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Moser L, Vouga M, Benkortbi K, Boussac E, Cuenoud A, Sichitiu J, Desseauve D. Optimizing blood conservation in caesarean sections: Intravaginal tamponade technique for abnormal placentae insertion. Eur J Obstet Gynecol Reprod Biol X 2024; 21:100282. [PMID: 38304276 PMCID: PMC10830511 DOI: 10.1016/j.eurox.2024.100282] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 12/28/2023] [Accepted: 01/12/2024] [Indexed: 02/03/2024] Open
Affiliation(s)
- Laureline Moser
- Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Manon Vouga
- Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Khadidja Benkortbi
- Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Emilie Boussac
- Anesthesiology Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alexia Cuenoud
- Anesthesiology Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Joanna Sichitiu
- Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - David Desseauve
- Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Hêches J, Marcadent S, Fernandez A, Adjahou S, Meuwly JY, Thiran JP, Desseauve D, Favre J. Accuracy and Reliability of Pelvimetry Measures Obtained by Manual or Automatic Labeling of Three-Dimensional Pelvic Models. J Clin Med 2024; 13:689. [PMID: 38337383 PMCID: PMC10856490 DOI: 10.3390/jcm13030689] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: The morphology of the pelvic cavity is important for decision-making in obstetrics. This study aimed to estimate the accuracy and reliability of pelvimetry measures obtained when radiologists manually label anatomical landmarks on three-dimensional (3D) pelvic models. A second objective was to design an automatic labeling method. (2) Methods: Three operators segmented 10 computed tomography scans each. Three radiologists then labeled 12 anatomical landmarks on the pelvic models, which allowed for the calculation of 15 pelvimetry measures. Additionally, an automatic labeling method was developed based on a reference pelvic model, including reference anatomical landmarks, matching the individual pelvic models. (3) Results: Heterogeneity among landmarks in radiologists' labeling accuracy was observed, with some landmarks being rarely mislabeled by more than 4 mm and others being frequently mislabeled by 10 mm or more. The propagation to the pelvimetry measures was limited; only one out of the 15 measures reported a median error above 5 mm or 5°, and all measures showed moderate to excellent inter-radiologist reliability. The automatic method outperformed manual labeling. (4) Conclusions: This study confirmed the suitability of pelvimetry measures based on manual labeling of 3D pelvic models. Automatic labeling offers promising perspectives to decrease the demand on radiologists, standardize the labeling, and describe the pelvic cavity in more detail.
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Affiliation(s)
- Johann Hêches
- Swiss BioMotion Lab, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), CH-1011 Lausanne, Switzerland;
| | - Sandra Marcadent
- Signal Processing Laboratory 5, École Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland; (S.M.); (J.-P.T.)
| | - Anna Fernandez
- Women-Mother-Child Department, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), CH-1011 Lausanne, Switzerland; (A.F.); (S.A.); (D.D.)
| | - Stephen Adjahou
- Women-Mother-Child Department, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), CH-1011 Lausanne, Switzerland; (A.F.); (S.A.); (D.D.)
| | - Jean-Yves Meuwly
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), CH-1011 Lausanne, Switzerland;
| | - Jean-Philippe Thiran
- Signal Processing Laboratory 5, École Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland; (S.M.); (J.-P.T.)
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), CH-1011 Lausanne, Switzerland;
| | - David Desseauve
- Women-Mother-Child Department, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), CH-1011 Lausanne, Switzerland; (A.F.); (S.A.); (D.D.)
| | - Julien Favre
- Swiss BioMotion Lab, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), CH-1011 Lausanne, Switzerland;
- The Sense Innovation and Research Center, CH-1007 Lausanne, Switzerland
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Frémondière P, Thollon L, Marchal F, Desseauve D. The impact of femoral rotation on sacroiliac articulation during pregnancy. Is there evidence to support Farabeuf's hypothesis by finite element modelization? Eur J Obstet Gynecol Reprod Biol 2023; 290:78-84. [PMID: 37738891 DOI: 10.1016/j.ejogrb.2023.08.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Counter-nutation movement is deemed crucial during the management of the birth process. It is a combination of lateral ilia expansion and backward displacement of the promontory resulting from the external rotations of the femurs producing an enlargement of the pelvic inlet. However, since its description by Farabeuf, this mechanism has never been challenged and analyzed in a dynamic finite element study. METHODS Based on a female pelvic mesh and sacroiliac ligaments, we simulated external rotations of both femurs with imposed rotation of the two acetabulum centers. We hypothesize that lateral ilia expansion generates a sacrum movement resulting in a backward displacement of the promontory and a pelvic inlet enlargement. RESULTS Finite element simulation confirms our hypothesis and reveals that ilio-sacro-transverse and axile ligaments play an essential role in this mechanism. Indeed, the increase in stiffness (ranging from 500 MPa to 750 MPa) of these ligaments accentuates the counter-nutation movement and the opening of the inlet. Instead of the anatomic congruence between the ilium and the sacrum, the sacroiliac ligaments may explain the counter-nutation. After a 6° of femur rotation, the inlet area increases to 11 cm2 (141 cm2 vs. 130 cm2). This enlargement could be noteworthy in case of obstructed labor or shoulder dystocia. Moreover, the association between external rotation and flexion of the femurs could be more efficient for opening the pelvic inlet. CONCLUSIONS Our result did not support the original assumption of Farabeuf. By revealing how postural adjustment increases the bony birth canal, this study provides essential information for the clinical management of the delivery.
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Affiliation(s)
- Pierre Frémondière
- Aix Marseille Univ, CNRS, EFS, ADES, 51 boulevard Pierre Dramard, 13344 Marseille cedex 15, France; Aix Marseille Univ, School of Midwifery, Faculty of Medical and Paramedical Sciences, 51 boulevard Pierre Dramard, 13344 Marseille cedex 15, France.
| | - Lionel Thollon
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, 51 boulevard Pierre Dramard, 13344 Marseille cedex 15, France
| | - François Marchal
- Aix Marseille Univ, CNRS, EFS, ADES, 51 boulevard Pierre Dramard, 13344 Marseille cedex 15, France
| | - David Desseauve
- Department of Women-Mother-Child, Gynecology and Obstetrics Unit, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Gynecology and Obstetrics Unit, Hôpital de la Croix-Rousse 103 Grande rue de la Croix-Rousse, 69004 Lyon, France.
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Deforges C, Sandoz V, Noël Y, Avignon V, Desseauve D, Bourdin J, Vial Y, Ayers S, Holmes EA, Epiney M, Horsch A. Single-session visuospatial task procedure to prevent childbirth-related posttraumatic stress disorder: a multicentre double-blind randomised controlled trial. Mol Psychiatry 2023; 28:3842-3850. [PMID: 37759037 PMCID: PMC10730415 DOI: 10.1038/s41380-023-02275-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/10/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
Preventive evidence-based interventions for childbirth-related posttraumatic stress disorder (CB-PTSD) are lacking. Yet, 18.5% of women develop CB-PTSD symptoms following an unplanned caesarean section (UCS). This two-arm, multicentre, double-blind superiority trial tested the efficacy of an early single-session intervention including a visuospatial task on the prevention of maternal CB-PTSD symptoms. The intervention was delivered by trained maternity clinicians. Shortly after UCS, women were included if they gave birth to a live baby, provided consent, and perceived their childbirth as traumatic. Participants were randomly assigned to the intervention or attention-placebo group (allocation ratio 1:1). Assessments were done at birth, six weeks, and six months postpartum. Group differences in maternal CB-PTSD symptoms at six weeks (primary outcomes) and six months postpartum (secondary outcomes) were assessed with the self-report PTSD Checklist for DSM-5 (PCL-5) and by blinded research assessors with the Clinician-administered PTSD scale for DSM-5 (CAPS-5). Analysis was by intention-to-treat. The trial was prospectively registered (ClinicalTrials.gov, NCT03576586). Of the 2068 women assessed for eligibility, 166 were eligible and 146 were randomly assigned to the intervention (n = 74) or attention-placebo control group (n = 72). For the PCL-5, at six weeks, a marginally significant intervention effect was found on the total PCL-5 PTSD symptom count (β = -0.43, S.E. = 0.23, z = -1.88, p < 0.06), and on the intrusions (β = -0.73, S.E. = 0.38, z = -1.94, p < 0.0525) and arousal (β = -0.55, S.E. = 0.29, z = -1.92, p < 0.0552) clusters. At six months, a significant intervention effect on the total PCL-5 PTSD symptom count (β = -0.65, S.E. = 0.32, z = -2.04, p = 0.041, 95%CI[-1.27, -0.03]), on alterations in cognition and mood (β = -0.85, S.E. = 0.27, z = -3.15, p = 0.0016) and arousal (β = -0.56, S.E. = 0.26, z = -2.19, p < 0.0289, 95%CI[-1.07, -0.06]) clusters appeared. No group differences on the CAPS-5 emerged. Results provide evidence that this brief, single-session intervention carried out by trained clinicians can prevent the development of CB-PTSD symptoms up to six months postpartum.
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Affiliation(s)
- Camille Deforges
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Vaud, Switzerland
| | - Vania Sandoz
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Vaud, Switzerland
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Yvonnick Noël
- Department of Psychology, Rennes 2 University, Rennes, France
| | - Valérie Avignon
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Vaud, Switzerland
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - David Desseauve
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Julie Bourdin
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Yvan Vial
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Susan Ayers
- Centre for Maternal and Child Health Research, City, University of London, London, UK
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Manuella Epiney
- Department of Woman, Child and Teenager, Geneva University Hospitals, Geneva, Switzerland
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Vaud, Switzerland.
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Vaud, Switzerland.
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Braggion A, Favre G, Lepigeon K, Sichitiu J, Baud D, Desseauve D. Advanced Maternal Age Among Nulliparous at Term and Risk of Unscheduled Cesarean Delivery. Am J Obstet Gynecol MFM 2023; 5:100972. [PMID: 37062508 DOI: 10.1016/j.ajogmf.2023.100972] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/05/2023] [Accepted: 04/09/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND With the rise in the number of women giving birth at an advanced age, the association between advanced maternal age and adverse obstetrical outcomes is a growing concern in developed countries. Despite the well-established link between advanced maternal age and pregnancy-related complications, there has been limited research examining the specific risks related to unscheduled cesarean delivery in nulliparas at term. OBJECTIVE This study aimed to evaluate the risks associated with unscheduled cesarean delivery in nulliparas at ≥37 weeks of gestation, comparing the outcomes of younger patients with those aged ≥40 years. STUDY DESIGN This retrospective cohort study was conducted in a tertiary maternity hospital in Switzerland (high-income country). The study included nulliparas who delivered a live-born infant at ≥37 weeks between January 2015 and December 2019. We excluded pregnant women who had a planned cesarean delivery, were aged <18 years, multiparous, delivered before 37 weeks of gestation, or had pregnancies that ended in stillbirth. Participants were divided into 2 age groups: (1) ≥40 years and (2) <40 years. The primary outcome was the incidence of unscheduled cesarean delivery. Its association with advanced maternal age was evaluated after adjusting for confounding factors by multivariate logistic regression, expressed as an adjusted odds ratio. Secondary outcomes included pregnancy outcomes and neonatal outcomes. RESULTS A total of 5211 patients were included: 173 in the ≥40-years (advanced maternal age) group and 5038 in the <40-years (non-advanced maternal age) group; 26.01% (95% confidence interval, 19.65-33.22; n=45) of women in the advanced maternal age group had an unscheduled cesarean delivery, whereas 15.26% (95% confidence interval, 14.28-16.29; n=769) of women in the non-advanced maternal age group underwent the procedure. Advanced maternal age was associated with unscheduled cesarean delivery, with an adjusted odds ratio of 1.51 (95% confidence interval, 1.06-2.17; P=.024). Among vaginal deliveries, assisted procedures were performed on 29.7% (95% confidence interval, 21.9-38.4; n=38) of advanced maternal age patients vs 20.1% (95% confidence interval, 18.9-21.3; n=856) of non-advanced maternal age patients. Postpartum blood loss >1000 mL occurred in 5.8% (95% confidence interval, 2.8-10.4; n=10) of advanced maternal age patients and 3.1% (95% confidence interval, 2.6-3.6; n=156) of non-advanced maternal age patients. CONCLUSION Advanced maternal age is associated with increased risk of unscheduled cesarean delivery among nulliparas. This provides healthcare professionals with confirmation that advanced age may represent an individual risk factor, suggesting that nulliparous patients aged over 40 years may benefit from improved information regarding the factors contributing to this pregnancy outcome.
