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Bretelle F, Loubière S, Desbriere R, Loundou A, Blanc J, Heckenroth H, Schmitz T, Benachi A, Haddad B, Mauviel F, Danoy X, Mares P, Chenni N, Ménard JP, Cocallemen JF, Slim N, Sénat MV, Chauleur C, Bohec C, Kayem G, Trastour C, Bongain A, Rozenberg P, Serazin V, Fenollar F. Effectiveness and Costs of Molecular Screening and Treatment for Bacterial Vaginosis to Prevent Preterm Birth: The AuTop Randomized Clinical Trial. JAMA Pediatr 2023; 177:894-902. [PMID: 37459059 PMCID: PMC10352927 DOI: 10.1001/jamapediatrics.2023.2250] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/04/2023] [Indexed: 07/20/2023]
Abstract
Importance Bacterial vaginosis (BV) is a well-known risk factor for preterm birth. Molecular diagnosis of BV is now available. Its impact in the screening and treatment of BV during pregnancy on preterm births has not been evaluated to date. Objective To evaluate the clinical and economic effects of point-of-care quantitative real-time polymerase chain reaction screen and treat for BV in low-risk pregnant women on preterm birth. Design, Setting, and Participants The AuTop trial was a prospective, multicenter, parallel, individually randomized, open-label, superiority trial conducted in 19 French perinatal centers between March 9, 2015, and December 18, 2017. Low-risk pregnant women before 20 weeks' gestation without previous preterm births or late miscarriages were enrolled. Data were analyzed from October 2021 to November 2022. Interventions Participants were randomized 1:1 to BV screen and treat using self-collected vaginal swabs (n = 3333) or usual care (n = 3338). BV was defined as Atopobium vaginae (Fannyhessea vaginae) load of 108 copies/mL or greater and/or Gardnerella vaginalis load of 109 copies/mL or greater, using point-of-care quantitative real-time polymerase chain reaction assays. The control group received usual care with no screening of BV. Main Outcomes and Measures Overall rate of preterm birth before 37 weeks' gestation and total costs were calculated in both groups. Secondary outcomes were related to treatment success as well as maternal and neonate health. Post hoc subgroup analyses were conducted. Results Among 6671 randomized women (mean [SD] age, 30.6 [5.0] years; mean [SD] gestational age, 15.5 [2.8] weeks), the intention-to-treat analysis of the primary clinical and economic outcomes showed no evidence of a reduction in the rate of preterm birth and total costs with the screen and treat strategy compared with usual care. The rate of preterm birth was 3.8% (127 of 3333) in the screen and treat group and 4.6% (153 of 3338) in the control group (risk ratio [RR], 0.83; 95% CI, 0.66-1.05; P = .12). On average, the cost of the intervention was €203.6 (US $218.0) per participant, and the total average cost was €3344.3 (US $3580.5) in the screen and treat group vs €3272.9 (US $3504.1) in the control group, with no significant differences being observed. In the subgroup of nulliparous women (n = 3438), screen and treat was significantly more effective than usual care (RR, 0.62; 95% CI, 0.45-0.84; P for interaction = .003), whereas no statistical difference was found in multiparous (RR, 1.30; 95% CI, 0.90-1.87). Conclusion and Relevance In this clinical trial of pregnant women at low risk of preterm birth, molecular screening and treatment for BV based on A vaginae (F vaginae) and/or G vaginalis quantification did not significantly reduce preterm birth rates. Post hoc analysis suggests a benefit of screen and treat in low-risk nulliparous women, warranting further evaluation in this group. Trial Registration ClinicalTrials.gov Identifier: NCT02288832.
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Affiliation(s)
- Florence Bretelle
- Department of Obstetrics and Gynecology, La Conception Hospital, Assistance Publique–Hopitaux de Marseille, Marseille, France
- Aix-Marseille Univ, IRD, Assistance Publique–Hopitaux de Marseille, UMRD-258 Microbes, Evolution, Phylogenie and Infection (MEPHI), Marseille, France
| | - Sandrine Loubière
- Research Unit EA 3279, CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Raoul Desbriere
- Department of Obstetrics and Gynecology, Fondation Hopital Saint Joseph, Marseille, France
| | - Anderson Loundou
- Research Unit EA 3279, CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Julie Blanc
- Research Unit EA 3279, CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
- Department of Obstetrics and Gynecology, Hopital Nord, Assistance Publique–Hopitaux de Marseille, Marseille, France
| | - Hélène Heckenroth
- Department of Obstetrics and Gynecology, La Conception Hospital, Assistance Publique–Hopitaux de Marseille, Marseille, France
| | - Thomas Schmitz
- Service de Gynécologie Obstétrique, Assistance Publique–Hôpitaux de Paris Hôpital Robert Debré, Université Paris Cité, Paris, France
| | - Alexandra Benachi
- Service de Gynécologie-Obstétrique, DMU Santé des Femmes et des nouveau-nés Hôpital Antoine Béclère, Assistance Publique–Hôpitaux de Paris, Clamart, France
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, Assistance Publique–Hôpitaux de Paris, Université Paris Saclay, Clamart, France
| | - Bassam Haddad
- Centre Hospitalier de Créteil, Créteil, France
- Department of Obstetrics and Gynecology, Institut Mondor de Recherche Biomedicale, Université Paris Est Creteil, Centre Hospitalier Creteil, Creteil, France
| | - Franck Mauviel
- Department of Obstetrics and Gynecology, Centre hospitalier de Toulon sainte Musse, Toulon, France
| | - Xavier Danoy
- Departement of Obstetrics and Gynecology, Centre hospitalier d’Aix en Provence, Centre hospitalier de Pertuis, Aix en Provence, France
| | - Pierre Mares
- Departement of Obstetrics and Gynecology, Centre hospitalier universitaire de Nimes, Nimes, France
| | - Nawal Chenni
- Departement of Obstetrics and Gynecology, Centre hospitalier d’Aubagne, Aubagne, France
| | - Jean-Pierre Ménard
- Direction de la Protection Maternelle et Infantile et de la Promotion de la Santé, Conseil départemental du Val-de-Marne, Créteil, France
| | - Jean-François Cocallemen
- Departement de recherche clinique, Hopital Nord, Assistance hôpitaux de Marseille, Assistance Publique–Hopitaux de Marseille, Marseille, France
| | | | - Marie Victoire Sénat
- Departement Gynécologie Obstétrique, Centre hospitalier Universitaire du Kremlin Bicetre, Kremlin Bicetre, France
- Clinical Epidemiology, Centre de Recherche en épidémiologie et Santé des populations, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Inserm, Team U1018, Villejuif, France
| | - Céline Chauleur
- Service de Gynécologie-obstétrique, CHU de Saint Etienne, INSERM, SAINBIOSE, U1059, Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, Saint Etienne, France
| | | | - Gilles Kayem
- Service de Gynécologie Obstétrique de l’hôpital Trousseau, Université Pierre et Marie Curie, INSERM U1153, Paris, France
| | - Cynthia Trastour
- Departement d’Obstétrique-Reproduction-Gynécologie, Hôpital Archet, CHU de Nice, Nice, France
| | - André Bongain
- Departement d’Obstétrique-Reproduction-Gynécologie, Hôpital Archet, CHU de Nice, Nice, France
| | - Patrick Rozenberg
- Clinical Epidemiology, Centre de Recherche en épidémiologie et Santé des populations, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Inserm, Team U1018, Villejuif, France
- American Hospital of Paris, Neuilly-sur-Seine, France
| | - Valerie Serazin
- Service de Biologie Médicale, CHI de Poissy-Saint-Germain-en-Laye, Poissy, France
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Institut national de la recherche agronomique, Biologie de la Reproduction, Environnement, Epigénétique et Développement, Paris, France
| | - Florence Fenollar
- Department of Infectious Diseases, Hopital de la Timone, Assistance Publique–Hopitaux de Marseille, IHU-Méditerranée Infection, Marseille, France
- Aix-Marseille Univ, Institut recherche et développement, Assistance Publique–Hopitaux de Marseille, SSA, Vecteurs – Infections Tropicales et Méditeranéennes, Marseille, France
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De Berti M, Le Gouge A, Monmousseau F, Gallot D, Sentilhes L, Winer N, Legendre G, Desbriere R, Girault A, Pozzi J, Gachon B, Barjat T, Perrotin F, Brunet-Houdard S, Diguisto C. Oxytocin versus prostaglandins for labour Induction of women with an unfavourable cervix after 24 hours of cervical ripening (OPIC): protocol for an open multicentre randomised non-inferiority trial. BMJ Open 2023; 13:e058282. [PMID: 37068892 PMCID: PMC10111897 DOI: 10.1136/bmjopen-2021-058282] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/30/2022] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION It remains uncertain whether the most appropriate management for women with an unfavourable cervix after 24 hours of cervical ripening is repeating the ripening procedure or proceeding directly to induction by oxytocin. No adequately powered trial has compared these strategies. We hypothesise that induction of labour with oxytocin among women who have just undergone an ineffective first ripening procedure is not associated with a higher risk of caesarean delivery than a repeated cervical ripening with prostaglandins. METHODS AND ANALYSIS We will conduct a multicentre, non-inferiority, open-label, randomised controlled trial aimed at comparing labour induction by oxytocin with a second cervical ripening that uses prostaglandins (slow-release vaginal dinoprostone; oral misoprostol 25 µg; dinoprostone vaginal gel 2 mg). Women (n=1494) randomised in a 1:1 ratio in 10 French maternity units must be ≥18 years with a singleton fetus in vertex presentation, at a term from ≥37+0 weeks of gestation, and have just completed a 24-hour cervical ripening procedure by any method (pharmacological or mechanical) with a Bishop score ≤6. Exclusion criteria comprise being in labour, having more than 3 contractions per 10 min, or a prior caesarean delivery or a history of uterine surgery, or a fetus with antenatally suspected severe congenital abnormalities or a non-reassuring fetal heart rate. The primary endpoint will be the caesarean delivery rate, regardless of indication. Secondary outcomes concern delivery, perinatal morbidity, maternal satisfaction and health economic evaluations. The nature of the assessed procedures prevents masking the study investigators and patients to group assignment. ETHICS AND DISSEMINATION All participants will provide written informed consent. The ethics committee 'Comité de Protection des Personnes Ile de France VII' approved this study on 2 April 2021 (No 2021-000989-15). Study findings will be submitted for publication and presented at relevant conferences. TRIAL REGISTRATION NUMBER NCT04949633.
