials (2797 women) were included, 20 comparing sweeping of membranes with no treatment, three comparing sweeping with prostaglandins and one comparing sweeping with oxytocin (two studies reported more than one comparison). Risk of caesarean section was similar between groups (relative risk (RR) 0.90, 95% confidence interval (CI) 0.70 to 1.15). Sweeping of the membranes, performed as a general policy in women at term, was associated with reduced duration of pregnancy and reduced frequency of pregnancy continuing beyond 41 weeks (RR 0.59, 95% CI 0.46 to 0.74) and 42 weeks (RR 0.28, 95% CI 0.15 to 0.50). To avoid one formal induction of labour, sweeping of membranes must be performed in eight women (NNT = 8). There was no evidence of a difference in the risk of maternal or neonatal infection. Discomfort during vaginal examination and other adverse effects (bleeding, irregular contractions) were more frequently reported by women allocated to sweeping. Studies comparing sweeping with prostaglandin administration are of limited sample size and do not provide evidence of benefit. AUTHORS' CONCLUSIONS Routine use of sweeping of membranes from 38 weeks of pregnancy onwards does not seem to produce clinically important benefits. When used as a means for induction of labour, the reduction in the use of more formal methods of induction needs to be balanced against women's discomfort and other adverse effects.
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Affiliation(s)
- M Boulvain
- Unité de Développement en Obstétrique, Maternité Hôpitaux Universitaires de Genève, Département de Gynécologie et d'Obstétrique, Boulevard de la Cluse, 32, Geneva 14, Switzerland, CH-1211.
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Antonelli E, Robyr-Susini R, Gucciardo L, Boulvain M, Irion O. [Gynaecology-obstetrics. Invasive prenatal diagnosis and in utero surgical treatments: what is new?]. Rev Med Suisse 2005; 1:31-4. [PMID: 15773195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Early ultrasonographic antenatal diagnosis permits to perform intrauterine treatment to improve the prognosis of the fetus. These interventions are, however, invasive and associated with risks. In 2004, the results of the randomized trial comparing treatment options in the case of twin-to-twin transfusion syndrome were published. We summarize in this article the current knowledge on invasive fetal therapy.
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Affiliation(s)
- E Antonelli
- Unité de médecine foetale et d'échographie, Service d'obstétrique, Département de gynécologie et d'obstétrique, Hôpitaux universitaires de Genève, 1211 Genève 14.
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Stan C, Megevand E, Irion O, Wang C, Bruchim I, Petignat P. Cervical cancer in pregnant women: laparoscopic evaluation before delaying treatment. EUR J GYNAECOL ONCOL 2005; 26:649-50. [PMID: 16398229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Cervical carcinoma diagnosed during pregnancy generates conflicting concerns between control of malignancy and continuation of pregnancy. CASE An invasive cervical carcinoma FIGO Stage IB2 was diagnosed in a 33-year-old primigravida during the first trimester of pregnancy. Because the patient strongly desired to preserve her pregnancy, laparoscopic lymphadenectomy was performed at 16 weeks of gestation to determine the extension of disease. Negative lymph node status was found and the patient was counseled about the possibility of proceeding until adequate fetal maturity had been achieved. An elective cesarean section and radical hysterectomy were performed at 36 weeks, followed by postoperative chemoradiation therapy. The clinical and Pap smear follow-up remain normal after four years. CONCLUSION Pregnant women diagnosed with early stage cervical carcinoma should receive a complete evaluation including lymphadenectomy before considering delayed therapy. This strategy seems to be an acceptable option in well-defined conditions, and offers these patients the possibility of maternity.
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Affiliation(s)
- C Stan
- Gynecologic Oncology and Senology Service, University Hospitals of Geneva, Switzerland
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Faltin DL, Boulvain M, Stan C, Epiney M, Weil A, Irion O. Intraobserver and interobserver agreement in the diagnosis of anal sphincter tears by postpartum endosonography. Ultrasound Obstet Gynecol 2003; 21:375-377. [PMID: 12704747 DOI: 10.1002/uog.86] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To evaluate intraobserver and interobserver agreement in the diagnosis of anal sphincter tears by endosonography when performed immediately postpartum by resident obstetricians. METHODS Fifty-four primiparous women who delivered vaginally and had no anal sphincter tears (third- or fourth-degree perineal tears) diagnosed clinically were recruited. Four observers assessed photographic prints and video recordings of anal endosonography performed before the suture of the perineum. We calculated the intra- and interobserver agreement and the kappa coefficient to quantify the reliability of the diagnosis of clinically occult sphincter tears. RESULTS The observers described sphincter tears in 13-28% of the prints, and in 7-32% of the video recordings. Intraobserver agreement was rated as substantial for prints (kappa, 0.63), and moderate for video recordings (kappa, 0.48). The interobserver agreement was fair for prints (kappa, 0.34) and moderate for video recordings (kappa, 0.42). CONCLUSION Endosonography performed immediately postpartum to diagnose anal sphincter tears is of moderate reliability.
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Affiliation(s)
- D L Faltin
- Department of Obstetrics and Gynaecology, University Hospitals of Geneva, Geneva, Switzerland.
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