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Affiliation(s)
- Axelle Braggion
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Guillaume Favre
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.
| | - Karine Lepigeon
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Joanna Sichitiu
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - David Baud
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - David Desseauve
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
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Corbaz F, Boussac E, Lepigeon K, Gomes Dias D, Marcadent S, Desseauve D, Horsch A. 'connEcted caesarean section': creating a virtual link between MOthers and their infanTs to ImprOve maternal childbirth experieNce - study protocol for a PILOT trial (e-motion-pilot). BMJ Open 2023; 13:e065830. [PMID: 37286319 DOI: 10.1136/bmjopen-2022-065830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION One-third of mothers rate their childbirth as traumatic. The prevalence of childbirth-related post-traumatic stress disorder (CB-PTSD) is 4.7%. Skin-to-skin contact is a protective factor against CB-PTSD. However, during a caesarean section (CS), skin-to-skin contact is not always feasible and mothers and infants are often separated. In those cases, there is no validated and available solution to substitute this unique protective factor. Based on the results of studies using virtual reality and head-mounted displays (HMDs) and studies on childbirth experience, we hypothesise that enabling the mother to have a visual and auditory contact with her baby could improve her childbirth experience while she and her baby are separated. To facilitate this connection, we will use a two-dimensional 360° camera filming the baby linked securely to an HMD that the mother can wear during the end of the surgery. METHODS AND ANALYSIS This study protocol describes a monocentric open-label controlled pilot trial with minimal risk testing the effects of a visual and auditory contact via an HMD worn by the mother airing a live video of her newborn compared with treatment-as-usual in 70 women after CS. The first 35 consecutive participants will be the control group and will receive the standard care. The next 35 consecutive participants will have the intervention. The primary outcome will be differences in maternal childbirth experience (Childbirth Experience Questionnaire 2) at 1-week postpartum between the intervention and control groups. Secondary outcomes will be CB-PTSD symptoms, birth satisfaction, mother-infant bonding, perceived pain and stress during childbirth, maternal anxiety and depression symptoms, anaesthesiological data and acceptability of the procedure. ETHICS AND DISSEMINATION Ethics approval was granted by the Human Research Ethics Committee of the Canton de Vaud (study number 2022-00215). Dissemination of results will occur via national and international conferences, peer-reviewed journals, public conferences and social media. TRIAL REGISTRATION NUMBER NCT05319665.
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Affiliation(s)
- Fiona Corbaz
- Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Emilie Boussac
- Anesthesiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Karine Lepigeon
- Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Diana Gomes Dias
- Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | | | - David Desseauve
- Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Antje Horsch
- Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
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Vakilzadeh N, Legardeur H, Desseauve D, Phan O. [Pregnancy and chronic renal failure: what is new in 2023?]. Rev Med Suisse 2023; 19:401-405. [PMID: 36876389 DOI: 10.53738/revmed.2023.19.816.401] [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] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Chronic renal failure (CRF) during pregnancy increases the risk of fetomaternal complications such as preeclampsia, premature delivery and, above all, a deterioration of renal function. A multidisciplinary preconceptional assessment is necessary in this complex clinical situation. Progress in neonatal resuscitation and a better understanding of the pathophysiological mechanisms of autoimmune nephropathy have improved the prognosis of these high-risk pregnancies. This article provides an overview of the issues related to the follow-up of pregnant women with renal disease. It summarizes the glomerular and hemodynamic physiological changes during pregnancy, the fetal and maternal risk, and the adaptation of antihypertensive and immunosuppressive drug treatments.
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Affiliation(s)
- Nima Vakilzadeh
- Service de néphrologie et d'hypertension, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Hélène Legardeur
- Service de gynécologie et d'obstétrique, Département femme-mère-enfant, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - David Desseauve
- Service de gynécologie et d'obstétrique, Département femme-mère-enfant, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Olivier Phan
- Service de néphrologie et d'hypertension, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
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8
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Fakhouri F, Schwotzer N, Cabiddu G, Barratt J, Legardeur H, Garovic V, Orozco-Guillen A, Wetzels J, Daugas E, Moroni G, Noris M, Audard V, Praga M, Llurba E, Wuerzner G, Attini R, Desseauve D, Zakharova E, Luders C, Wiles K, Leone F, Jesudason S, Costedoat-Chalumeau N, Kattah A, Soto-Abraham V, Karras A, Prakash J, Lightstone L, Ronco P, Ponticelli C, Appel G, Remuzzi G, Tsatsaris V, Piccoli GB. Glomerular diseases in pregnancy: pragmatic recommendations for clinical management. Kidney Int 2023; 103:264-281. [PMID: 36481180 DOI: 10.1016/j.kint.2022.10.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/10/2022] [Accepted: 10/18/2022] [Indexed: 12/12/2022]
Abstract
Our understanding of the various aspects of pregnancy in women with kidney diseases has significantly improved in the last decades. Nevertheless, little is known about specific kidney diseases. Glomerular diseases are not only a frequent cause of chronic kidney disease in young women, but combine many challenges in pregnancy: immunologic diseases, hypertension, proteinuria, and kidney tissue damage. An international working group undertook the review of available current literature and elicited expert opinions on glomerular diseases in pregnancy with the aim to provide pragmatic information for nephrologists according to the present state-of-the-art knowledge. This work also highlights areas of clinical uncertainty and emphasizes the need for further collaborative studies to improve maternal and fetal health.
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Affiliation(s)
- Fadi Fakhouri
- Service de Néphrologie et d'Hypertension, Département de Médecine, Centre Hospitalier Universitaire Vaudois, and Université de Lausanne, Lausanne, Switzerland.
| | - Nora Schwotzer
- Service de Néphrologie et d'Hypertension, Département de Médecine, Centre Hospitalier Universitaire Vaudois, and Université de Lausanne, Lausanne, Switzerland
| | - Gianfranca Cabiddu
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy; Department of Nephrology, San Michele Hospital, ARNAS G. Brotzu, Cagliari, Italy
| | - Jonathan Barratt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Hélène Legardeur
- Gynaecology, Woman Mother Child Department of the Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Vesna Garovic
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA; Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Alejandra Orozco-Guillen
- National Institute of Perinatology Isidro Espinosa de los Reyes (INPER), Department of Nephrology, Ciudad de Mexico, Mexico
| | - Jack Wetzels
- Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Eric Daugas
- Service de Néphrologie, Hôpital Bichat and Université Paris Cité, Paris, France; Institut national de la santé et de la recherche médicale Inserm U1149, Paris, France
| | - Gabriella Moroni
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Nephrology and Dialysis Division, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Marina Noris
- Istituto di Ricerche Farmacologiche Mario Negri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Laboratory of Immunology and Genetics of Rare Diseases, Bergamo, Italy
| | - Vincent Audard
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France; Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire « Innovative therapy for immune disorders », Créteil, France
| | - Manuel Praga
- Department of Nephrology, Hospital Universitario 12 de Octubre, Complutense University Madrid, Madrid, Spain
| | - Elisa Llurba
- Department of Obstetrics and Gynaecology, Institut d'Investigació Biomèdica Sant Pau - IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Madrid, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), Instituto de Salud Carlos III, Madrid, Spain
| | - Grégoire Wuerzner
- Service de Néphrologie et d'Hypertension, Département de Médecine, Centre Hospitalier Universitaire Vaudois, and Université de Lausanne, Lausanne, Switzerland
| | - Rossella Attini
- Department of Obstetrics and Gynecology, University of Turin, Città della Salute e della Scienza, Sant'Anna Hospital, Turin, Italy
| | - David Desseauve
- Gynaecology, Woman Mother Child Department of the Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. Sergey Petrovich Botkin, Moscow, Russian Federation; Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
| | - Claudio Luders
- Centro de Nefrologia e Dialise, Hospital Sirio-Libanes, São Paulo, Brazil
| | - Kate Wiles
- Department of Women's Health, Barts Health NHS Trust, London, UK
| | - Filomena Leone
- Clinical Nutrition Unit, S. Anna Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Shilpanjali Jesudason
- Central Northern Adelaide Renal and Transplantation Service (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Nathalie Costedoat-Chalumeau
- Centre de Référence Maladies Auto-Immunes et Systémiques Rares de l'île de France, Cochin Hospital, Université Paris Cité, Paris, France; Unité de l'Institut national de la santé et de la recherche médicale (INSERM) Unité 1153, Center for Epidemiology and Statistics (CRESS), Paris, France
| | - Andrea Kattah
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Virgilia Soto-Abraham
- Pathology Department, Hospital General de México Dr Eduardo Liceaga, México City, México
| | - Alexandre Karras
- Paris University, Paris, France; Renal Division, Georges Pompidou European Hospital, Paris, France
| | - Jai Prakash
- Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Liz Lightstone
- Imperial Lupus Centre, Department of Medicine, Imperial College London, London, UK; Section of Renal Medicine and Vascular Inflammation, Department of Medicine, Imperial College London, London, UK
| | - Pierre Ronco
- Sorbonne Université, and Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S1155, Paris, France; Department of Nephrology, Centre Hospitalier du Mans, Le Mans, France
| | | | - Gerald Appel
- Division of Nephrology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, New York, USA
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Laboratory of Immunology and Genetics of Rare Diseases, Bergamo, Italy
| | - Vassilis Tsatsaris
- Maternité Port-Royal, Fédération Hospitalo-Universitaire Prématurité (FHU PREMA), Assistance Publique des Hôpitaux de Paris AP-HP, Hôpital Cochin, AP-HP, Paris, France; Centre-Université de Paris, Université de Paris, Paris, France
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9
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Farin A, Ceccaldi PF, Tapie L, Derisbourg S, Desseauve D, Daelemans C. Training for breech deliveries with the mother in an upright position: An innovative adaptation of a simulation model. Eur J Obstet Gynecol Reprod Biol 2023; 280:108-111. [PMID: 36446258 DOI: 10.1016/j.ejogrb.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Delivery of a breech baby with the mother in an upright position or on all fours has gained a renewed interest. In these positions, the obstetrician or midwife needs to learn new landmarks and maneuvers. A realistic simulation model would be a valuable adjunct for breech on all fours teaching programs. MATERIAL AND METHODS This article describes the simulation model and training program we have developed to train an interprofessional team to assist breech births when the mother is on all fours. A questionnaire was used to evaluate the realism of the adapted mannequin and the impact of training on the confidence level of the participants. RESULTS On a Likert scale of 1 to 5, 92% of participants agreed or strongly agreed that the adapted mannequin used was realistic for training obstetric maneuvers for complicated breech births. After training, their confidence level supporting a breech birth in an upright position rose from an average of 2.5 to 5.7 on a scale of 1 to 10. CONCLUSION Learning the skills for breech deliveries on all fours is made possible by targeted training with this adapted simulation model.
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Affiliation(s)
- Alexandre Farin
- Obstetrics Unit, Hôpital Riviera-Chablais, Rennaz, Switzerland
| | - Pierre-François Ceccaldi
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Hôpital Foch, 92150 Suresnes, France; Innovative Materials and Interfaces Research Unit, (URB2i - EA 4462), Faculty of Health, University of Paris, University of Sorbonne Paris Nord, 93430 Villetaneuse, France; Center of Simulation iLumens, Paris, Diderot-Paris Nord, Faculty of Health, University of Paris, Paris, France
| | - Laurent Tapie
- Innovative Materials and Interfaces Research Unit, (URB2i - EA 4462), Faculty of Health, University of Paris, University of Sorbonne Paris Nord, 93430 Villetaneuse, France
| | - Sara Derisbourg
- Obstetrics Unit, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - David Desseauve
- Departement of Woman, Mother and Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Caroline Daelemans
- Department of Women, Children and Adolescents, Geneva University Hospitals, Geneva, Switzerland.