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Affiliation(s)
- Marion De Berti
- Maternité Olympe de Gouges, Centre Hospitalier Régional Universitaire Tours, Université de Tours, Tours, France
| | | | - Fanny Monmousseau
- Tours University Hospital - Health-Economic Evaluation Unit, CHRU de Tours, Tours Area, France
- University of Tours - EA 7505-Education Ethics Health, Tours Area, France
| | - Denis Gallot
- Service de Gynécologie-Obstétrique, Hôpital d'Estaing, CHU de Clermont-Ferrand, Maternité Clermont Ferrand, France
| | - Loïc Sentilhes
- Service de Gynécologie-Obstétrique, Groupe Hospitalier Pellegrin, CHRU de Bordeaux, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, University Hospital of Nantes, 44093 Nantes, NUN, INRAE, UMR 1280, PhAN, F-44000 Université de Nantes, France
| | - Guillaume Legendre
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Raoul Desbriere
- Department of Obstetrics and Gynecology, Hôpital Saint Joseph, Marseille, France
| | - Aude Girault
- Maternité Port-Royal, AP-HP, Hôpital Cochin, FHU PREMA, F-75014, Paris, France
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE,F-75004, Paris, France
| | - Jordan Pozzi
- CHU Brest, Hôpital Morvan, service de gynécologie-obstétrique, Brest, France
| | - Bertrand Gachon
- Department of Obstetrics and Gynaecology, La Milétrie University Hospital, Poitiers France; Nantes University, Movement - Interactions - Performance, MIP, EA 4334, F-44000 Nantes, France; INSERM CIC-P 1402, La Milétrie University Hospital, Poitiers, France
| | - Thiphaine Barjat
- Service de Gynécologie Obstétrique, CHU de Saint Etienne, Saint Etienne, France
| | - Franck Perrotin
- Maternité Olympe de Gouges, Centre Hospitalier Régional Universitaire Tours, Université de Tours, Tours, France
| | - Solène Brunet-Houdard
- Tours University Hospital - Health-Economic Evaluation Unit, CHRU de Tours, Tours Area, France
- University of Tours - EA 7505-Education Ethics Health, Tours Area, France
| | - Caroline Diguisto
- Maternité Olympe de Gouges, Centre Hospitalier Régional Universitaire Tours, Université de Tours, Tours, France
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE,F-75004, Paris, France
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Girault A, Sentilhes L, Desbriere R, Rozenberg P, Korb D, Bertholdt C, Carrara J, Winer N, Verspyck E, Boudier E, Barjat T, Levy G, Roth GE, Kayem G, Massoud M, Bohec C, Guerby P, Azria E, Blanc J, Heckenroth H, Garabedian C, Le Ray C. Reducing neonatal morbidity by discontinuing oxytocin during the active phase: the STOPOXY trial. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.007] [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: 01/09/2023]
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Groussolles M, Winer N, Sentilhes L, Biquart F, Massoud M, Vivanti AJ, Bouchghoul H, Rozenberg P, Olivier P, Desbriere R, Chauleur C, Perrotin F, Coatleven F, Fuchs F, Bretelle F, Tsatsaris V, Salomon LJ, Sananes N, Kayem G, Houflin-Debarge V, Schmitz T, Benoist G, Arnaud C, Ehlinger V, Vayssière C. Arabin pessary to prevent adverse perinatal outcomes in twin pregnancies with a short cervix: a multicenter randomized controlled trial (PESSARONE). Am J Obstet Gynecol 2022; 227:271.e1-271.e13. [PMID: 35123930 DOI: 10.1016/j.ajog.2022.01.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/17/2022] [Accepted: 01/28/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The number of twin pregnancies continues to increase worldwide as both the number of pregnancies obtained by medically assisted reproduction and age at first pregnancy keep rising. Preterm delivery is the major complication associated with twin pregnancies. The effectiveness of preventive treatments such as progesterone or cervical cerclage for women with a short cervix is doubtful in twin pregnancies. The effectivity of cervical pessaries in preventing preterm birth and its associated morbidity and mortality is also controversial. OBJECTIVE We sought to investigate if the Arabin pessary reduces adverse neonatal outcomes in twin pregnancies with a short cervix. STUDY DESIGN This open-label, multicenter, randomized controlled trial on twin pregnancies with a cervical length of <35 mm compared pessary placement at 16+0 to 24+0 weeks' gestation with standard care alone. The primary endpoint was a composite of adverse neonatal outcomes, namely peripartum or neonatal death or significant neonatal morbidity before hospital discharge, defined as at least 1 of the following complications: bronchopulmonary dysplasia, intraventricular hemorrhage grade III to IV, periventricular leukomalacia, necrotizing enterocolitis grade II or higher, culture-proven sepsis, and retinopathy requiring treatment. A sample size of 308 pregnancies was planned to ensure 80% power to compare the proportions of women with at least 1 infant with an adverse neonatal outcome. The intention-to-treat analysis after multiple imputation of missing data, was supplemented with a secondary analysis that controlled for gestational age and cervical length, both at inclusion. The primary endpoint was also compared between randomization groups in the per-protocol population, which excluded patients with prespecified major protocol violations (mostly cervical cerclage and/or progesterone after inclusion). Secondary endpoints included preterm birth, spontaneous preterm birth, and pessary side effects. RESULTS In total, 315 women were randomized to either receive a pessary (n=157) or standard management (n=158). Overall, 10.8% (34 women) of participants had a missing value for the primary endpoint, mostly (79%) because of the lack of paternal consent for neonatal data collection. In the intention-to-treat analysis, the adverse neonatal outcome occurred in 16.8% of the pessary group vs in 22.5% of the control group (risk ratio, 0.69; 95% confidence interval, 0.39-1.23; P=.210). The per-protocol analysis did not show any significant difference between groups (risk ratio, 0.78; 95% confidence interval, 0.47-1.28; P=.320). The occurrence of preterm birth or spontaneous preterm birth did not differ significantly between groups. No serious side effects were associated with pessary use. CONCLUSION Pessary use in our study did not significantly reduce adverse neonatal outcomes in twin pregnancies with a short cervix.
