[Impact of a service protocol on the practice of vaginal delivery of breech presentations at term]

OBJECTIVES

The delivery of breech presentations remains controversial. Our study analysed the impact of a service protocol on the proportion of planned vaginal delivery and its success. Immediate neonatal morbidity and factors that may influence the success of vaginal delivery were studied.

METHODS

Retrospective study, between 2009 and 2020 at the CHRU of Limoges, type 3 maternity hospital, on patients with a breech foetus at term. The proportion of planned vaginal delivery and the rate of effective vaginal delivery were compared before/after 2015. Neonatal morbidity was compared for planned vaginal delivery and planned cesarean delivery groups.

RESULTS

We included 923 patients. The rate of planned vaginal delivery was significantly higher after 2015 from 5.2% to 19% (P<0.001), with a success rate increasing from 60% to 82.1% (P=0.06). The rate of vaginal breech deliveries significantly increased from 3.8% to 17% (P<0.001). We found significantly more newborns with moderate acidosis when a vaginal delivery was attempted (P<0.001). The success of vaginal delivery was correlated to the Magnin index (P=0.044), to gestational age (P=0.037), and to multiparity (OR 3.78 95% CI [1.42-10.03] P=0.006).

CONCLUSION

Our study demonstrates the benefits of setting up a service protocol for the practice of breech vaginal delivery.

[Cervical ripening after previous cesarean section with dinoprostone vaginal insert]

OBJECTIVES

Because, to date in France, 20 % of pregnant women had a scared uterus and because the best mean of cervical ripening is unknown and controversial, we want to evaluate efficacy and safety of dinoprostone for cervical ripening in women with previous cesarean.

MATERIALS AND METHODS

We conducted a retrospective unicentric study, from 2010 to 2014, at Limoges regional university hospitals. Two hundred and sixty nine patients, with medical indication for induction of labor and scared uterus, were included and ripened with dinoprostone (Propess^® and/or Prostine^®). Women had unfavorable cervix with Bishop score inferior to 6.

RESULTS

Overall rate of vaginal delivery was 62 %. Patients have had more of one prostaglandin in 19 % of cases; the cesarean rate was significantly higher in this case (cesarean: 55.6 % vs. vaginal delivery: 44.4 %; P=0.0043). Overall, there were respectively 4 % and 0.7 % of post-partum hemorrhage and uterine rupture. One percent of newborns had a severe acidosis (pH<7 in umbilical artery) and 1 % was admitted to the Intensive Neonatal Care Unit.

CONCLUSION

Dinoprostone is an effective procedure in patients with previous cesarean section requiring labor induction, with a morbidity comparable to other methods of induction of labor.

Chemical constituents, antifungal and antioxidative effects of ajwain essential oil and its acetone extract

GC and GC-MS analysis of ajwain essential oil showed the presence of 26 identified components which account for 96.3% of the total amount. Thymol (39.1%) was found as a major component along with p-cymene (30.8%), gamma-terpinene (23.2%), beta-pinene (1.7%), terpinene-4-ol (0.8%) whereas acetone extract of ajwain showed the presence of 18 identified components which account for 68.8% of the total amount. The major component was thymol (39.1%) followed by oleic acid (10.4%), linoleic acid (9.6%), gamma-terpinene (2.6%), p-cymene (1.6%), palmitic acid (1.6%), and xylene (0.1%). Moreover, the oil exhibited a broad spectrum of fungitoxic behavior against all tested fungi such as Aspergillus niger, Aspergillus flavus, Aspergillus oryzae, Aspergillus ochraceus, Fusarium monoliforme, Fusarium graminearum, Pencillium citrium, Penicillium viridicatum, Pencillium madriti, and Curvularia lunata as absolute mycelial zone inhibition was obtained at a 6-microL dose of the oil. However, the acetone extract showed better antioxidative activity for linseed oil as compared with synthetic antioxidants such as butylated hydroxyl toluene and butylated hydroxyl anisole.