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10
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Marcadent S, Heches J, Favre J, Desseauve D, Thiran JP. 3-D Freehand Ultrasound Calibration Using a Tissue-Mimicking Phantom With Parallel Wires. Ultrasound Med Biol 2023; 49:165-177. [PMID: 36257837 DOI: 10.1016/j.ultrasmedbio.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/18/2022] [Accepted: 08/14/2022] [Indexed: 06/16/2023]
Abstract
This article describes a method used to calibrate 3-D freehand ultrasound systems based on phantoms with parallel wires forming two perpendicular planes, such as the usual general-purpose commercial phantoms. In our algorithm, the phantom pose is co-optimized with the calibration to avoid the need to precisely track the phantom. We provide a geometrical analysis to explain the proposed acquisition protocol. Finally, we give an estimate of the system accuracy and precision based on measurements acquired on an independent test phantom. We obtained error norms of 1.6 mm up to 6 cm of depth and 3.5 mm between 6 and 14 cm of depth, in total average. In conclusion, it is possible to calibrate ultrasound tracked-probe systems with a reasonable accuracy based on a general-purpose phantom. Contrarily to most calibration methods that imply the construction of the phantom, the present algorithm is based on a standard phantom geometry that is commercially available.
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Affiliation(s)
- Sandra Marcadent
- Swiss Federal Institute of Technology (EPFL), Signal Processing Laboratory 5 (LTS5), Lausanne, Switzerland.
| | - Johann Heches
- Lausanne University Hospital (CHUV), Swiss BioMotion Lab, Lausanne, Switzerland; University of Lausanne (UNIL), Lausanne, Switzerland
| | - Julien Favre
- Lausanne University Hospital (CHUV), Swiss BioMotion Lab, Lausanne, Switzerland; University of Lausanne (UNIL), Lausanne, Switzerland
| | - David Desseauve
- Lausanne University Hospital (CHUV), Department of Woman-Mother-Child, Lausanne, Switzerland
| | - Jean-Philippe Thiran
- Swiss Federal Institute of Technology (EPFL), Signal Processing Laboratory 5 (LTS5), Lausanne, Switzerland; University of Lausanne (UNIL), Lausanne, Switzerland; Lausanne University Hospital (CHUV), Department of Radiology, Lausanne, Switzerland
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11
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Diciolla A, Gianoni M, Fleury M, Szturz P, Demartines N, Peters S, Duran R, Desseauve D, Panchaud MA, Fasquelle F, Digklia A. Gallbladder cancer during pregnancy treated with surgery and adjuvant gemcitabine: A case report and review of the literature. Front Oncol 2022; 12:1006387. [PMID: 36353558 PMCID: PMC9638103 DOI: 10.3389/fonc.2022.1006387] [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] [Received: 08/03/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundGallbladder cancer (GBC) represents the most common biliary tract cancer. Prognosis remains poor with 5-year overall survival rates less than 5% in advanced stages. GBCs are diagnosed more frequently in women, supposedly due to endocrine factors.CaseA 35-year-old woman, diagnosed with a non-metastatic GBC in the 22nd week of gestation, underwent a complete surgical resection 5 weeks later. Adjuvant gemcitabine was administered without complications, temporarily discontinued in the 32nd week to allow childbirth. The patient was disease-free for more than 3 years with ongoing remission at the last visit in July 2022. During the follow-up period, the child had no developmental, cognitive, or other health issues.ConclusionMalignant tumors occur in about 0.1% of pregnant women, many are treated with chemotherapy. In oncology, the need to deliver optimal treatment in these patients represents a major concern. Both surgery and adjuvant chemotherapy of locally advanced GBC can be performed safely, with certain considerations, in the second trimester of pregnancy.
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Affiliation(s)
- A. Diciolla
- Département d’Oncologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - M. Gianoni
- University of Lausanne (UNIL) et Service de Gynécologie, CHUV, Lausanne, Switzerland
| | - M. Fleury
- Département d’Oncologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - P. Szturz
- Département d’Oncologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - N. Demartines
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Visceral Surgery, CHUV, Lausanne, Switzerland
| | - S. Peters
- Département d’Oncologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - R. Duran
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - D. Desseauve
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Monnat A. Panchaud
- Service of Pharmacy Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - F. Fasquelle
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Institut Universitaire de Pathologie, Pathologie Clinique, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - A. Digklia
- Département d’Oncologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- *Correspondence: A. Digklia,
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12
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Desseauve D, Legardeur H, Haydar A, Vial Y, Jastrow N, Daelemans C. [Trial of labour after c-section in 2022: a narrative review of the literature]. Rev Med Suisse 2022; 18:1973-1977. [PMID: 36259704 DOI: 10.53738/revmed.2022.18.800.1973] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
One in three women in Switzerland gives birth by c-section. This high incidence of c-section frequently exposes obstetricians and midwives to the management of women and their deliveries with a scarred uterus. The decision of couples is multifactorial, but the information that will be delivered by their gynaecologist will necessarily influence the delivery route choice. We propose to review the international recommendations and the literature on the subject, to provide the couple and the attending physician with elements of reflection to guide the choice of delivery route or to monitor adequately when attempting vaginal delivery after a caesarean section.
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Affiliation(s)
- David Desseauve
- Service d'obstétrique, Département femme-mère-enfant, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Hélène Legardeur
- Service d'obstétrique, Département femme-mère-enfant, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Ahmad Haydar
- Clinique générale Beaulieu, Chemin de Beau-Soleil 20, 1206 Genève
| | - Yvan Vial
- Service d'obstétrique, Département femme-mère-enfant, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Nicole Jastrow
- Service d'obstétrique, Département de la femme, de l'enfant et de l'adolescent, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Caroline Daelemans
- Service d'obstétrique, Département de la femme, de l'enfant et de l'adolescent, Hôpitaux universitaires de Genève, 1211 Genève 14
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13
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Pache B, Balaya V, Desseauve D. Temporary cervical sling and uterine twist before B-Lynch for massive uterine bleeding after delivery. J OBSTET GYNAECOL 2022; 42:3393-3394. [PMID: 35930408 DOI: 10.1080/01443615.2022.2106827] [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: 01/06/2023]
Abstract
Massive uterine bleeding occurring after delivery is in most cases unpredictable and can have fatal consequences. This article presents the technique of combining the twisting of uterus on a 90° rotation on its axis and positioning a sling around the cervix, allowing to decrease incoming blood flow from uterine and ovarian arteries. The aim of this easy-to-use procedure is to enable surgeons and anaesthesiologists to respectively ensure the presence of an experienced surgeon and to stabilise the haemodynamic of the patient. It is a modus operandi of particular interest in resources' challenged environments.
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Affiliation(s)
- Basile Pache
- Department of Women-Mother-Child, Gynecology and Obstetrics Unit, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,University of Lausanne (UNIL), Lausanne, Switzerland
| | - Vincent Balaya
- Department of Women-Mother-Child, Gynecology and Obstetrics Unit, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,University of Lausanne (UNIL), Lausanne, Switzerland
| | - David Desseauve
- Department of Women-Mother-Child, Gynecology and Obstetrics Unit, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,University of Lausanne (UNIL), Lausanne, Switzerland
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14
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Boussac E, Gery C, Desseauve D. How to Adapt Anesthetic Human Resources to Health Emergencies Such as the COVID-19 Outbreak: Replacing a Pre-anesthetic Consultation With a Questionnaire in a University Obstetric Unit. Front Med (Lausanne) 2022; 9:770199. [PMID: 35665325 PMCID: PMC9158324 DOI: 10.3389/fmed.2022.770199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
To manage referrals to the pre-anesthetic consultation during the COVID-19 pandemic, a screening questionnaire was created and sent to parturients with anesthetic risk during the pre-anesthetic consultation. This innovative approach enabled the redistribution of medical anesthetic resources in units that were heavily affected by the pandemic.
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Affiliation(s)
- Emilie Boussac
- Department of Surgical and Anesthesiology Services, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Charlene Gery
- Department "Woman-Mother-Child", Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - David Desseauve
- Department "Woman-Mother-Child", Lausanne University Hospital (CHUV), Lausanne, Switzerland
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15
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Desseauve D, Daelemans C, Farin A, Jauvion IBM, Ceccaldi PF. Internal podalic version of second twin: Improving feet identification using a simulation model. Eur J Obstet Gynecol Reprod Biol 2022; 275:9-11. [PMID: 35691221 DOI: 10.1016/j.ejogrb.2022.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/16/2022] [Accepted: 05/30/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Podalic version and breech extraction require high obstetrical expertise. Identifying fetal extremities is the first crucial step for trainees. When this skill is not polished enough, it increases the inter-twin delivery interval and can even jeopardize the whole manoeuver. MATERIAL AND METHODS We present a model for simulating and training this specific skill, with obstetrical mannequin, and 3D printed hands and feet. Five feet and five hands (five rights and five lefts of each one) were printed in 3D after initial ultrasound acquisition of a near term fetus. Each foot and hand, was individually set in a condom filled with 100 cc of water and closed with a knot. A Sophie's Mum Birth Simulator Version 4.0 de MODEL-med was placed on the edge of the table. Each hand and foot was inserted into the pelvic mannequin. An evaluation of the students' skills using this model was performed. A significant reduction of the global mean to extract the first foot and all the feet was noticed at three month of interval. CONCLUSION This model is an option to train and assess a crucial skill for version and breech extraction.
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Affiliation(s)
- David Desseauve
- Women-Mother-Child Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Caroline Daelemans
- Women-Mother-Child Department, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Alexandre Farin
- Obstetric Unit, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - Imane Ben M'Bareck Jauvion
- Department of Simulation, Université de Paris, Paris, France; Obstetrics and Gynecology Service, Assistance Publique - Hôpitaux de Paris, Hôpital Beaujon, Clichy La Garenne, France
| | - Pierre-François Ceccaldi
- Department of Simulation, Université de Paris, Paris, France; Obstetrics and Gynecology Service, Assistance Publique - Hôpitaux de Paris, Hôpital Beaujon, Clichy La Garenne, France
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16
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Moi L, Stehlin F, Desseauve D, Ribi C, Muller YD. [Hypersensitivity reactions to intravenous iron: an allergist' perspective]. Rev Med Suisse 2022; 18:639-645. [PMID: 35385614 DOI: 10.53738/revmed.2022.18.776.639] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Intravenous iron infusions rarely result in severe hypersensitivity reactions. The primary suspected hypersensitivity mechanism is an abnormal complement activation by non-IgE antibodies to the carbohydrate moieties stabilizing iron formulations. A major risk factor for hypersensitivity reactions is related to the infusion speed. Fishbane-like reactions usually resolve after pausing the infusion, which can be resumed under medical surveillance and at a lower infusion rate. Yet, anaphylactic reactions require emergency first aid and subsequent strict avoidance of intravenous iron. Desensitization protocols can be implemented in selected cases and under strict medical surveillance to reduce the risks of severe reactions upon re-exposure.
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Affiliation(s)
- Laura Moi
- Service d'immunologie et allergie, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Florian Stehlin
- Service d'immunologie et allergie, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - David Desseauve
- Service d'obstétrique, Département femme-mère-enfant, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Camillo Ribi
- Service d'immunologie et allergie, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Yannick D Muller
- Service d'immunologie et allergie, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
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17
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Vouga M, Desseauve D. Elective induction in low-risk nulliparous women at 39 weeks' gestation: is it worse changing obstetrical practices? Am J Obstet Gynecol 2022; 227:371. [PMID: 35381193 DOI: 10.1016/j.ajog.2022.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/30/2022] [Indexed: 11/24/2022]
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Desseauve D, Pomar L, Baud D. INTERCOVID prospective longitudinal study: preeclampsia and COVID-19. Am J Obstet Gynecol 2022; 226:152-153. [PMID: 34481771 PMCID: PMC8411594 DOI: 10.1016/j.ajog.2021.08.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/29/2021] [Indexed: 11/01/2022]
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Knüsli J, Desseauve D, Laubscher B. Parental resistance to oral vitamin K prophylaxis was much more common in Swiss birthing centres than private or public hospitals. Acta Paediatr 2021; 110:3365-3366. [PMID: 34329534 PMCID: PMC9292146 DOI: 10.1111/apa.16052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 11/27/2022]
Affiliation(s)
- José Knüsli
- Faculty of Biology and Medicine University of Lausanne Lausanne Switzerland
| | - David Desseauve
- Faculty of Biology and Medicine University of Lausanne Lausanne Switzerland
- Women‐Mother‐Child Department Lausanne University Hospital Lausanne Switzerland
| | - Bernard Laubscher
- Faculty of Biology and Medicine University of Lausanne Lausanne Switzerland
- Women‐Mother‐Child Department Lausanne University Hospital Lausanne Switzerland
- Department of Pediatrics Réseau Hospitalier Neuchâtelois Neuchâtel Switzerland
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20
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Von Aarburg N, Veit-Rubin N, Boulvain M, Bertuit J, Simonson C, Desseauve D. Physical activity and urinary incontinence during pregnancy and postpartum: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 267:262-268. [PMID: 34839247 DOI: 10.1016/j.ejogrb.2021.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/26/2021] [Accepted: 11/02/2021] [Indexed: 12/12/2022]
Abstract
To assess the association of physical activity and urinary incontinence, or its recovery, during pregnancy and postpartum. A search of publications indexed in five major electronic databases (CENTRAL, PubMed, EMBASE, CINAHL and PEDro) was performed from their respective inception dates to the 30 March 2020 with a combination of keywords to identify studies of interest. Google Scholar was used for non-indexed literature. All studies comparing physical activity with standard care in pregnant and postpartum women were selected. Two reviewers independently selected studies, assessed quality and extracted data. Odds ratios with 95% confidence intervals were calculated using fixed effects or random effects models, for low and moderate heterogeneity between studies, respectively. Seven studies (n = 12479) were included. Data of four studies could be pooled for meta-analyses; subgroup and sensitivity analyses were not possible. Physical activity, either during pregnancy or postpartum, is not associated with urinary incontinence, OR 0.90 (95% CI: 0.69-1.18) and OR 1.31 (95% CI: 0.74-2.34), respectively. Due to a lack of available data, urinary incontinence recovering could not be assessed. The available low evidence does not show that physical activity during pregnancy or postpartum is associated with urinary incontinence. Moderate physical activity should therefore be encouraged for the evidence-based benefits on other obstetrical outcomes.