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Haddad ME, Karlmark K, Donato XC, Martin G, Bretelle F, Lesavre N, Cocallemen JF, Martin M, Picard C, Roudier J, Desbriere R, Lambert NC. Corrigendum: Factors Predicting the Presence of Maternal Cells in Cord Blood and Associated Changes in Immune Cell Composition. Front Immunol 2021; 12:763236. [PMID: 34659269 PMCID: PMC8518619 DOI: 10.3389/fimmu.2021.763236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marina El Haddad
- INSERM UMRs 1097 Arthrites Autoimmunes, Aix Marseille Université, Marseille, France
| | - Karlin Karlmark
- INSERM UMRs 1097 Arthrites Autoimmunes, Aix Marseille Université, Marseille, France
| | - Xavier-Côme Donato
- Department of Obstetrics and Gynecology, St Joseph Hospital, Marseille, France
| | - Gabriel Martin
- INSERM UMRs 1097 Arthrites Autoimmunes, Aix Marseille Université, Marseille, France
| | - Florence Bretelle
- Department of Gynaecology and Obstetrics, Pôle Femme Enfant, AP-HM, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université, France
| | | | - Jean-François Cocallemen
- Department of Gynaecology and Obstetrics, Pôle Femme Enfant, AP-HM, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université, France
| | - Marielle Martin
- INSERM UMRs 1097 Arthrites Autoimmunes, Aix Marseille Université, Marseille, France
| | - Christophe Picard
- Centre National de la Recherche Scientifique (CNRS) UMR7268 (ADES), "Biologie des Groupes Sanguin", Marseille, France.,Etablissement Français du Sang (EFS), Marseille, France
| | - Jean Roudier
- INSERM UMRs 1097 Arthrites Autoimmunes, Aix Marseille Université, Marseille, France.,Service de Rhumatologie, Hôpital Sainte Marguerite, AP-HM, Marseille, France
| | - Raoul Desbriere
- Department of Obstetrics and Gynecology, St Joseph Hospital, Marseille, France
| | - Nathalie C Lambert
- INSERM UMRs 1097 Arthrites Autoimmunes, Aix Marseille Université, Marseille, France
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Haddad ME, Karlmark KR, Donato XC, Martin GV, Bretelle F, Lesavre N, Cocallemen JF, Martin M, Picard C, Roudier J, Desbriere R, Lambert NC. Factors Predicting the Presence of Maternal Cells in Cord Blood and Associated Changes in Immune Cell Composition. Front Immunol 2021; 12:651399. [PMID: 33968049 PMCID: PMC8100674 DOI: 10.3389/fimmu.2021.651399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/09/2021] [Accepted: 03/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background Cord blood (CB) samples are increasingly used as a source of hematopoietic stem cells in transplantation settings. Maternal cells have been detected in CB samples and their presence is associated with a better graft outcome. However, we still do not know what influences the presence of maternal microchimerism (MMc) in CB samples and whether their presence influences CB hematopoietic cell composition. Patients and Methods Here we test whether genetic, biological, anthropometric and/or obstetrical parameters influence the frequency and/or quantity of maternal Mc in CB samples from 55 healthy primigravid women. Mc was evaluated by targeting non-shared, non-inherited Human Leukocyte Antigen (HLA)-specific real-time quantitative PCR in whole blood and four cell subsets (T, B lymphocytes, granulocytes and/or hematopoietic progenitor cells). Furthermore CB samples were analyzed for their cell composition by flow cytometry and categorized according to their microchimeric status. Results MMc was present in 55% of CB samples in at least one cell subset or whole blood, with levels reaching up to 0.3% of hematopoietic progenitor cells. Two factors were predictive of the presence of MMc in CB samples: high concentrations of maternal serological Pregnancy-Associated-Protein-A at first trimester of pregnancy (p=0.018) and feto-maternal HLA-A and/or –DR compatibility (p=0.009 and p=0.01 respectively). Finally, CB samples positive for MMc were significantly enriched in CD56+ cells compared to CB negative for MMc. Conclusions We have identified two factors, measurable at early pregnancy, predicting the presence of maternal cells in CB samples at delivery. We have shown that MMc in CB samples could have an influence on the hematopoietic composition of fetal cells. CD56 is the phenotypic marker of natural killer cells (NK) and NK cells are known to be the main effector for graft versus leukemia reactions early after hematopoietic stem cell transplantation. These results emphasize the importance of MMc investigation for CB banking strategies.
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Affiliation(s)
- Marina El Haddad
- INSERM UMRs 1097 Arthrites Autoimmunes, Aix Marseille Université, Marseille, France
| | - Karlin R Karlmark
- INSERM UMRs 1097 Arthrites Autoimmunes, Aix Marseille Université, Marseille, France
| | - Xavier-Côme Donato
- Department of Obstetrics and Gynecology, St Joseph Hospital, Marseille, France
| | - Gabriel V Martin
- INSERM UMRs 1097 Arthrites Autoimmunes, Aix Marseille Université, Marseille, France
| | - Florence Bretelle
- Department of Gynaecology and Obstetrics, Pôle Femme Enfant, AP-HM, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université, Marseille, France
| | | | - Jean-François Cocallemen
- Department of Gynaecology and Obstetrics, Pôle Femme Enfant, AP-HM, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université, Marseille, France
| | - Marielle Martin
- INSERM UMRs 1097 Arthrites Autoimmunes, Aix Marseille Université, Marseille, France
| | - Christophe Picard
- Centre National de la Recherche Scientifique (CNRS) UMR7268 (ADES), "Biologie des Groupes Sanguins", Marseille, France.,Etablissement Français du Sang PACA Corse, Immunogenetics Laboratory, Marseille, France
| | - Jean Roudier
- INSERM UMRs 1097 Arthrites Autoimmunes, Aix Marseille Université, Marseille, France.,Service de Rhumatologie, Hôpital Sainte Marguerite, AP-HM, Marseille, France
| | - Raoul Desbriere
- Department of Obstetrics and Gynecology, St Joseph Hospital, Marseille, France
| | - Nathalie C Lambert
- INSERM UMRs 1097 Arthrites Autoimmunes, Aix Marseille Université, Marseille, France
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Diguisto C, Le Gouge A, Arthuis C, Winer N, Parant O, Poncelet C, Chauleur C, Hannigsberg J, Ducarme G, Gallot D, Gabriel R, Desbriere R, Beucher G, Faraguet C, Isly H, Rozenberg P, Giraudeau B, Perrotin F. Cervical ripening in prolonged pregnancies by silicone double balloon catheter versus vaginal dinoprostone slow release system: The MAGPOP randomised controlled trial. PLoS Med 2021; 18:e1003448. [PMID: 33571294 PMCID: PMC7877637 DOI: 10.1371/journal.pmed.1003448] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Prolonged pregnancies are a frequent indication for induction of labour. When the cervix is unfavourable, cervical ripening before oxytocin administration is recommended to increase the likelihood of vaginal delivery, but no particular method is currently recommended for cervical ripening of prolonged pregnancies. This trial evaluates whether the use of mechanical cervical ripening with a silicone double balloon catheter for induction of labour in prolonged pregnancies reduces the cesarean section rate for nonreassuring fetal status compared with pharmacological cervical ripening by a vaginal pessary for the slow release of dinoprostone (prostaglandin E2). METHODS AND FINDINGS This is a multicentre, superiority, open-label, parallel-group, randomised controlled trial conducted in 15 French maternity units. Women with singleton pregnancies, a vertex presentation, ≥41+0 and ≤42+0 weeks' gestation, a Bishop score <6, intact membranes, and no history of cesarean delivery for whom induction of labour was decided were randomised to either mechanical cervical ripening with a Cook Cervical Ripening Balloon or pharmacological cervical ripening by a Propess vaginal pessary serving as a prostaglandin E2 slow-release system. The primary outcome was the rate of cesarean for nonreassuring fetal status, with an independent endpoint adjudication committee determining whether the fetal heart rate was nonreassuring. Secondary outcomes included delivery (time from cervical ripening to delivery, number of patients requiring analgesics), maternal and neonatal outcomes. Between January 2017 and December 2018, 1,220 women were randomised in a 1:1 ratio, 610 allocated to a silicone double balloon catheter, and 610 to the Propess vaginal pessary for the slow release of dinoprostone. The mean age of women was 31 years old, and 80% of them were of white ethnicity. The cesarean rates for nonreassuring fetal status were 5.8% (35/607) in the mechanical ripening group and 5.3% (32/609) in the pharmacological ripening group (proportion difference: 0.5%; 95% confidence interval (CI) -2.1% to 3.1%, p = 0.70). Time from cervical ripening to delivery was shorter in the pharmacological ripening group (23 hours versus 32 hours, median difference 6.5 95% CI 5.0 to 7.9, p < 0.001), and fewer women required analgesics in the mechanical ripening group (27.5% versus 35.4%, difference in proportion -7.9%, 95% CI -13.2% to -2.7%, p = 0.003). There were no statistically significant differences between the 2 groups for other delivery, maternal, and neonatal outcomes. A limitation was a low observed rate of cesarean section. CONCLUSIONS In this study, we observed no difference in the rates of cesarean deliveries for nonreassuring fetal status between mechanical ripening with a silicone double balloon catheter and pharmacological cervical ripening with a pessary for the slow release of dinoprostone. TRIAL REGISTRATION ClinicalTrials.gov NCT02907060.
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Affiliation(s)
- Caroline Diguisto
- Pôle de gynécologie obstétrique, médecine fœtale, médecine et biologie de la reproduction, centre Olympe de Gouges, CHRU de Tours, Tours, France
- Université de Tours, France
- Université de Paris, CRESS, INSERM, INRA, Paris, France
- * E-mail:
| | | | - Chloé Arthuis
- Department of Obstetrics and Gynecology, University Hospital of Nantes, NUN, INRAE, UMR 1280, PhAN, Université de Nantes, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, University Hospital of Nantes, NUN, INRAE, UMR 1280, PhAN, Université de Nantes, France
| | - Olivier Parant
- Pôle de gynécologie obstétrique, hôpital Paule-de-Viguier, CHU de Toulouse, Toulouse, France
| | - Christophe Poncelet
- Department of Obstetrics and Gynecology, Rene DUBOS Hospital, Cergy-Pontoise, France
- Université Paris 13, Sorbonne Paris Cité, UFR SMBH, Bobigny, France
| | - Celine Chauleur
- Department of Gynecology and Obstetrics, University Hospital of Saint-Etienne, Saint-Etienne, France
- INSERM, SAINBIOSE, U1059, Dysfonction Vasculaire et Hémostase, Université Jean-Monnet; CIC1408, Saint-Etienne, France
| | - Jacob Hannigsberg
- CHU Brest, Hôpital Morvan, service de gynécologie-obstétrique, Brest, France
| | - Guillaume Ducarme
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche sur Yon, France
| | - Denis Gallot
- Pôle femme et enfant, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, Clermont-Ferrand, France, Team Translational approach to epithelial injury and repair, UMR6293 CNRS-Université Clermont Auvergne, U1103 Inserm, GReD, Clermont-Ferrand, France
| | - Rene Gabriel
- Service de Gynécologie-Obstétrique, Hôpital Maison Blanche, Reims Cedex, Université de Reims Champagne Ardennes, France
| | - Raoul Desbriere
- Hôpital Saint Joseph, Department of Obstetrics and Gynecology, Marseille, France
| | - Gael Beucher
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, Caen, France
| | - Cyrille Faraguet
- Service de Gynécologie Obstétrique, Centre Hospitalier de Chartre, France
| | - Helene Isly
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire de Rennes, France
| | - Patrick Rozenberg
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France
- Versailles St-Quentin University, research unit EA 7285. Montigny-le-Bretonneux, France
| | - Bruno Giraudeau
- Université de Tours, France
- INSERM CIC1415, CHRU de Tours, Tours, France
| | - Franck Perrotin
- Pôle de gynécologie obstétrique, médecine fœtale, médecine et biologie de la reproduction, centre Olympe de Gouges, CHRU de Tours, Tours, France
- Université de Tours, France
- INSERM U1253 Imaging and Brain (iBrain), Tours, France
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8
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Tenoudji-Cohen Couka L, Donato XC, Glowaczower E, Squercioni-Aumont A, Katsogiannou M, Desbriere R. Does Assessment of Cervical Phosphorylated Insulin-like Growth Factor Binding Protein-1 by Bedside Vaginal Swab Test Really Predict Preterm Birth? Reprod Sci 2021; 28:2006-2011. [PMID: 33405213 DOI: 10.1007/s43032-020-00432-y] [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: 07/14/2020] [Accepted: 12/13/2020] [Indexed: 11/25/2022]
Abstract
Preterm birth is the first cause of neonatal mortality and is associated with elevated risks of long-term complications such as neurodevelopmental impairment. Prediction of spontaneous preterm birth, one of the biggest challenges in obstetrics, aims at delaying birth in order to allow corticosteroid therapy and, if necessary, transfer of patient to a higher-level maternity care unit. We aimed to assess the predictive role of phIGFBP-1 (Actim® Partus) diagnostic test on patients at risk of preterm labor, routinely used in our institution. We conducted a retrospective cohort study on 99 patients admitted in the high-risk pregnancy unit of our institution from June 2012 to November 2014. The primary outcome measures were delivery before 34+0 and 37+0 weeks. Data analysis allowed measure of Actim® Partus test sensitivity (Se), specificity (Sp), positive and negative predictive values (PPV and NPV), diagnostic efficiency as well as positive and negative likelihood ratios. Actim® Partus test features (Se, Sp, PPV and NPV) were 53.3, 67.9, 23.5 and 88.7% respectively for deliveries occurring ≤ 34+0 weeks and 54.2, 75.4, 55.8, and 74.2%, respectively, for deliveries occurring ≤ 37+0 weeks. Diagnostic efficiency of the test was 65.7% (≤ 34+0 weeks) and 67.7% (≤ 37+0 weeks). Positive likelihood ratios were 1.6 (≤ 34+0 weeks) and 2.2 (≤ 37+0 weeks). Negative likelihood ratios were 0.7 (≤ 34+0 weeks) and 0.6 (≤ 37+0 weeks). Results of our study show that phIGFBP-1 diagnostic test is not accurate enough in predicting preterm birth before 34+0 or 37+0 weeks, and therefore, there is little clinical interest in its everyday use.
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Affiliation(s)
- Laura Tenoudji-Cohen Couka
- Department of Obstetrics and Gynecology, Hôpital Saint Joseph, 26 Boulevard de Louvain, FR-13008, Marseille, France
| | - Xavier-Côme Donato
- Department of Obstetrics and Gynecology, Hôpital Saint Joseph, 26 Boulevard de Louvain, FR-13008, Marseille, France
| | - Eric Glowaczower
- Department of Obstetrics and Gynecology, Hôpital Saint Joseph, 26 Boulevard de Louvain, FR-13008, Marseille, France
| | - Anne Squercioni-Aumont
- Department of Obstetrics and Gynecology, Hôpital Saint Joseph, 26 Boulevard de Louvain, FR-13008, Marseille, France
| | - Maria Katsogiannou
- Department of Obstetrics and Gynecology, Hôpital Saint Joseph, 26 Boulevard de Louvain, FR-13008, Marseille, France
| | - Raoul Desbriere
- Department of Obstetrics and Gynecology, Hôpital Saint Joseph, 26 Boulevard de Louvain, FR-13008, Marseille, France.
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9
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Katsogiannou M, Amar-Millet A, Muller C, Desbriere R. Radiofrequency ablation of retained placenta accreta after conservative management. Eur J Obstet Gynecol Reprod Biol 2019; 240:383-384. [PMID: 31337515 DOI: 10.1016/j.ejogrb.2019.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 07/15/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Maria Katsogiannou
- Hôpital Saint Joseph, Department of Obstetrics and Gynecology, FR-13008, Marseille, France
| | - Annie Amar-Millet
- Hôpital Saint Joseph, Department of Anesthetics, FR-13008, Marseille, France
| | - Cyrille Muller
- Hôpital Saint Joseph, Department of Radiology, FR-13008, Marseille, France
| | - Raoul Desbriere
- Hôpital Saint Joseph, Department of Obstetrics and Gynecology, FR-13008, Marseille, France.
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10
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Katsogiannou M, Donato XC, Loundou A, Glowaczower E, Raffray M, Planchet-Barraud B, Quarello E, Brechard MP, Desbriere R. Managing pain and anxiety during transabdominal chorionic villus sampling. A noninferiority randomized trial of nitrous oxide vs local anesthesia. Acta Obstet Gynecol Scand 2018; 98:351-358. [PMID: 30346026 DOI: 10.1111/aogs.13495] [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: 09/05/2018] [Accepted: 10/17/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Transabdominal chorionic villus sampling (CVS) is an invasive procedure for prenatal diagnosis reported to be associated with anxiety and pain. In this context, the need for analgesia during CVS has been considered useful. Even though several authors have been interested in pain management during amniocentesis, no study has been published on pain reduction during CVS. Our objective was to evaluate pain and anxiety management during transabdominal CVS using nitrous oxide (N2 O) and local anesthesia. MATERIAL AND METHODS In a randomized controlled noninferiority trial, self-administered nitrous oxide (N2 O) inhalation (equimolar premix of oxygen and nitrous oxide) was compared with local anesthesia (1% lidocaine) before CVS. Primary outcome was pain and secondary outcome was anxiety, both measured on a visual analog scale 30-60 minutes before, immediately after (5-10 minutes) and 30-60 minutes after CVS. With a statistical power of 90%, type I error of 5% and two-sided test and potential exclusions, a sample size of 96 patients per group was enrolled and randomized. No patient was enrolled before the trial registration date. RESULTS From 13 March 2013 through 10 February 2015, 192 patients (96 per group) were screened and randomized. Most characteristics were similar across groups. Pain in the N2 O group was 2.65 ± 0.22 vs 3.32 ± 0.26 in local anesthesia group [mean ± standard error of mean (SEM)]. Mean anxiety in the N2 O group was 3.17 ± 0.27 vs 5.19 ± 0.30 in the local anesthesia group. CONCLUSION N2 O was as efficient and even superior to local anesthesia for both pain and anxiety reduction during CVS, as the 95% confidence intervals were both below the prespecified noninferiority margin of 0.8 and below zero.