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Affiliation(s)
- Nadine Von Aarburg
- School of Health Sciences (HESAV), University of Applied Sciences and Arts, Western Switzerland (HES-SO), University of Lausanne, Lausanne, Switzerland
| | - Nikolaus Veit-Rubin
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - Michel Boulvain
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jeanne Bertuit
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Colin Simonson
- Department of Obstetrics and Gynaecology, Hôpital du Valais, Sion, Switzerland
| | - David Desseauve
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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21
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Giacalone S, Kottmann A, Darioli V, Carron PN, Desseauve D, Albrecht R, Pasquier M. Clinical characteristics and haemodynamic state of patients undergoing interhospital transfer for postpartum haemorrhage: A study of a single-centre helicopter emergency medical service. Eur J Obstet Gynecol Reprod Biol 2021; 268:48-55. [PMID: 34800817 DOI: 10.1016/j.ejogrb.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/24/2021] [Accepted: 11/02/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Uterine artery embolization is an attractive option for the management of postpartum haemorrhage, however it is not available in every hospital. We compared the clinical characteristics and haemodynamic state of patients with postpartum haemorrhage, before and after helicopter transfer to a tertiary hospital for possible uterine artery embolization. We also analysed whether the type of treatment could modify the outcome. STUDY DESIGN Between 1999 and 2019 in Switzerland, we retrospectively found 82 consecutive patients with postpartum haemorrhage who were transferred by a physician-staffed helicopter emergency medical service to the tertiary hospital for potential uterine artery embolization. The collected data included the type of delivery, estimated blood loss, shock index and blood lactate levels before transfer and at destination, uterine artery embolization rate and hospital mortality rate. Our primary outcome was to describe the clinical characteristics, outcomes and haemodynamic state of the patients with postpartum haemorrhage before and after helicopter transfer. Our secondary outcome was to report the treatments performed at the tertiary hospital. The collected data were analysed with Stata version 14 (Stata Corporation, College Station, TX, USA). Continuous data are compared by using the Student's t-test or the Mann-Whitney U test, as appropriate. RESULTS We included 69 patients. Postpartum haemorrhage occurred after vaginal delivery in 38 cases (55%). Blood loss prior to transfer exceeded 2 L in 34% of cases. The median shock index was 1 (IQR 0.8-1.1) before transfer and 0.9 (IQR 0.8-1.1) after transfer (p = 0.41). The median lactate level was 2.9 mmol/L (IQR 2.1-6.8) before, and 2.1 mmol/L (IQR 1.55-3.5) after transfer (p = 0.90). Forty-four patients underwent uterine artery embolization (64%), with an overall success rate of 93%. One patient died (1.4%), from a haemorrhagic shock of abdominal origin. CONCLUSIONS Interhospital helicopter transfer of patients with postpartum haemorrhage to a tertiary hospital seems to be safe in our setting, despite a significant proportion of patients exhibiting signs of haemodynamic instability. Decision criteria would be helpful to better guide choices regarding the transfer of patients with postpartum haemorrhage.
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Affiliation(s)
- S Giacalone
- Emergency Department, Lausanne University Hospital, and University of Lausanne, Lausanne, Switzerland
| | - A Kottmann
- Emergency Department, Lausanne University Hospital, and University of Lausanne, Lausanne, Switzerland; Swiss Air Ambulance (Rega), Zürich, Switzerland
| | - V Darioli
- Emergency Department, Lausanne University Hospital, and University of Lausanne, Lausanne, Switzerland
| | - P N Carron
- Emergency Department, Lausanne University Hospital, and University of Lausanne, Lausanne, Switzerland
| | - D Desseauve
- Department of Gynaecology and Obstetrics, Lausanne University Hospital, and University of Lausanne, Lausanne, Switzerland
| | - R Albrecht
- Swiss Air Ambulance (Rega), Zürich, Switzerland
| | - M Pasquier
- Emergency Department, Lausanne University Hospital, and University of Lausanne, Lausanne, Switzerland.
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Boussac É, Berna C, Gomes Dias D, Horsch A, Desseauve D. [Contribution of the use of virtual reality in childbirth: A narrative review of the literature]. Rev Med Suisse 2021; 17:1779-1784. [PMID: 34669292] [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: 06/13/2023]
Abstract
The current use of virtual reality (VR) in medicine is expanding rapidly. This non-pharmacological option is increasingly proposed as primary or complementary/multimodal analgesic or anxiolytic management. The role of VR in obstetrics remains to be defined. We propose a narrative review of the literature on the role of VR in obstetrics during childbirth, which shows promise. If used properly, this technique could help improve the experience of childbirth.
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Affiliation(s)
- Émilie Boussac
- Service d'anesthésiologie, Département des centres interdisciplinaires, CHUV, 1011 Lausanne
| | - Chantal Berna
- Service d'anesthésiologie, Centre de médecine intégrative et complémentaire, CHUV, 1011 Lausanne
| | - Diana Gomes Dias
- Service d'obstétrique, Département femme-mère-enfant, CHUV, 1011 Lausanne
| | - Antje Horsch
- Institut universitaire de formation et recherche en soins, Université de Lausanne, 1010 Lausanne
- Service de néonatologie, Département femme-mère-enfant, CHUV, 1011 Lausanne
| | - David Desseauve
- Service d'obstétrique, Département femme-mère-enfant, CHUV, 1011 Lausanne
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Bouille L, Sichitiu J, Favre J, Desseauve D. Assessing feasibility and maternal acceptability of a biomechanically-optimized supine birth position: A pilot study. PLoS One 2021; 16:e0257285. [PMID: 34506580 PMCID: PMC8432866 DOI: 10.1371/journal.pone.0257285] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 06/30/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND In order to manage a protracted second stage of labor, "eminence-based" birth positions have been suggested by some healthcare professionals. Recent biomechanical studies have promoted the use of an optimized supine birthing position in this setting. However, uncertainty exists regarding the feasibility of this posture, and its acceptability by women. This pilot study primarily aimed to assess these characteristics. OBJECTIVE AND METHODS In this monocentric prospective study, 20 women with a protracted second stage of labor were asked to maintain a biomechanically-optimized position for at least 20 minutes at full dilatation. This posture is similar to the McRoberts' maneuver. Maintaining the position for 20 minutes or more was considered clinically relevant and indicative of feasibility and acceptability. Satisfaction with the position was assessed using a Visual Analogue Scale (VAS). A sub-group analysis was performed to assess eventual differences between more and less satisfied patients, according to the median of patients' satisfaction scores. RESULTS Seventeen patients (85%) maintained the optimized position for at least 20 minutes. The median satisfaction score of these participants was 8 (interquartile range: 1) out of 10. No significant differences were found between the two sub-groups (satisfaction score <8 vs satisfaction score ≥8) regarding general and obstetric characteristics, as well as obstetrical and fetal outcomes. CONCLUSION The optimized position is acceptable and feasible for women experiencing a protracted second stage of labor. Further clinical studies are needed to assess the efficiency of such positions when women undergo an obstructed labor.
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Affiliation(s)
- Lisa Bouille
- Women-Mother-Child Department, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Joanna Sichitiu
- Women-Mother-Child Department, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Julien Favre
- Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Vaud, Switzerland
| | - David Desseauve
- Women-Mother-Child Department, Lausanne University Hospital, Lausanne, Vaud, Switzerland
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Sichitiu J, Baud D, Desseauve D. Carbetocin for the prevention of post-partum hemorrhage after vaginal birth: a real-world application. J Matern Fetal Neonatal Med 2021; 35:8114-8117. [PMID: 34470143 DOI: 10.1080/14767058.2021.1962841] [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: 10/20/2022]
Abstract
OBJECTIVE To compare maternal outcomes using Carbetocin versus Oxytocin for the active management of the third stage of labor, given a temporary national shortage of Oxytocin. METHODS We conducted a retrospective observational study on a cohort of 866 women with vaginal deliveries at our center, >36 weeks of gestation, between November 2018 and March 2019. During the shortage period, each woman received a single slow intravenous injection of Carbetocin 100 µg at delivery of the anterior shoulder, rather than Oxytocin 5 UI, as postpartum hemorrhage prophylaxis. 146 (16.9%) patients received Carbetocin versus 720 (83.1%) receiving Oxytocin. The outcomes were rates of postpartum hemorrhage, severe postpartum hemorrhage, and placental retention. RESULTS Incidence rates of placental retention and postpartum hemorrhage were 4.9% and 9.4% respectively. Placenta retention was significantly more likely following Carbetocin administration (adjusted odds ratio 2.5; 95% confidence interval 1.2-5.0). Postpartum hemorrhage rates were not significantly different (adjusted odds ratio 1.1; 95% confidence interval 0.6-2.1), as were severe postpartum hemorrhage rates (adjusted odds ratio 0.7; 95% confidence interval 0.2-2.2). CONCLUSION Carbetocin is as effective as Oxytocin for postpartum hemorrhage prevention. However, we would reserve it for use after placental delivery due to the increased retention rates.
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Affiliation(s)
- Joanna Sichitiu
- Women-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - David Baud
- Women-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - David Desseauve
- Women-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
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Sichitiu J, Meuwly JY, Baud D, Desseauve D. Using shear wave elastography to assess uterine tonicity after vaginal delivery. Sci Rep 2021; 11:10420. [PMID: 34001934 PMCID: PMC8129155 DOI: 10.1038/s41598-021-89756-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/30/2021] [Indexed: 12/19/2022] Open
Abstract
This study aims to evaluate the feasibility and clinical interest of shear wave elastography, by quantitatively estimating the baseline stiffness of the myometrium before and after placental expulsion. We conducted a prospective cohort study of women at term, without known risk factors for postpartum hemorrhage, who gave birth via spontaneous labor in our tertiary center. Myometrium tonicity was evaluated based on measurements of shear wave speed (SWS) in the anterior uterine corpus. All data points were collected by a single operator. Measurements were carried out at three different time points: after fetal delivery (T1), after placental delivery (T2) and 30 min after placental delivery (T3). Our primary objective was to assess the feasibility of this new imaging technique. Ten valid SWS measurements obtained at each of the three different time points were considered as a positive primary outcome. Our secondary objectives were to evaluate the difference in median myometrial shear wave velocity between each time point, as well as to determine the correlation between myometrial shear wave velocity and patients’ characteristics. 38 women were recruited during the study period, of whom 34 met the study criteria. 1017 SWS measurements were obtained. The median time to perform measurements was 16 s for one value, and 2 min 56 s for ten. For 11 women (32%) it was not possible to achieve ten SWS at T1 as placental expulsion immediately followed the birth of the newborn. One patient experienced placental retention and only measurements at T1 were performed. For all other patients, we were successfully able to obtain all measures as intended. There was no difference in the mean shear wave speed between the three time points. After adjustments for confounders, we observed a significant correlation for total blood loss (correlation coefficient = − 0.26, p < 0.001, units of oxytocin (correlation coefficient = − 0.34, p = 0.03), and newborn weight (correlation coefficient = − 0.08, p = 0.001). It is feasible to assess uterine tonicity by shear wave imaging, after placental expulsion. We did not observe a variance in uterine tonicity between the three time points. Women who had higher blood loss, received more units of oxytocin and/or those with newborns of a higher weight exhibited lower shear wave speed measures.