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Affiliation(s)
- Maria Katsogiannou
- Department of Obstetrics and Gynecology, Hôpital Saint Joseph, Marseille, France.,Department of Clinical Research, Hôpital Saint Joseph, Marseille, France
| | - Xavier-Côme Donato
- Department of Obstetrics and Gynecology, Hôpital Saint Joseph, Marseille, France
| | - Anderson Loundou
- Department of Epidemiology and Methodology, Aix Marseille University, Marseille, France
| | - Eric Glowaczower
- Department of Obstetrics and Gynecology, Hôpital Saint Joseph, Marseille, France
| | - Marie Raffray
- Department of Clinical Research, Hôpital Saint Joseph, Marseille, France
| | | | - Edwin Quarello
- Department of Obstetrics and Gynecology, Hôpital Saint Joseph, Marseille, France
| | - Marie-Pierre Brechard
- Department of Reproductive Medicine and Biology, Hôpital Saint Joseph, Marseille, France
| | - Raoul Desbriere
- Department of Obstetrics and Gynecology, Hôpital Saint Joseph, Marseille, France
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11
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Donato XC, Brechard MP, François-Renard P, Hairion D, Quarello E, Hoffet M, Katsogiannou M, Desbriere R. Pregnancy course and outcomes in mosaic trisomy 16 confined to the placenta: A case series. Prenat Diagn 2018; 38:924-927. [PMID: 30198079 DOI: 10.1002/pd.5357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/04/2018] [Accepted: 09/05/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Xavier-Côme Donato
- Hôpital Saint Joseph, Obstetrics and Gynecology Department, FR-13008, Marseille, France
| | - Marie-Pierre Brechard
- Hôpital Saint Joseph, Reproductive Medicine and Biology Department, FR-13008, Marseille, France
| | | | - Dominique Hairion
- Institut de Médecine de la Reproduction (IMR), Genetics Department, Marseille, France
| | - Edwin Quarello
- Hôpital Saint Joseph, Obstetrics and Gynecology Department, FR-13008, Marseille, France
| | - Médéric Hoffet
- Hôpital Saint Joseph, Obstetrics and Gynecology Department, FR-13008, Marseille, France
| | - Maria Katsogiannou
- Hôpital Saint Joseph, Obstetrics and Gynecology Department, FR-13008, Marseille, France
| | - Raoul Desbriere
- Hôpital Saint Joseph, Obstetrics and Gynecology Department, FR-13008, Marseille, France
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12
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Amouroux M, Mieusset R, Desbriere R, Opinel P, Karsenty G, Paci M, Fernandes S, Courbiere B, Perrin J. Are men ready to use thermal male contraception? Acceptability in two French populations: New fathers and new providers. PLoS One 2018; 13:e0195824. [PMID: 29813095 PMCID: PMC5973589 DOI: 10.1371/journal.pone.0195824] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 06/30/2017] [Accepted: 03/30/2018] [Indexed: 11/21/2022] Open
Abstract
Background Since the 1970s, international research has actively pursued hormonal male contraception (HMC) and, to a lesser extent, thermal male contraception (TMC). Although the efficacy of TMC has been confirmed in limited populations, its acceptability has not been studied in either potential users or potential prescribers. Methods A cross-sectional descriptive multicentre study of potential male users of TMC (new fathers) and potential prescribers of TMC (new providers) was conducted between November 2016 and February 2017.The participants completed a 3-part survey, and their responses were evaluated to i) determine their socio-demographic profiles; ii) identify personal experiences with contraception; and iii) gauge the participants’ knowledge, interest and preference for male contraception, particularly TMC. For new providers only, the survey included a fourth part to evaluate professional experience with male contraception. Results The participation rate was 51% for new fathers (305 NFs) and 34% for new providers (300 NPs, including 97 men (male new providers, MNPs) and 203 women (female new providers, FNPs)). Only 3% of NFs and 15% of NPs knew about TMC (including 26% of the MNPs and 10% of the FNPs, p<0.01). After reading information on TMC, new fathers were significantly less willing to try TMC (29%) than were new providers (40%) (p<0.01). The 3 main advantages of TMC for the new fathers included the following factors: “natural” (52%), “without side effects” (38%) and “non-hormonal” (36%). The main disadvantages were “lengthy wear time” (56%), “daily undergarment wear” (43%) and “concern about possible discomfort” (39%). Conclusions Young male and female providers have limited knowledge of male contraception, are interested in further information and would generally prescribe TMC to their patients. Successful expansion of the use of male contraception, including TMC, would require distribution of better information to potential users and providers.
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Affiliation(s)
- Marie Amouroux
- Département Universitaire de Médecine Générale Faculté de Médecine de Marseille Aix-Marseille Université, Marseille, France
| | - Roger Mieusset
- Université Toulouse III-Paul Sabatier, Groupe de Recherche en Fertilité Humaine (Human Fertility Research Group), Toulouse, France
- Andrologie-Médecine de la Reproduction, Hôpital Paule de Viguier, CHU de Toulouse, Toulouse, France
| | - Raoul Desbriere
- Service de Gynécologie-Obstétrique, Pôle Parents Enfants, Hôpital Saint-Joseph, Bd de Louvain, Marseille, France
| | - Pierre Opinel
- Centre Hospitalier Pays d'Aix, Aix-en-Provence, France
| | - Gilles Karsenty
- Service d’Urologie et Transplantation Rénale, Aix Marseille Université, CHU La Conception, Marseille, France
| | - Marine Paci
- Aix Marseille Univ, INSERM, GMGF UMR_S 910, Marseille, France
- AP-HM La Conception, Centre Clinico-Biologique d'Assistance Médicale à la Procréation -CECOS, Marseille, France
| | - Sara Fernandes
- Laboratoire de Santé Publique, bd Jean Moulin–Marseille, France
| | - Blandine Courbiere
- AP-HM La Conception, Centre Clinico-Biologique d'Assistance Médicale à la Procréation -CECOS, Marseille, France
- Aix Marseille Univ, CNRS, IRD, Avignon Univ, IMBE UMR 7263, Marseille, France
| | - Jeanne Perrin
- AP-HM La Conception, Centre Clinico-Biologique d'Assistance Médicale à la Procréation -CECOS, Marseille, France
- Aix Marseille Univ, CNRS, IRD, Avignon Univ, IMBE UMR 7263, Marseille, France
- * E-mail:
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13
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Desbriere R, Pascal A, Katsogiannou M, Mace P, Laplane C, Amar-Millet A, Albert P, Bayle O. Delayed disseminated intravascular coagulation revealed by spontaneous hematomas after conservative treatment of placenta percreta. Eur J Obstet Gynecol Reprod Biol 2018; 226:77-78. [PMID: 29804883 DOI: 10.1016/j.ejogrb.2018.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 05/15/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Raoul Desbriere
- Obstetrics and Gynecology unit, Hôpital Saint Joseph, Marseille, France.
| | - Alain Pascal
- Obstetrics and Gynecology unit, Hôpital Saint Joseph, Marseille, France
| | - Maria Katsogiannou
- Obstetrics and Gynecology unit, Hôpital Saint Joseph, Marseille, France; Clinical Research unit, Hôpital Saint Joseph, Marseille, France
| | - Pierre Mace
- Department of Gynecology and Obstetrics, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille, France
| | - Charlotte Laplane
- Department of Gynecology and Obstetrics, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille, France
| | | | - Paul Albert
- Urology Unit, Hôpital Saint Joseph, Marseille, France
| | - Olivier Bayle
- Radiology Unit, Hôpital Saint Joseph, Marseille, France
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Sénat MV, Affres H, Letourneau A, Coustols-Valat M, Cazaubiel M, Legardeur H, Jacquier JF, Bourcigaux N, Simon E, Rod A, Héron I, Castera V, Sentilhes L, Bretelle F, Rolland C, Morin M, Deruelle P, De Carne C, Maillot F, Beucher G, Verspyck E, Desbriere R, Laboureau S, Mitanchez D, Bouyer J. Effect of Glyburide vs Subcutaneous Insulin on Perinatal Complications Among Women With Gestational Diabetes: A Randomized Clinical Trial. JAMA 2018; 319:1773-1780. [PMID: 29715355 PMCID: PMC6583037 DOI: 10.1001/jama.2018.4072] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [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] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Randomized trials have not focused on neonatal complications of glyburide for women with gestational diabetes. OBJECTIVE To compare oral glyburide vs subcutaneous insulin in prevention of perinatal complications in newborns of women with gestational diabetes. DESIGN, SETTINGS, AND PARTICIPANTS The Insulin Daonil trial (INDAO), a multicenter noninferiority randomized trial conducted between May 2012 and November 2016 (end of participant follow-up) in 13 tertiary care university hospitals in France including 914 women with singleton pregnancies and gestational diabetes diagnosed between 24 and 34 weeks of gestation. INTERVENTIONS Women who required pharmacologic treatment after 10 days of dietary intervention were randomly assigned to receive glyburide (n=460) or insulin (n=454). The starting dosage for glyburide was 2.5 mg orally once per day and could be increased if necessary 4 days later by 2.5 mg and thereafter by 5 mg every 4 days in 2 morning and evening doses, up to a maximum of 20 mg/d. The starting dosage for insulin was 4 IU to 20 IU given subcutaneously 1 to 4 times per day as necessary and increased according to self-measured blood glucose concentrations. MAIN OUTCOMES AND MEASURES The primary outcome was a composite criterion including macrosomia, neonatal hypoglycemia, and hyperbilirubinemia. The noninferiority margin was set at 7% based on a 1-sided 97.5% confidence interval. RESULTS Among the 914 patients who were randomized (mean age, 32.8 [SD, 5.2] years), 98% completed the trial. In a per-protocol analysis, 367 and 442 women and their neonates were analyzed in the glyburide and insulin groups, respectively. The frequency of the primary outcome was 27.6% in the glyburide group and 23.4% in the insulin group, a difference of 4.2% (1-sided 97.5% CI, -∞ to 10.5%; P=.19). CONCLUSION AND RELEVANCE This study of women with gestational diabetes failed to show that use of glyburide compared with subcutaneous insulin does not result in a greater frequency of perinatal complications. These findings do not justify the use of glyburide as a first-line treatment. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01731431.
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Affiliation(s)
- Marie-Victoire Sénat
- Assistance Publique–Hôpitaux de Paris, Department of Gynecology-Obstetrics, Bicêtre Hospital, Le Kremlin-Bicêtre, France
- University of Paris-Sud, University of Medicine Paris-Saclay, Le Kremlin-Bicêtre, France
- Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Université Paris-Sud, Université de Versailles Saint-Quentin-en-Yvelines, INSERM, Villejuif, France
| | - Helene Affres
- Assistance Publique–Hôpitaux de Paris, Department of Reproductive Endocrinology, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Alexandra Letourneau
- Assistance Publique–Hôpitaux de Paris, Department of Gynecology-Obstetrics, Béclère Hospital, Clamart, France
| | - Magali Coustols-Valat
- Department of Endocrinology-Obstetrics, Toulouse University Hospital, Toulouse, France
| | - Marie Cazaubiel
- Department of Endocrinology, Lille University Hospital EA 4489–Environnement Périnatal et Santé, Lille, France
| | - Helene Legardeur
- Assistance Publique–Hôpitaux de Paris, Department of Gynecology and Obstetrics, Hôpital Louis Mourier, Colombes, France
| | - Julie Fort Jacquier
- Department of Gynecology-Obstetrics, Poissy St-Germain Hospital, Poissy, France
| | - Nathalie Bourcigaux
- Assistance Publique–Hôpitaux de Paris, Department of Endocrinology, St Antoine Hospital Paris, France
| | - Emmanuel Simon
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital Center of Tours, Tours, France
| | - Anne Rod
- Department of Endocrinology, Caen University Hospital, Caen, France, France
| | - Isabelle Héron
- Department of Endocrinology, Rouen University Hospital–Charles Nicolle, Rouen, France
| | - Virginie Castera
- Department of Endocrinology, St Joseph Hospital, Marseille, France
| | - Loic Sentilhes
- Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Florence Bretelle
- Assistance Publique–Hôpitaux de Marseille; AMU, Aix-Marseille Université, Department of Gynecology and Obstetrics, Pole Femme Enfant, Marseille, France
| | - Catherine Rolland
- Assistance Publique–Hôpitaux de Paris, Department of Hepato-Enterology-Gastroenteritis, Béclère Hospital, Clamart, France
| | - Mathieu Morin
- Department of Gynecology-Obstetrics, Toulouse University Hospital, Toulouse, France
| | - Philippe Deruelle
- Department of Gynecology-Obstetrics, Lille University, EA 4489–Environnement Périnatal et Santé, Lille, France
| | - Celine De Carne
- Assistance Publique–Hôpitaux de Paris, Department of Gynecology-Obstetrics, Trousseau Hospital, Paris, France
| | - François Maillot
- Department of Internal Medicine, François-Rabelais University, University Hospital Center of Tours, Tours, France
| | - Gael Beucher
- Department of Gynecology-Obstetrics, Caen University Hospital, Caen, France, France
| | - Eric Verspyck
- Department of Gynecology and Obstetrics, Rouen University Hospital–Charles Nicolle, Rouen, France
| | - Raoul Desbriere
- Department of Gynecology-Obstetrics, St Joseph Hospital, Marseille, France
| | | | - Delphine Mitanchez
- Assistance Publique–Hôpitaux de Paris, Sorbonne Universities, University Pierre and Marie Curie, University Paris 06, Department of Neonatology, Armand Trousseau Hospital, Paris, France
| | - Jean Bouyer
- Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Université Paris-Sud, Université de Versailles Saint-Quentin-en-Yvelines, INSERM, Villejuif, France
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15
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Haumonte JB, Raylet M, Christophe M, Mauviel F, Bertrand A, Desbriere R, d'Ercole C. French validation and adaptation of the Grobman nomogram for prediction of vaginal birth after cesarean delivery. J Gynecol Obstet Hum Reprod 2017; 47:127-131. [PMID: 29229362 DOI: 10.1016/j.jogoh.2017.12.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 12/03/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To validate Grobman nomogram for predicting vaginal birth after cesarean delivery (VBAC) in a French population and adapt it. STUDY DESIGN Multicenter retrospective study of maternal and obstetric factors associated with VBAC between May 2012 and May 2013 in 6 maternity units. External validation and adaptation of the prenatal and intrapartum Grobman nomograms for vaginal birth prediction after cesarean delivery in a French cohort. RESULTS The study included 523 women with previous cesarean deliveries; 70% underwent a trial of labor for a subsequent delivery (n=367) with a success rate of 65% (n=240). In the univariate analysis, 5 factors were associated with successful VBAC: previous vaginal delivery before the cesarean (P<0.001), the number of previous vaginal deliveries (P<0.001), and a favorable cervix at delivery room admission, cervical effacement (P=0.035), or cervical dilatation at least 3cm (P<0.001), or a Bishop score >6 (P=0.03). A potentially recurrent indication (defined as arrest of dilation or descent as the indication for the previous cesarean) (P=0.039), a hypertensive disorder during pregnancy (P=0.05), and labor induction (P=0.017) were each associated with failed VBAC. External validation of the prenatal and intrapartum Grobman nomograms showed an area under the ROC curve of 69% (95% CI: 0.638, 0.736) and 65% (95% CI: 0.599, 0.700) respectively. Adaptation of the nomogram to the French cohort resulted in the inclusion of the following factors: maternal age, body mass index at last prenatal visit, hypertensive disorder, gestational age at delivery, recurring indication, cervical dilatation, and induction of labor. Its area under the curve to predict successful VBAC was 78% (95% CI: 0.738, 0.825). CONCLUSION The nomogram to predict VBAC developed by Grobman et al. is validated in the French population. Adaptation to the French population, by excluding ethnicity, appeared to improve its performance. Impact of the nomogram use on the caesarean section rate has to be validated in a randomized control trial.