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Affiliation(s)
- Joanna Sichitiu
- Women - Mother - Child Department, Lausanne University Hospital, Avenue Pierre Decker 2, 1011, Lausanne, Switzerland.
| | - Jean-Yves Meuwly
- Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - David Baud
- Women - Mother - Child Department, Lausanne University Hospital, Avenue Pierre Decker 2, 1011, Lausanne, Switzerland
| | - David Desseauve
- Women - Mother - Child Department, Lausanne University Hospital, Avenue Pierre Decker 2, 1011, Lausanne, Switzerland
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Nadal J, Pierre F, Fernandez A, Boussac E, Loupec T, Desseauve D. Drinking during low-risk labor: monocentric randomized clinical trial on patients' satisfaction, and maternal and neonatal outcomes. J Matern Fetal Neonatal Med 2021; 35:5697-5702. [PMID: 33678098 DOI: 10.1080/14767058.2021.1891219] [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: 10/22/2022]
Abstract
INTRODUCTION This study aimed to assess satisfaction of patients affected by various fluid regimes during uncomplicated labor; to identify factors possibly associated with the level of satisfaction; to compare obstetrical and neonatal outcomes between the intervention groups. METHODS Between October and December 2014, 40 women were included in the study set at the Poitiers University Hospital, France. Women were randomly allocated to two study arms: 20 to strict and 20 to liberal fluid regime group. Women's satisfaction was assessed using visual analog scale. Categorical obstetrical and neonatal outcomes were analyzed using Chi-squared test and Fischer's exact test. The between-group difference was assessed with Mann-Whitney U-test. RESULTS Overall satisfaction was higher among women from the liberal fluid regime than from the strict fluid regime group (median score: 88, interquartile range [IQR]: 21 vs. 72, IQR: 21; p = 0.03). The active phase of the second stage of labor was shorter in the liberal fluid regime than in the strict fluid regime group (median 9 min, IQR: 7 vs. 17 min, IQR: 12; p = 0.02). The length of stay in the delivery room was significantly shorter in liberal fluid regime than in strict fluid regime group (median 190 min, IQR: 128 vs. 340 min, IQR: 195, p = 0.04). There were no significant differences in other obstetrical and neonatal outcomes. CONCLUSION Liberal fluid regime during labor was associated with significantly higher satisfaction of women. The active phase of the second stage of labor and the length of stay in the delivery room were significantly shorter in the liberal fluid regime group.
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Affiliation(s)
- Justine Nadal
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Poitiers University Hospital, Poitiers, France
| | - Fabrice Pierre
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Poitiers University Hospital, Poitiers, France
| | - Anna Fernandez
- Women-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Emilie Boussac
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Poitiers University Hospital, Poitiers, France
| | - Thibaut Loupec
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Poitiers University Hospital, Poitiers, France
| | - David Desseauve
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Poitiers University Hospital, Poitiers, France
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Walther D, Halfon P, Tanzer R, Burnand B, Robertson M, Vial Y, Desseauve D, Le Pogam MA. Hospital discharge data is not accurate enough to monitor the incidence of postpartum hemorrhage. PLoS One 2021; 16:e0246119. [PMID: 33534862 PMCID: PMC7857548 DOI: 10.1371/journal.pone.0246119] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 01/13/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Postpartum hemorrhage remains a leading cause of maternal morbidity and mortality worldwide. Therefore, cumulative incidence of postpartum hemorrhage and severe postpartum hemorrhage are commonly monitored within and compared across maternity hospitals or countries for obstetrical safety improvement. These indicators are usually based on hospital discharge data though their accuracy is seldom assessed. We aimed to measure postpartum hemorrhage and severe postpartum hemorrhage using electronic health records and hospital discharge data separately and compare the detection accuracy of these methods to manual chart review, and to examine the temporal trends in cumulative incidence of these potentially avoidable adverse outcomes. MATERIALS AND METHODS We analyzed routinely collected data of 7904 singleton deliveries from a large Swiss university hospital for a three year period (2014-2016). We identified postpartum hemorrhage and severe postpartum hemorrhage in electronic health records by text mining discharge letters and operative reports and calculating drop in hemoglobin from laboratory tests. Diagnostic and procedure codes were used to identify cases in hospital discharge data. A sample of 334 charts was reviewed manually to provide a reference-standard and evaluate the accuracy of the other detection methods. RESULTS Sensitivities of detection algorithms based on electronic health records and hospital discharge data were 95.2% (95% CI: 92.6% 97.8%) and 38.2% (33.3% to 43.0%), respectively for postpartum hemorrhage, and 87.5% (85.2% to 89.8%) and 36.2% (26.3% to 46.1%) for severe postpartum hemorrhage. Postpartum hemorrhage cumulative incidence based on electronic health records decreased from 15.6% (13.1% to 18.2%) to 8.5% (6.7% to 10.5%) from the beginning of 2014 to the end of 2016, with an average of 12.5% (11.8% to 13.3%). The cumulative incidence of severe postpartum hemorrhage remained at approximately 4% (3.5% to 4.4%). Hospital discharge data-based algorithms provided significantly underestimated incidences. CONCLUSIONS Hospital discharge data is not accurate enough to assess the incidence of postpartum hemorrhage at hospital or national level. Instead, automated algorithms based on structured and textual data from electronic health records should be considered, as they provide accurate and timely estimates for monitoring and improvement in obstetrical safety. Furthermore, they have the potential to better code for postpartum hemorrhage thus improving hospital reimbursement.
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Affiliation(s)
- Diana Walther
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Patricia Halfon
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Romain Tanzer
- Data Science and Research Unit, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Bernard Burnand
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Moira Robertson
- Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Yvan Vial
- Department Woman-Mother-Child, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - David Desseauve
- Department Woman-Mother-Child, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- * E-mail:
| | - Marie-Annick Le Pogam
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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Dokmak F, Michalek IM, Boulvain M, Desseauve D. Squatting position in the second stage of labor: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 254:147-152. [PMID: 32966958 DOI: 10.1016/j.ejogrb.2020.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The influence of squatting during delivery on maternal and fetal outcomes remains unclear. We performed a systematic review and meta-analysis to evaluate the benefits and risks of adopting a squatting position during the second stage of labor. STUDY DESIGN Search Strategy: A systematic search in the three major electronic databases (CENTRAL, PubMed and Embase) was performed, from their respective inception dates to the 14th of December 2019, using 'squatting', and a combination of keywords to identify delivery. Eligibility criteria: Randomized controlled trials comparing squatting position to any supine position during the second stage of labor. STATISTICAL ANALYSES Risk ratio for dichotomous outcomes, mean difference for continuous outcomes, with 95 % confidence intervals. Fixed-effects meta-analysis (Mantel-Haenszel method) or random-effects model (inverse variance method), for low and high heterogeneity between trials, respectively. PROSPERO Registration number: CRD42018093244 RESULTS: Seven randomized controlled trials (n = 1219) were included. Three studies were assessed as low risk of bias, three others as moderate and one study as high risk of bias. The main limitation is the lack of reporting on the methods to achieve randomization and concealment of allocation in most of the studies. There was no difference in the duration of the second stage of labor (mean -11.09 min; 95 %CI -38.85 to 16.68). In the squatting group, the risk of caesarean section was increased (RR 2.26, 95 %CI 1.07-4.80) and the risk of instrumental delivery was decreased (RR 0.60, 95 %CI 0.45-0.81), which results in a similar probability of spontaneous delivery. There were no differences regarding the other maternal and fetal outcomes. CONCLUSIONS The available evidence does not show the squatting position during childbirth to be beneficial. As there is no evidence for or against squatting, women should be able to choose the position they prefer.
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Affiliation(s)
- Fatima Dokmak
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Irmina Maria Michalek
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Michel Boulvain
- GHOL Hôpital de Nyon, Switzerland and University of Geneva, Nyon, Switzerland
| | - David Desseauve
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Michalek IM, Comte C, Desseauve D. Impact of maternal physical activity during an uncomplicated pregnancy on fetal and neonatal well-being parameters: a systematic review of the literature. Eur J Obstet Gynecol Reprod Biol 2020; 252:265-272. [PMID: 32634674 DOI: 10.1016/j.ejogrb.2020.06.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 11/25/2022]
Abstract
We carried a thorough systematic review of the contemporary literature regarding the impact of maternal physical activity during pregnancy on the fetal and neonatal well-being parameters. We searched systematically publications indexed in PubMed and ScienceDirect, according to the PRISMA protocol. Studies examining following fetal and neonatal well-being parameters were included: fetal heart rate, active fetal movements, Doppler assessment of the placental and fetal circulations, amniotic fluid index, Apgar score, and umbilical cord blood acid-basis analysis at delivery. Altogether, 73 studies were identified (pooled sample size n = 7867). Out of these, 42 pertained to acute and 31 pertained to chronic exposure to maternal physical activity. The majority of the identified studies reported a positive or neutral effect of maternal physical activity on the fetal heart rate, Doppler-derived umbilical and cerebral blood flow parameters, and Apgar score. The literature regarding uterine arteries Doppler assessment, fetal active movements, amniotic fluid index, and umbilical cord blood acid-base analysis at delivery is sparse and does not allow us to generalize the inferences. Maternal physical activity during physiological pregnancy is safe for fetal and neonatal well-being when practiced according to recommendations. There is a need for better quality studies concerning the subject.
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Affiliation(s)
- Irmina Maria Michalek
- Obstetric Research Lab, Women-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland.
| | | | - David Desseauve
- Obstetric Research Lab, Women-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
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Desseauve D, Fradet L, Pierre F. [Dessauve D et al. in reply to the article by N Mottet et al. Focus on the Odon Device™: "Technical improvements, mechanical principles and progress of the clinical research program", Gynecol Obstet Fertil 2020 March 14. https://doi.org/10.1016/j.gofs.2020.03.011]. ACTA ACUST UNITED AC 2020; 48:844. [PMID: 32522612 DOI: 10.1016/j.gofs.2020.06.001] [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: 05/05/2020] [Indexed: 11/19/2022]
Affiliation(s)
- D Desseauve
- Service d'obstétrique, département Femme-Mère-Enfant, CHU Vaudois, Lausanne, Suisse.
| | - L Fradet
- Institut Pprime UPR 3346-CNRS, Axe RoBioSS, université de Poitiers, Poitiers, France
| | - F Pierre
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, Poitiers, France
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Diallo A, Michalek IM, Bah IK, Diallo IA, Sy T, Roth-Kleiner M, Desseauve D. Maternal mortality risk indicators: Case-control study at a referral hospital in Guinea. Eur J Obstet Gynecol Reprod Biol 2020; 251:254-257. [PMID: 32554328 DOI: 10.1016/j.ejogrb.2020.05.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study aimed to describe intrapartum and postpartum exposures possibly associated with the risk of in-hospital maternal mortality in Guinea. STUDY DESIGN Data were collected in the Western Sub-Saharan Africa setting at the university hospital in Conakry, Guinea, during 2016-2017. Case-control study design was applied. The cases comprised all intrapartum and postpartum maternal deaths recorded during the study period. The controls were selected by random sampling from patients discharged alive following hospitalization due to vaginal delivery or cesarean section. Maternal mortality ratio (MMR) was defined as a quotient of the number of maternal deaths per 100,000 live births. Multivariable logistic regression was applied to generate odds ratios (OR) and 95 % confidence intervals (95 %CI). RESULTS A total of 10,208 live births and 144 maternal deaths were recorded. The MMR was at 1411 per 100,000 live births. The main causes of maternal death included postpartum hemorrhage (56 %), retroplacental hematoma (10 %), and eclampsia (9%). The ORs of maternal death were significantly elevated in case of transfer from another hospital (OR 24.60, 95 %CI 11.32-53.46), misoprostol-induced labor (OR 4.26, 95 %CI 2.51-7.91), non-use of partogram (OR 3.70, 95 %CI 1.31-5.20), duration of labor ≥24 h (OR 2.87, 95 %CI 1.35-5.29), and positive history of cesarean section (OR 2.54, 95 %CI 1.12-6.19). CONCLUSION To stop preventable maternal mortality in Sub-Saharan Africa, continued efforts are needed to provide perinatal monitoring, to reorganize the obstetric reference system, and to decrease the number of avoidable cesarean sections. Furthermore, the internal supervision of misoprostol doses used for labor induction should be a priority.