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Affiliation(s)
- J-B Haumonte
- Obstetrics and Gynaecology unit, Hospital Saint-Joseph, 13285 Marseille, France; Hôpital Nord, Assistance publique-hôpitaux de Marseille, 13015 Marseille, France.
| | - M Raylet
- Obstetrics and Gynaecology unit, centre hospitalier du Pays d'Aix, 13616 Aix-en-Provence, France
| | - M Christophe
- Obstetrics and Gynaecology unit, CHG de Martigues, 13500 Martigues, France
| | - F Mauviel
- Obstetrics and Gynaecology unit, CHIC de Toulon-La-Seyne, 83100 Toulon-La-Seyne, France
| | - A Bertrand
- Obstetrics and Gynaecology unit, CHG de Salon-de-Provence, 13300 Salon-de-Provence, France
| | - R Desbriere
- Obstetrics and Gynaecology unit, Hospital Saint-Joseph, 13285 Marseille, France
| | - C d'Ercole
- Obstetrics and Gynaecology unit, hôpital Conception, Assistance publique-hôpitaux de Marseille, 13005 Marseille, France
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Dabadie A, Quarello E, Degardin N, Desbriere R, Heckenroth H, Sigaudy S, Gorincour G. Added value of MRI for the prenatal diagnosis of isolated orofacial clefts and comparison with ultrasound. Diagn Interv Imaging 2016; 97:915-21. [DOI: 10.1016/j.diii.2015.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 09/03/2015] [Accepted: 11/20/2015] [Indexed: 10/22/2022]
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Pivano A, Alessandrini M, Desbriere R, Agostini A, Opinel P, d’Ercole C, Haumonte JB. A score to predict the risk of emergency caesarean delivery in women with antepartum bleeding and placenta praevia. Eur J Obstet Gynecol Reprod Biol 2015; 195:173-176. [DOI: 10.1016/j.ejogrb.2015.10.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/29/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
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Lafouge A, Gorincour G, Desbriere R, Quarello E. Prenatal diagnosis of Blake's pouch cyst following first-trimester observation of enlarged intracranial translucency. Ultrasound Obstet Gynecol 2012; 40:479-480. [PMID: 22271517 DOI: 10.1002/uog.11099] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Quarello E, Saada J, Desbriere R, Rousseau V, De Lagausie P, Benachi A. Prenatal diagnosis and evaluation of defect length in esophageal atresia using direct and indirect (tracheal print) signs. Ultrasound Obstet Gynecol 2011; 38:225-228. [PMID: 21105018 DOI: 10.1002/uog.8888] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/2010] [Indexed: 05/30/2023]
Abstract
The prenatal diagnosis of esophageal atresia is challenging. The length of the defect of the esophageal atretic portion is one of the parameters affecting outcome and prenatal evaluation of this length has not, to our knowledge, been described previously. We report on seven fetuses assessed prospectively which were suspected to have esophageal atresia. Targeted ultrasound examination of both fetal cervical and thoracic structures was performed in each case in order to assess prenatally the atretic portion. The length of the defect was assessed both directly, by visualizing the interruption of the hyperechoic lines representing the walls of the esophagus in a mid-sagittal view (n = 4), and indirectly, by means of the 'tracheal print' (n = 5). Both methods were used in three cases. Prenatal results were compared with postnatal or postmortem findings. The prenatal diagnosis of esophageal atresia was made correctly in six of the seven cases and in all of these there was concordance between prenatal and postnatal estimates of the esophageal defect lengths. Direct or indirect sonographic assessment of the esophagus in cases of suspected prenatal esophageal atresia improves the specificity of its diagnosis and aids prenatal evaluation.
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Affiliation(s)
- E Quarello
- Unité d'Échographies Obstétricales, Pôle Parents Enfants, Hôpital Saint Joseph, Marseille, France.
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Carcopino X, Blanc J, Courbiere B, Desbriere R, Bretelle F, Boubli L, d’Ercole C. Reply of the authors. Fertil Steril 2011. [DOI: 10.1016/j.fertnstert.2011.04.086] [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: 10/18/2022]
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21
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Blanc J, Courbiere B, Desbriere R, Bretelle F, Boubli L, d’Ercole C, Carcopino X. Is uterine-sparing surgical management of persistent postpartum hemorrhage truly a fertility-sparing technique? Fertil Steril 2011; 95:2503-6. [DOI: 10.1016/j.fertnstert.2011.01.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Revised: 12/07/2010] [Accepted: 01/06/2011] [Indexed: 11/26/2022]
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Desbriere R, Courbiere B, Mattei S, Haumonte JB, Shojaï R, Antonini F, d'Ercole C, Boubli L. Hemostatic multiple square suturing is an effective treatment for the surgical management of intractable obstetric hemorrhage. Eur J Obstet Gynecol Reprod Biol 2008; 138:244-6. [PMID: 17490801 DOI: 10.1016/j.ejogrb.2007.03.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Revised: 02/14/2007] [Accepted: 03/26/2007] [Indexed: 11/25/2022]
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Abstract
Adipose tissue synthesizes all components of the renin-angiotensin system. The renin receptor (RenR) is able, on renin binding, to increase its efficiency to generate angiotensin I from angiotensinogen. We demonstrate that RenR is specifically synthesized in the stromal portion of human adipose tissue in both isolated interadipocyte stromal cells and in stromal areas. RenR is expressed at the periphery of cells, strongly suggesting a membranal localization. RenR protein expression in primary cultures of human stromal cells decreased significantly during differentiation, whereas RenR mRNA levels did not change, demonstrating that RenR was expressed in both preadipocyte and nonpreadipocyte cells, and was regulated at a posttranscriptional level. Double-labeling immunohistochemistry of human adipose tissue sections revealed that RenR was colocalized with renin, whereas incubation of 3T3-L1, a preadipocyte cell line, with renin stimulated the phosphorylation state of the intracellular signaling pathway ERK 1/2, and short exposure of human adipose stromal cells in primary culture to renin was followed by a long-lasting dose-dependent increase of angiotensin I generation, indicating that adipose RenR is functional. We show, using a large set of human adipose tissue biopsies, that RenR expression was increased in visceral compared with subcutaneous adipose tissue of lean and obese patients. Taken together with our finding that RenR was colocalized with plasminogen activator inhibitor type 1, the main inhibitor of the fibrinolytic system in visceral adipose tissue, the above-mentioned data suggest that RenR plays a role in obesity-induced visceral adipose tissue accumulation and its accompanying cardiovascular complications.
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Affiliation(s)
- Vincent Achard
- Inserm UMR 626, Faculté de Médecine, 27 Boulevard Jean Moulin, 13385 Marseille cedex 5, France
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Paulmyer-Lacroix O, Desbriere R, Poggi M, Achard V, Alessi MC, Boudouresque F, Ouafik L, Vuaroqueaux V, Labuhn M, Dutourand A, Grino M. Expression of adrenomedullin in adipose tissue of lean and obese women. Eur J Endocrinol 2006; 155:177-85. [PMID: 16793965 DOI: 10.1530/eje.1.02170] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Adrenomedullin (AM), a potent vasodilatator and antioxidative peptide, was shown recently to be expressed by adipose tissue. The aim of our study was to investigate the precise localization of AM within human adipose tissue, and to examine AM regulation in obesity. DESIGN Subcutaneous (SC) and omental (OM) adipose tissues from 9 lean and 13 obese women were profiled for AM expression changes. Preadipocytes from human adipose tissue were isolated and differentiated under defined adipogenic conditions. METHODS AM expression was analyzed by immunohistochemistry, in situ hybridization and quantitative RT-PCR. RESULTS A strong AM expression was observed in vessel walls, stromal cell clusters and isolated stromal cells, some of them being CD 68 positive, whereas mature adipocytes were not labeled. Calcitonin receptor-like receptor and receptor activity-modifying proteins (RAMP) 2 and RAMP 3 were expressed in vessel walls. In vitro, preadipocytes of early differentiation stages spontaneously secreted AM. No difference in AM localization was found between SC and OM adipose tissue. AM levels in SC tissue did not differ between lean and obese subjects. By contrast, AM levels in OM tissue were significantly higher in obese as compared with lean women. Moreover, we found a positive relationship between OM AM and tumor necrosis factor alpha mRNA levels and AM-immunoreactive area in OM tissue followed the features of the metabolic syndrome. CONCLUSION Stromal cells from human adipose tissue, including macrophages, produce AM. Its synthesis increased in the OM territory during obesity and paralleled the features of the metabolic syndrome. Therefore, AM should be considered as a new member of the adipokine family.
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Affiliation(s)
- O Paulmyer-Lacroix
- Inserm UMR 626, UFR de Médecine secteur Timone, 27 Bd Jean Moulin, 13385 Marseille cedex 5, France.