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Affiliation(s)
- Abdourahamane Diallo
- Department of Gynecology-Obstetrics, Ignace Deen National Hospital of the University Hospital Center of Conakry, Conakry, Guinea
| | - Irmina Maria Michalek
- Women-Mother-Child Department, Lausanne University Hospital, Lausanne and University of Lausanne, Switzerland
| | - Ibrahima Koussy Bah
- Department of Gynecology-Obstetrics, Ignace Deen National Hospital of the University Hospital Center of Conakry, Conakry, Guinea
| | - Ibrahima Amadou Diallo
- Department of Gynecology-Obstetrics, Ignace Deen National Hospital of the University Hospital Center of Conakry, Conakry, Guinea
| | - Telly Sy
- Department of Gynecology-Obstetrics, Ignace Deen National Hospital of the University Hospital Center of Conakry, Conakry, Guinea
| | - Matthias Roth-Kleiner
- Women-Mother-Child Department, Lausanne University Hospital, Lausanne and University of Lausanne, Switzerland
| | - David Desseauve
- Women-Mother-Child Department, Lausanne University Hospital, Lausanne and University of Lausanne, Switzerland.
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Sichitiu J, Fakhouri F, Desseauve D. Antenatal corticosteroid therapy and COVID-19: Pathophysiological considerations. Acta Obstet Gynecol Scand 2020; 99:952. [PMID: 32356302 PMCID: PMC7267570 DOI: 10.1111/aogs.13887] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Joanna Sichitiu
- Women-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Fadi Fakhouri
- Department of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland
| | - David Desseauve
- Women-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
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Desseauve D, Fradet L, Gherman RB, Cherni Y, Gachon B, Pierre F. Does the McRoberts' manoeuvre need to start with thigh abduction? An innovative biomechanical study. BMC Pregnancy Childbirth 2020; 20:264. [PMID: 32366292 PMCID: PMC7197156 DOI: 10.1186/s12884-020-02952-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 04/16/2020] [Indexed: 11/18/2022] Open
Abstract
Background Guidelines and description about the achievement of the McRoberts manoeuvre are discordant, particularly concerning the need for abduction before the beginning of the manoeuvre. We sought to compare the biomechanical efficiency of the McRoberts’ manoeuvre, with and without thigh abduction. Methods In a postural comparative study, twenty-three gravidas > 32 weeks of gestational age and not in labour were assessed during three repetitions of two McRoberts’ manoeuvre that differed in terms of starting position. For the (i) McRoberts, the legs were initially placed in stirrups; for the (m) McRoberts, the legs were resting on the bed, with thighs in wide abduction. For each manoeuvre, flexion of the plane of the external conjugate of the pelvis on the spine (ANGce), hip flexion and abduction, were assessed using an optoelectronic motion capture system. Lumbar curve were assessed with Epionics Spine® system. Temporal parameters including movement duration or acceleration of the external conjugate were also computed. All values obtained for the two types of manoeuvres were compared using a Wilcoxon matched-pairs signed-ranks test. The significance level was defined as p < 0.05. Results The starting position of McRoberts’ otherwise had no effect on the maximum ANGce (p = 0.199), the minimal lordosis of the lumbar curve (p = 0.474), or the maximal hip flexion (p = 0.057). The other parameters were not statistically different according to the starting position (p > 0.005). Conclusion Regardless of the starting position, the McRoberts’ manoeuvre allows ascension of the pubic symphysis and reduction of the lumbar lordosis. This results imply that the McRoberts’ manoeuvre could be performed with the legs initially placed in the stirrups.
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Affiliation(s)
- David Desseauve
- Department of Obstetrics and Gynecology and Reproductive Medicine, University Hospital of Poitiers, Poitiers, France. .,Pprime Institute, CNRS UPR 3346, Axis RoBioSS, University of Poitiers, Poitiers, France. .,Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Vaudois (CHUV), 1011, Lausanne, Switzerland.
| | - Laetitia Fradet
- Pprime Institute, CNRS UPR 3346, Axis RoBioSS, University of Poitiers, Poitiers, France
| | - Robert B Gherman
- Department of OB/GYN, Division of Maternal/ Fetal Medicine, Wellspan Medical Center, York, PA, USA
| | - Yosra Cherni
- Pprime Institute, CNRS UPR 3346, Axis RoBioSS, University of Poitiers, Poitiers, France
| | - Bertrand Gachon
- Department of Obstetrics and Gynecology and Reproductive Medicine, University Hospital of Poitiers, Poitiers, France
| | - Fabrice Pierre
- Department of Obstetrics and Gynecology and Reproductive Medicine, University Hospital of Poitiers, Poitiers, France
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Sichitiu J, Vial Y, Panchaud A, Baud D, Desseauve D. Tachysystole and risk of cesarean section after labor induction using misoprostol: A cohort study. Eur J Obstet Gynecol Reprod Biol 2020; 249:54-58. [PMID: 32361173 DOI: 10.1016/j.ejogrb.2020.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/04/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To investigate if tachysystole was associated with an increased risk of cesarean section or unfavorable maternal or neonatal outcomes following induction of labor by misoprostol vaginal inserts. STUDY DESIGN We conducted a retrospective cohort study of 446 women over 37 weeks of gestation admitted for labor induction by misoprostol vaginal inserts between May 2016 and May 2017. Fetal heart rate and uterine activity tracings were assessed for tachysystole, defined as ≥ 6 contractions per 10 min, averaged over a 30-minute window. Univariate analysis was performed by using t-test and Chi-square, comparing demographics, pregnancy characteristics, intrapartum monitoring, mode of delivery, neonatal outcomes (Apgar score < 7 at 5 min, umbilical cord artery pH < 7.10, neonatal intensive care unit admission) and maternal outcomes, with regard to the presence of tachysystole. The association between tachysystole and cesarean section was evaluated after adjusting for potential confounders by a modified Poisson regression model, expressed as an adjusted risk ratio and 95 % confidence intervals. RESULTS A total of 140 women (31.4 %) presented with tachysystole. The median duration of tachysystole was 2 h 12 min. The rate of cesarean section was 25.0 % (N = 35) among patients with tachysystole and 19.6 % (N = 60) for those without tachysystole. Presence of tachysystole during induction of labor with misoprostol vaginal inserts was not associated with cesarean section (adjusted risk ratio,1.0; 95 % confidence interval, 0.7-1.4). Neonatal and maternal outcomes were similar between mothers who did and did not experience tachysystole. CONCLUSIONS This study illustrates that tachysystole is not associated with an increased risk of cesarean section after induction of labor by misoprostol vaginal inserts. The impact of excessive uterine activity on the fetal wellbeing defined by the frequency of uterine contraction alone is probably insufficient. Further research on the development of accurate measures of uterine contractility is necessary to better understand its effect on fetal well-being.
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Affiliation(s)
- Joanna Sichitiu
- Women - Mother - Child Department, University Hospital of Lausanne, Lausanne, Switzerland.
| | - Yvan Vial
- Women - Mother - Child Department, University Hospital of Lausanne, Lausanne, Switzerland
| | - Alice Panchaud
- School of Pharmaceutical Sciences, Geneva University and Service of Pharmacy, University Hospital of Lausanne, Lausanne, Switzerland
| | - David Baud
- Women - Mother - Child Department, University Hospital of Lausanne, Lausanne, Switzerland
| | - David Desseauve
- Women - Mother - Child Department, University Hospital of Lausanne, Lausanne, Switzerland
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Sichitiu J, Desseauve D. Intrapartum care of women with COVID-19: A practical approach. Eur J Obstet Gynecol Reprod Biol 2020; 249:94-95. [PMID: 32307204 PMCID: PMC7195107 DOI: 10.1016/j.ejogrb.2020.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Joanna Sichitiu
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Avenue Pierre-Decker 2, 1011, Lausanne, Switzerland.
| | - David Desseauve
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Avenue Pierre-Decker 2, 1011, Lausanne, Switzerland
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Desseauve D, Pierre F, Fernandez A, Panjo H, Decatoire A, Lacouture P, Fradet L. Assessment of Pelvic-Lumbar-Thigh Biomechanics to Optimize The Childbirth Position: An "In Vivo" Innovative Biomechanical Study. Sci Rep 2019; 9:15968. [PMID: 31685875 PMCID: PMC6828717 DOI: 10.1038/s41598-019-52338-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/15/2019] [Indexed: 01/20/2023] Open
Abstract
The study aimed to assess the associations between the pelvis orientation, lumbar curve and thigh postures throughout pregnancy in a population of healthy women. Additionally, optimal mechanical birth conditions in terms of the pelvic inlet and lumbar curve were researched. The individuals' posture was assessed with three-dimensional motion analysis and the lumbar curve with the Epionics SPINE system. The association between the hip joint angles (flexion and abduction), the pelvis external conjugate, and lumbar curve position was assessed with a generalized linear mixed model (GLMM) adjusted to individuals' characteristics. Joint laxity was assessed with a modified Jobbin's extensometer. For all of the subjects, hip flexion and hip abduction were significantly associated with the angle between the external conjugate and spine, with higher correlation in the multivariate regression model. The association between hip flexion and the lumbar curve was less significant in multivariate than univariate regression analysis. Optimal birth conditions were never reached. The findings contribute to the understanding of the association between the hip position (flexion and abduction), pelvic orientation, and lumbar curve adjusted for joint laxity in healthy pregnant women. They lay the groundwork for future research in the field of obstetrical biomechanics.
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Affiliation(s)
- David Desseauve
- Department of Obstetrics and Gynecology and Reproductive Medicine, University Hospital, Poitiers University, Poitiers, France. .,Pprime Institute - CNRS UPR 3346, Axis RoBioSS, Poitiers University, Poitiers, France.
| | - Fabrice Pierre
- Department of Obstetrics and Gynecology and Reproductive Medicine, University Hospital, Poitiers University, Poitiers, France
| | - Anna Fernandez
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, CH, Switzerland
| | - Henri Panjo
- Gender, Sexual and Reproductive Health, Centre for Research in Epidemiology and Population Health, (CESP), F-94807, Villejuif, France.,INED, F-75020, Paris, France
| | - Arnaud Decatoire
- Pprime Institute - CNRS UPR 3346, Axis RoBioSS, Poitiers University, Poitiers, France
| | - Patrick Lacouture
- Pprime Institute - CNRS UPR 3346, Axis RoBioSS, Poitiers University, Poitiers, France
| | - Laetitia Fradet
- Pprime Institute - CNRS UPR 3346, Axis RoBioSS, Poitiers University, Poitiers, France
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Sichitiu J, Desseauve D. Should we offer elective induction of labor to nulliparous women at 39 weeks? Am J Obstet Gynecol 2019; 221:288. [PMID: 31277807 DOI: 10.1016/j.ajog.2019.05.048] [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: 04/14/2019] [Accepted: 05/28/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Joanna Sichitiu
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | - David Desseauve
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Abstract
In the last 30 years, with increasing cesarean section rates, the incidence of the placenta accreta spectrum has also increased. It is estimated that by the year 2020 there will be nearly 9000 cases annually in the United States. Currently, no consensus exists regarding optimal management. Conventional treatment by cesarean-hysterectomy is challenging, with a high maternal morbidity due to massive hemorrhage, and surgical complications such as urinary tract, bowel and pelvic nerve injury, in addition to loss of fertility and its accompanying psychological trauma. Innovative approaches seek to preserve the uterus with the adherent placenta in situ, thus maintaining fertility and potentially reducing hemorrhage and adjacent organ injury. This review reports strategies for conservative treatment of such conditions, based on the current literature.
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Affiliation(s)
- Joanna Sichitiu
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Zeina El-Tani
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Patrice Mathevet
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - David Desseauve
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Desseauve D, Fradet L, Lacouture P, Pierre F. Is there an impact of feet position on squatting birth position? An innovative biomechanical pilot study. BMC Pregnancy Childbirth 2019; 19:251. [PMID: 31324160 PMCID: PMC6642516 DOI: 10.1186/s12884-019-2408-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background The squatting birth position is widely used for “natural” birth or in countries where childbirth occurs in non-medical facilities. Squatting birth positions, like others, are roughly defined so a biomechanical assessment is required with the availability of noninvasive technology in pregnant women. In practice, we can observe spontaneously two kinds of squatting birth position: on tiptoes and with feet flat. Objective To compare the impact of foot posture on biomechanical parameters considered essential in obstetrical biomechanics during a squatting birth position: on tiptoes versus with feet flat on the floor. Study design Thirteen pregnant women beyond 32 weeks of gestational age who were not in labor were assessed during squatting birth position firstly spontaneously and secondly with the foot posture that was not taken spontaneously (on the tiptoes vs with feet flat). For each position, ANGle of flexion on the spine of the plane of the pelvis external conjugate (ANGec), hip flexion and abduction, and lumbar curve were assessed using an optoelectronic motion capture system and a biomechanical model adapted from the conventional gait model as well as a measuring system of the lumbar curve. Results Spontaneously, 11 out of 13 women squatted on tiptoe at the first test. On tiptoes the hip flexion was lower than with feet flat (p < 0.02), whereas hip abduction was not significantly different (p = 0.28). A lower ANGec angle (p = 0.003) was noticed for the tiptoe position than feet flat. The lumbar curve (lordosis) was more marked for the squatting position on tiptoes than for the position with feet flat (p < 0.001). On tiptoes no woman had a pelvic inlet plane perpendicular to the spine and none had a flat back or kyphosis. No woman on tiptoes fulfilled the two conditions necessary for the position that we consider optimal. Conclusion In squatting birth position, foot posture has a biomechanical impact on lumbar curve and pelvic orientation. When comparing squatting positions (on tiptoes vs feet flat), feet flat on the ground is closer to optimal birth conditions than on tiptoes.
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Affiliation(s)
- David Desseauve
- Department of Obstetrics and Gynecology and Reproductive Medicine, University Hospital, Poitiers University, CHU de Poitiers, 2 rue de la Milétrie, BP 577, 86021, Poitiers, France. .,Pprime Institute - CNRS UPR 3346, Axis RoBioSS, Poitiers University, Poitiers, France. .,Faculty of Biology and Medicine, Lausanne University, 1011, Lausanne, Switzerland. .,Present Address: Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Vaudois (CHUV), 1011, Lausanne, Switzerland.
| | - Laetitia Fradet
- Pprime Institute - CNRS UPR 3346, Axis RoBioSS, Poitiers University, Poitiers, France
| | - Patrick Lacouture
- Pprime Institute - CNRS UPR 3346, Axis RoBioSS, Poitiers University, Poitiers, France
| | - Fabrice Pierre
- Department of Obstetrics and Gynecology and Reproductive Medicine, University Hospital, Poitiers University, CHU de Poitiers, 2 rue de la Milétrie, BP 577, 86021, Poitiers, France
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Sichitiu J, Baud D, Vial Y, Desseauve D. Ten labor ward commandments: reducing the cesarean section rate by one-third. J Matern Fetal Neonatal Med 2019; 34:1318-1319. [PMID: 31256693 DOI: 10.1080/14767058.2019.1633302] [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: 10/26/2022]
Affiliation(s)
- Joanna Sichitiu
- Department of Woman-Mother-Child, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - David Baud
- Department of Woman-Mother-Child, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Yvan Vial
- Department of Woman-Mother-Child, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - David Desseauve
- Department of Woman-Mother-Child, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Gachon B, Desseauve D. Why introducing biomechanical considerations into obstetrical management of women from pregnancy to delivery? Comput Methods Biomech Biomed Engin 2019. [DOI: 10.1080/10255842.2020.1714239] [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: 10/24/2022]
Affiliation(s)
- B. Gachon
- Department of Obstetrics and Gynecology, Poitiers University Hospital, Poitiers, France
- Laboratory “Movement, Interactions, Performance” EA 4334, Faculty of Sport Sciences, University of Nantes, Nantes, France
- Institut PPrime RoBioSS Unit, Poitiers ENSMA, CNRS UPR 3346, Futuroscope, France
| | - D. Desseauve
- Department of Obstetrics and Gynecology, Poitiers University Hospital, Poitiers, France
- Institut PPrime RoBioSS Unit, Poitiers ENSMA, CNRS UPR 3346, Futuroscope, France
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Swiss Biomotion Lab, Centre Hopsitalier Universitaire Vaudois, Lausanne, Switzerland
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Walther D, Halfon P, Tanzer R, Burnand B, Baeriswyl M, Vial Y, Desseauve D, Le Pogam MA. Le dossier patient informatisé est plus fiable que les données médico-administratives hospitalières pour la surveillance automatisée des hémorragies du post-partum. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.01.030] [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] Open
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Cherni Y, Desseauve D, Decatoire A, Veit-Rubinc N, Begon M, Pierre F, Fradet L. Evaluation of ligament laxity during pregnancy. J Gynecol Obstet Hum Reprod 2019; 48:351-357. [PMID: 30794956 DOI: 10.1016/j.jogoh.2019.02.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 01/28/2019] [Accepted: 02/19/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Pregnancy-related changes in ligament laxity have been shown to be associated with various disorders such as back pain or pelvic floor disorders. The purpose of this study was to assess laxity changes during pregnancy by confronting different methods in order to suggest a simple clinical tool helping to prevent the aforementioned problems. DESIGN Seventeen pregnant women were evaluated at the first, second and third trimesters as cases and 16 non-pregnant women participated as controls. Ligamentous laxity was measured using an extensometer for the metacarpophalangeal joint of the index, a fingertip to floor test and a sit and reach test to assess hip and lumbar flexibility and the Beighton score. Statistical analysis included independent samples t-tests, analysis of variance and Pearson correlation coefficients. RESULTS Laxity of the metacarpophalangeal joint increased by 11% from the first to the second trimester of pregnancy and stabilized until delivery. The Beighton score was significantly higher in the second trimester of pregnancy (p < 0.05). The flexibility of the hip and lumbar vertebra showed a significant increase of the distance measured between the foot soles and the middle fingers at third trimester (p < 0.05). A moderate correlation was observed between the results given by the extensometer and the Beighton score in both the cases and the control group at first trimester (r = 0.60, p < 0.05) but none was found for the two hip and lumbar flexibility tests. CONCLUSION Laxity reached its maximum at the second trimester. The combination of an objective measurement by the extensometer and a global evaluation of the laxity by the Beighton' score for example may be useful for a daily assessment of laxity. However, the chosen clinical tests don't seem appropriate to be used alone in pregnant women.
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Affiliation(s)
- Yosra Cherni
- Institut Pprime. Axe RoBioSS, CNRS UPR 3346 Université de Poitiers, Téléport 2, boulevard Marie et Pierre Curie BP 30179, 86962, Futuroscope, France; Département de Kinésiologie, Université de Montréal, 1700 rue Jacques-Tétreault, H7N 0B6, Laval, Québec, Canada
| | - David Desseauve
- Institut Pprime. Axe RoBioSS, CNRS UPR 3346 Université de Poitiers, Téléport 2, boulevard Marie et Pierre Curie BP 30179, 86962, Futuroscope, France; Service de Gynécologie Obstétrique et Médecine de la Reproduction, CHU de Poitiers, 2 rue de la Milétrie, 86021, Poitiers Cedex, France
| | - Arnaud Decatoire
- Institut Pprime. Axe RoBioSS, CNRS UPR 3346 Université de Poitiers, Téléport 2, boulevard Marie et Pierre Curie BP 30179, 86962, Futuroscope, France
| | | | - Mickaël Begon
- Département de Kinésiologie, Université de Montréal, 1700 rue Jacques-Tétreault, H7N 0B6, Laval, Québec, Canada; Centre de recherche du centre de réadaptation Marie-Enfant, CHU Sainte-Justine, 5200 Rue Bélanger, H1T 1C9, Montréal, Québec, Canada
| | - Fabrice Pierre
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, CHU de Poitiers, 2 rue de la Milétrie, 86021, Poitiers Cedex, France
| | - Laetitia Fradet
- Institut Pprime. Axe RoBioSS, CNRS UPR 3346 Université de Poitiers, Téléport 2, boulevard Marie et Pierre Curie BP 30179, 86962, Futuroscope, France.
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Subtil D, Brabant G, Tilloy E, Devos P, Canis F, Fruchart A, Bissinger MC, Dugimont JC, Nolf C, Hacot C, Gautier S, Chantrel J, Jousse M, Desseauve D, Plennevaux JL, Delaeter C, Deghilage S, Personne A, Joyez E, Guinard E, Kipnis E, Faure K, Grandbastien B, Ancel PY, Goffinet F, Dessein R. Early clindamycin for bacterial vaginosis in pregnancy (PREMEVA): a multicentre, double-blind, randomised controlled trial. Lancet 2018; 392:2171-2179. [PMID: 30322724 DOI: 10.1016/s0140-6736(18)31617-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 02/22/2018] [Accepted: 07/10/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Preterm delivery during pregnancy (<37 weeks' gestation) is a leading cause of perinatal mortality and morbidity. Treating bacterial vaginosis during pregnancy can reduce poor outcomes, such as preterm birth. We aimed to investigate whether treatment of bacterial vaginosis decreases late miscarriages or spontaneous very preterm birth. METHODS PREMEVA was a double-blind randomised controlled trial done in 40 French centres. Women aged 18 years or older with bacterial vaginosis and low-risk pregnancy were eligible for inclusion and were randomly assigned (2:1) to three parallel groups: single-course or triple-course 300 mg clindamycin twice-daily for 4 days, or placebo. Women with high-risk pregnancy outcomes were eligible for inclusion in a high-risk subtrial and were randomly assigned (1:1) to either single-course or triple-course clindamycin. The primary outcome was a composite of late miscarriage (16-21 weeks) or spontaneous very preterm birth (22-32 weeks), which we assessed in all patients with delivery data (modified intention to treat). Adverse events were systematically reported. This study is registered with ClinicalTrials.gov, number NCT00642980. FINDINGS Between April 1, 2006, and June 30, 2011, we screened 84 530 pregnant women before 14 weeks' gestation. 5630 had bacterial vaginosis, of whom 3105 were randomly assigned to groups in the low-risk trial (n=943 to receive single-course clindamycin, n=968 to receive triple-course clindamycin, and n=958 to receive placebo) or high-risk subtrial (n=122 to receive single-course clindamycin and n=114 to receive triple-course clindamycin). In 2869 low-risk pregnancies, the primary outcome occurred in 22 (1·2%) of 1904 participants receiving clindamycin and 10 (1·0%) of 956 participants receiving placebo (relative risk [RR] 1·10, 95% CI 0·53-2·32; p=0·82). In 236 high-risk pregnancies, the primary outcome occurred in 5 (4·4%) participants in the triple-course clindamycin group and 8 (6·0%) participants in the single-course clindamycin group (RR 0·67, 95% CI 0·23-2·00; p=0·47). In the low-risk trial, adverse events were more common in the clindamycin groups than in the placebo group (58 [3·0%] of 1904 vs 12 [1·3%] of 956; p=0·0035). The most commonly reported adverse event was diarrhoea (30 [1·6%] in the clindamycin groups vs 4 [0·4%] in the placebo group; p=0·0071); abdominal pain was also observed in the clindamycin groups (9 [0·6%] participants) versus none in the placebo group (p=0·034). No severe adverse event was reported in any group. Adverse fetal and neonatal outcomes did not differ significantly between groups in the high-risk subtrial. INTERPRETATION Systematic screening and subsequent treatment for bacterial vaginosis in women with low-risk pregnancies shows no evidence of risk reduction of late miscarriage or spontaneous very preterm birth. Use of antibiotics to prevent preterm delivery in this patient population should be reconsidered. FUNDING French Ministry of Health.