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Desbriere R, Vuaroqueaux V, Achard V, Boullu-Ciocca S, Labuhn M, Dutour A, Grino M. 11beta-hydroxysteroid dehydrogenase type 1 mRNA is increased in both visceral and subcutaneous adipose tissue of obese patients. Obesity (Silver Spring) 2006; 14:794-8. [PMID: 16855188 DOI: 10.1038/oby.2006.92] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.9] [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] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Data from rodents provide evidence for a causal role of 11beta-hydroxysteroid dehydrogenase type 1 (11beta-HSD-1) in the development of obesity and its complications. In humans, 11beta-HSD-1 is increased in subcutaneous adipose tissue (SAT) of obese patients, and higher adipose 11beta-HSD-1 was associated with features of the metabolic syndrome. To date, there is no evidence for an increased expression of 11beta-HSD-1 in human visceral adipose tissue (VAT), although VAT is the major predictor for insulin resistance and the metabolic syndrome. RESEARCH METHODS AND PROCEDURES 11beta-HSD-1 and hexose-6-phosphate dehydrogenase (the enzyme responsible for the synthesis of nicotinamide adenine dinucleotide phosphate, the cofactor required for 11beta-HSD-1 oxoreductase activity) mRNA levels were measured using real-time quantitative reverse transcriptase-polymerase chain reaction in abdominal SAT and VAT biopsies obtained from 10 normal-weight and 12 obese women. Adiponectin mRNA was used as an internal control. RESULTS 11beta-HSD-1 mRNA concentrations were significantly increased in both SAT and VAT of obese patients (720% and 450% of controls, respectively; p < 0.05) and correlated with hexose-6-phosphate dehydrogenase mRNA levels. The level of VAT 11beta-HSD-1 mRNA correlated with anthropometric parameters: BMI (r = 0.41, p = 0.05), waist circumference (r = 0.44, p = 0.04), abdominal sagittal diameter (r = 0.51, p = 0.02), and percentage fat (r = 0.51, p = 0.02). DISCUSSION Our results demonstrate for the first time that 11beta-HSD-1 mRNA expression is increased in VAT from obese patients. They strengthen the importance of 11beta-HSD-1 in human obesity and its associated complications and suggest the need of clinical studies with specific 11beta-HSD-1 inhibitors.
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Affiliation(s)
- Raoul Desbriere
- Service de Gynécologie/Obstétrique, CHU Nord, Marseille, France
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Martin F, Viviand X, Desbriere R, Boubli L, Martin C. [Do we have to monitor foetal heart rate during general anesthesia?]. ACTA ACUST UNITED AC 2005; 23:1179-81. [PMID: 15589358 DOI: 10.1016/j.annfar.2004.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2004] [Accepted: 09/10/2004] [Indexed: 10/26/2022]
Abstract
We present a case of an emergency Caesarean section due to misinterpretation of the cardiotocography (CTG) trace during general anaesthesia for treatment of dental abscess. Following failure of the dental abscess treatment under local anaesthesia, a 29-year-old female in the 36th week of a twin pregnancy was to undergo general anaesthesia. Foetal well-being was monitored with ultrasonographic evaluations of foetal heart rate. During surgery, senior obstetrician recorded a lack of beat-to-beat variability of the cardiotocography trace. The CTG pattern was interpreted as foetal distress and an emergency Caesarean section was performed under general anaesthesia. That was probably due to general anaesthesia. Then, two infants were extracted without neonatal distress necessitating intubation. This case report underlines the risk to misread an intraoperative CTG monitoring and if the CTG monitoring is normal before anaesthesia, reduced foetal beat-to-beat variability with a normal baseline heart rate during general anaesthesia is probably normal.
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Affiliation(s)
- F Martin
- Département d'anesthésie et de réanimation, CHU Nord, boulevard Pierre-Dramard, 13915, Marseille 20, France.
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d'Ercole C, Shojai R, Desbriere R, Cravello L, Boubli L. [Surgical management of primary postpartum hemorrhage]. J Gynecol Obstet Biol Reprod (Paris) 2004; 33:4S103-4S119. [PMID: 15577736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Despite the development of medical, obstetrical and arterial embolization techniques to control acute postpartum hemorrhage, familiarity with surgical procedures is essential. They may be the ultimate available option in order to obtain hemostasis. Conservative techniques consist of arterial ligations and uterine compression sutures that preserve the reproductive future and may be combined together. Radical options include hysterectomy which may be total or sub-total. To date, there are no comparative trials assessing the superiority of a given surgical option. In this review, the main surgical interventions are described and a practical stepwise approach is discussed according to the etiology, based on a professional consensus work-shop. Surgical management must be timely triggered after failure of first line treatments and integrated in a global strategy aimed to cease hemorrhage. It should be adapted to the available local health resources and in compliance with the various members of the medical staff.
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Affiliation(s)
- C d'Ercole
- Service de Gynécologie-Obstétrique, Hôpital Nord, chemin des Bourrelys, 13015 Marseille. Claude.D'
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Quarello E, Desbriere R, Hartung O, Portier F, d'Ercole C, Boubli L. [Postpartum ovarian vein thrombophlebitis: report of 5 cases and review of the literature]. ACTA ACUST UNITED AC 2004; 33:430-40. [PMID: 15480283 DOI: 10.1016/s0368-2315(04)96551-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Postpartum ovarian vein thrombophlebitis (POVT) is an uncommon life-threatening situation. It should be systematically evoked in case of persistent fever during the postpartum. We describe here the imaging techniques to assert the diagnosis and the different therapeutic options. METHODS AND MATERIAL We report five cases from 1997 to 2002. Only one patient was surgically treated. RESULTS No death was observed. In all cases, fever and pain rapidly disappeared. CONCLUSION Search for postpartum ovarian vein thrombophlebitis should be undertaken in patients with persistent fever. Treatment is more often medical.
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Affiliation(s)
- E Quarello
- Service de Gynécologie-Obstétrique, Université de la Méditerranée, Faculté de Médecine, Marseille.
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Abstract
INTRODUCTION Fetal invasive procedures provide ovular samples that are helpful in establishing diagnosis, etiology, and prognosis when ultrasonography and MRI show a central nervous system (CNS) anomaly or when the fetus is at high risk of such pathology. PROCEDURES Invasive procedure techniques are amniocentesis, fetal blood sampling (FBS), and chorionic villous sampling (CVS). They provide material for fetal DNA, biochemical analysis, or identification of various infectious agents. COMPLICATIONS The main complications are miscarriage and premature delivery. Counseling the parents about the risks and benefits of these procedures is therefore mandatory. DISCUSSION Amniocentesis may be performed as early as 15 weeks' gestation and is the most widely used invasive technique. FBS is performed after 18 to 20 weeks of pregnancy and CVS may be carried out after 11 weeks. Indications for invasive techniques include DNA and cytogenetic analysis, diagnosis of neural tube defects, identification of infectious agents (toxoplasmosis, cytomegalovirus, rubella, and varicella), and etiology of intracerebral hemorrhage (fetal platelets and coagulation factors).
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Affiliation(s)
- Claude d'Ercole
- Service de Gynecologie Obstétrique, Hôpital Nord, Chemin des Borrellys, 13015 Marseille, France. Claude.D'
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D'ercole C, Bretelle F, Shojai R, Desbriere R, Boubli L. [Tocolysis: indications and contraindications. When to start and when to stop]. J Gynecol Obstet Biol Reprod (Paris) 2002; 31:5S84-95. [PMID: 12454630] [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: 02/27/2023]
Abstract
Clinical trials have demonstrated that most tocolytic agents such as beta mimetics, atosiban and indometacine -exception made for magnesium sulfate- extend the duration of pregnancy, when compared to placebo. They reduce the rate of delivery at 24 hours, 48 hours and at 7 days. There is no proof however for their beneficial effect on perinatal or neonatal outcomes. Usual obstetrical contraindications of tocolytic treatments (infection, genital haemorrhage, fetal distress and certain maternal conditions) are often determined on a case by case basis, rather than upon evidence based medicine. Tocolysis may be considered in case of maternal infection without chorioamniotitis or during moderate hemorrhage due to placenta preavia (NP 4). There is no objective argument to refute a tocolytic attempt due and in accordance with a low gestationnal age limit. The risk for neonatal respiratory distress syndrome is higher at 34 weeks compared to 35 and 36 weeks. The studies were however realized before the corticosteroid era of fetal lung maturation. There are no available randomized trials concerning the benefits of tocolysis after 34 weeks of amenorrhea. Furthermore, there are no satisfactory trials preconising a specific tocolytic agent based on amniotic liquid study of lung maturity. In case of advanced cervical dilatation, rare studies have concluded the usefulness of tocolysis to allow fetal lung maturation by corticosteroids. Most studies have evaluated the effectiveness of tocolytic treatment during 48 hours. There is no evidence for continuing tocolytic treatment after an effective tocolysis prescribed during the first 48 hours. For intermediate situations, between franc success or failure of tocolysis (such as reduction but persistent painful uterine contractions or major cervical modification at a low gestational age despite reduction of uterine contractile activity), literature guidelines are poorly contributive. The management of such patients is most often empirical.
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Affiliation(s)
- C D'ercole
- Service de Gynécologie-Obstétrique, Hôpital Nord, chemin des Bourrelys, 13015 Marseille, France.
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Desbriere R, Roquelaure B, Sarles J, Boubli L. [Pregnancy in a patient treated with trientine dihydrochloride for Wilson's disease]. Presse Med 1998; 27:806. [PMID: 9767885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
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