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Affiliation(s)
- Damien Subtil
- Pôle Femme Mère Nouveau-né, Centre Hospitalier Universitaire de Lille, Lille, France; Epidémiologie et Qualité des soins (EA 2694), Université de Lille, Lille, France
| | - Gilles Brabant
- Service de Gynécologie-Obstétrique, Groupement des Hôpitaux de l'Institut Catholique de Lille, Hôpital Saint Vincent, Lille, France
| | - Emma Tilloy
- Pôle Femme Mère Nouveau-né, Centre Hospitalier Universitaire de Lille, Lille, France; Epidémiologie et Qualité des soins (EA 2694), Université de Lille, Lille, France
| | - Patrick Devos
- Epidémiologie et Qualité des soins (EA 2694), Université de Lille, Lille, France
| | - Frédérique Canis
- Laboratoire de Biologie Médicale, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Annie Fruchart
- Institut de Microbiologie, Centre Hospitalier Universitaire de Lille, Lille, France
| | | | | | - Catherine Nolf
- Association des Biologistes des Régions Nord Picardie, Marcq-en-Baroeul, France
| | - Christophe Hacot
- Association des Biologistes des Régions Nord Picardie, Marcq-en-Baroeul, France
| | - Sophie Gautier
- Centre Regional de Pharmacovigilance, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Jérôme Chantrel
- Hôpital Privé de Villeneuve d'Ascq, Villeneuve d'Ascq, France
| | - Marielle Jousse
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - David Desseauve
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | | | - Christine Delaeter
- Pôle Femme Mère Nouveau-né, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Sylvie Deghilage
- Pôle Femme Mère Nouveau-né, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Anne Personne
- Pôle Femme Mère Nouveau-né, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Emmanuelle Joyez
- Service de Gynécologie-Obstétrique, Centre Hospitalier de Calais, Calais, France
| | - Elisabeth Guinard
- Service de Gynécologie-Obstétrique, Centre Hospitalier de Calais, Calais, France
| | - Eric Kipnis
- Service de Réanimation Chirurgicale, Centre Hospitalier Universitaire de Lille, Lille, France; Recherche Translationelle Relation Hôte-Pathogènes, Université de Lille, Lille, France
| | - Karine Faure
- Service de Maladies Infectieuses, Centre Hospitalier Universitaire de Lille, Lille, France; Recherche Translationelle Relation Hôte-Pathogènes, Université de Lille, Lille, France
| | - Bruno Grandbastien
- Service de Gestion de Risque Infectieux et des Vigilances, Centre Hospitalier Universitaire de Lille, Lille, France; Epidémiologie et Qualité des soins (EA 2694), Université de Lille, Lille, France
| | - Pierre-Yves Ancel
- Epidemiological Research in Perinatal Health and Women's and Children Health, INSERM UMR 1153, Paris, France
| | - François Goffinet
- Epidemiological Research in Perinatal Health and Women's and Children Health, INSERM UMR 1153, Paris, France; Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Cochin Port Royal Saint Vincent de Paul, Paris, France
| | - Rodrigue Dessein
- Institut de Microbiologie, Centre Hospitalier Universitaire de Lille, Lille, France; Recherche Translationelle Relation Hôte-Pathogènes, Université de Lille, Lille, France.
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Ribeiro K, Sichitiu J, Meuwly JY, Vial Y, Baud D, Desseauve D. [The breech comeback : implementation of a vaginal delivery protocol in the CHUV]. Rev Med Suisse 2018; 14:1888-1892. [PMID: 30375789] [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: 06/08/2023]
Abstract
Choosing between vaginal delivery and caesarean section in cases of breech presentation is still a matter of controversy. In this article, we present the Lausanne University Hospital's protocol following the introduction of an institutional vaginal breech delivery policy. Vaginal breech delivery is a viable alternative to caesarean section in the presence of an experienced obstetrician and rigorous patient-selection criteria.
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Affiliation(s)
| | | | - Jean-Yves Meuwly
- Département de radiodiagnostic et radiologie interventionnelle, CHUV, 1011 Lausanne
| | - Yvan Vial
- Département femme-mère-enfant, CHUV, 1011 Lausanne
| | - David Baud
- Département femme-mère-enfant, CHUV, 1011 Lausanne
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Sedille L, Pierre F, Pourrat O, Desseauve D. Keeping eyes on preeclampsia. Pregnancy Hypertens 2018; 13:286-290. [PMID: 30177067 DOI: 10.1016/j.preghy.2018.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 06/15/2018] [Accepted: 06/30/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Lucie Sedille
- Department of Obstetrics and Gynecology, University Hospital of Poitiers, CS 90577, 86021 Poitiers Cedex, France; Poitiers University, UFR Medicine and Pharmacy, Poitiers, France.
| | - Fabrice Pierre
- Department of Obstetrics and Gynecology, University Hospital of Poitiers, CS 90577, 86021 Poitiers Cedex, France; Poitiers University, UFR Medicine and Pharmacy, Poitiers, France.
| | - Olivier Pourrat
- Poitiers University, UFR Medicine and Pharmacy, Poitiers, France; ICU and Internal Medicine, University Hospital of Poitiers, CS 90577, 86021 Poitiers Cedex, France.
| | - David Desseauve
- Department of Obstetrics and Gynecology, University Hospital of Poitiers, CS 90577, 86021 Poitiers Cedex, France; Poitiers University, UFR Medicine and Pharmacy, Poitiers, France
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Walther D, Halfon P, Desseauve D, Vial Y, Burnand B, Le Pogam MA. Postpartum Hemorrhage: Differences in Definition, Data and Incidence. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i4.779] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
IntroductionPostpartum hemorrhage (PPH) remains a major cause of morbidity and mortality worldwide. Geo-temporal comparisons of in-hospital PPH incidence remain a challenge due to differences in definition, data quality and the absence of accurate, validated indicators.
Objectives and ApproachTo compare the incidence of PPH using different definitions to assess the need for a validated indicator. Singleton births from 2014-2016 at Lausanne University Hospital, Switzerland, were included. PPH was defined based on 1) clinical diagnosis using International Classification of Diseases (ICD-10-GM) PPH diagnostic codes, 2) volume of blood loss ≥500ml for vaginal births and ≥1000ml for cesareans 3) peripartum Hb change >2g/dl in vaginal births and ≥4g/dl in cesareans and 4) fulfillment of criteria from definition one, two or three. Data were extracted from hospital discharge data and linked with electronic health records.
ResultsThere were 2529, 2660 and 2715 singleton births in 2014, 2015 and 2016, respectively, 28.8% were cesareans. Peripartum change in Hb was available for 17% of births. The incidence (95% CI) of PPH in 2014, 2015 and 2016 was, respectively: 1)6.0% (5.1, 7.0), 6.3% (5.4, 7.3) and 7.9% (6.9, 9.0) based on diagnostic codes; 2)7.9% (6.8, 9.0), 7.1% (6.2, 8.2) and 7.2% (6.3, 8.3) based on blood loss volumes; 3)2.4% (1.8, 3.1), 2.7% (2.1, 3.4) and 3.5% (2.9, 4.3) based on change in Hb; 4)11.3% (10.1, 12.6), 10.4% (9.3, 11.6) and 11.0% (9.9, 12.3) based on the combined definition. Differences in PPH incidence by year between definitions one and four, two and four and three and four were all statistically significant (McNemar p-values
Conclusion/ImplicationsIncidence varied widely according to definition and data availability, not to mention data quality. Our results highlight the need for a validated PPH indicator to enable monitoring. Future prospects include the validation of a diagnostic code based PPH indicator aided by text mining in electronic health records.
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Fradet-Menard C, Deparis J, Gachon B, Sichitiu J, Pierre F, Fritel X, Desseauve D. Obstetrical anal sphincter injuries and symptoms after subsequent deliveries: A 60 patient study. Eur J Obstet Gynecol Reprod Biol 2018; 226:40-46. [DOI: 10.1016/j.ejogrb.2018.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 04/22/2018] [Accepted: 05/08/2018] [Indexed: 11/29/2022]
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Gachon B, Desgranges M, Fradet L, Decatoire A, Poireault F, Pierre F, Fritel X, Desseauve D. Is increased peripheral ligamentous laxity in term pregnant women associated with obstetric anal sphincter injury? Int Urogynecol J 2018. [PMID: 29516128 DOI: 10.1007/s00192-018-3598-2] [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] [Indexed: 02/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Increased ligamentous laxity is associated with pelvic floor distension in pregnant women. This considered, it may also be related to the risk of obstetric anal sphincter injury (OASI). Our objective was to assess the association among increased ligamentous laxity, perineal tear severity, and OASI occurrence. METHODS This is a prospective study. We assessed ligamentous laxity between the 36th week of pregnancy and the onset of labor, by measuring the passive extension of the nondominant index finger for a 0.26 N.m torque applied to the second metacarpophalangeal joint (MCP laxity). We collected perineal tear occurrence and classification (Royal College of Obstetricians and Gynecologists). We investigated the MCP laxity distribution according to the stage of perineal tears, and then we looked for a predictive level of MCP laxity for OASI. RESULTS A total of 272 of the 300 pregnant women included had a vaginal delivery and were considered for the analysis. Mean age was 29 years, mean body mass index was 24.5 kg/m2 and 39.2% of women were nulliparous. We reported 12 cases of OASI. MCP laxity significantly increased with the stage of perineal tears from 58° in stage 0 to 69° and 66° for stages 3a and 3b respectively. An MCP laxity higher than 64° was associated with OASI with sensitivity of 75%, specificity of 56%, and an area under the curve of 0.65. CONCLUSION Increased ligamentous laxity seems associated with OASI occurrence, which is the opposite of the initial hypothesis. This suggests that the stiffest tissues might be at a lower risk of injury.
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Affiliation(s)
- Bertrand Gachon
- Department of Obstetrics and Gynecology, La Miletrie University Hospital, 2 rue de la Miletrie CS90577, 86021, Poitiers Cedex, France.
| | - Marion Desgranges
- Department of Obstetrics and Gynecology, La Miletrie University Hospital, 2 rue de la Miletrie CS90577, 86021, Poitiers Cedex, France
| | - Laetitia Fradet
- Pprime Institute, RoBioSS Unit, Poitiers University, ENSMA, CNRS UPR 3346, Futuroscope, France
| | - Arnaud Decatoire
- Department of Obstetrics and Gynecology, La Miletrie University Hospital, 2 rue de la Miletrie CS90577, 86021, Poitiers Cedex, France.,Pprime Institute, RoBioSS Unit, Poitiers University, ENSMA, CNRS UPR 3346, Futuroscope, France
| | - Florian Poireault
- Department of Obstetrics and Gynecology, La Miletrie University Hospital, 2 rue de la Miletrie CS90577, 86021, Poitiers Cedex, France
| | - Fabrice Pierre
- Department of Obstetrics and Gynecology, La Miletrie University Hospital, 2 rue de la Miletrie CS90577, 86021, Poitiers Cedex, France
| | - Xavier Fritel
- Department of Obstetrics and Gynecology, La Miletrie University Hospital, 2 rue de la Miletrie CS90577, 86021, Poitiers Cedex, France.,INSERM, Center for Research in Epidemiology and Population Health (CESP), U1018, Gender, Sexuality and Health Team, Univ Paris-Sud, UMRS 1018, Villejuif, France.,INSERM CIC-P 1402, La Miletrie University Hospital, Poitiers, France
| | - David Desseauve
- Department of Obstetrics and Gynecology, La Miletrie University Hospital, 2 rue de la Miletrie CS90577, 86021, Poitiers Cedex, France.,Pprime Institute, RoBioSS Unit, Poitiers University, ENSMA, CNRS UPR 3346, Futuroscope, France
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Haydar A, Vial Y, Baud D, Desseauve D. [Evolution of cesarean section rates according to Robson classification in a swiss maternity hospital]. Rev Med Suisse 2017; 13:1846-1851. [PMID: 29071835] [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: 06/07/2023]
Abstract
We conducted a retrospective study was conducted in the Centre Hospitalier Universitaire Vaudois (CHUV) including all births between the 1st January 1997 and 31st December 2011 to analyze the cesarean section (CS) rate using the different groups of the Robson classification in a Swiss maternity hospital. The overall CS rate was 29 %, mainly related to group 5 (multiparous with previous CS) and group 2 (nulliparous women induced or who had CS before labor). The study also shows that induction of labor on maternal request in nulliparous at term (group 2a) increased significantly the risk of CS compared to induction of labor for medical reason (p<0.001). The Robson classification system appears as a simple tool for monitoring CS rates. The main strategies for reducing CS rates will be through better selection of women for VBAC (vaginal birth after caesarean) and limitation of induction of labor, especially in nulliparous women.
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Affiliation(s)
- Ahmad Haydar
- Département femme-mère-enfant, CHUV, 1011 Lausanne
| | - Yvan Vial
- Département femme-mère-enfant, CHUV, 1011 Lausanne
| | - David Baud
- Département femme-mère-enfant, CHUV, 1011 Lausanne
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