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Gaucher L, Puill C, Baumann S, Hommey S, Touzet S, Rudigoz RC, Cortet M, Huissoud C, Gaucherand P, Dupont C, Mougeot F. The challenge of adopting a collaborative information system for independent healthcare workers in France: a comprehensive study. Sci Rep 2024; 14:11429. [PMID: 38763960 PMCID: PMC11102904 DOI: 10.1038/s41598-024-62164-2] [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] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 05/14/2024] [Indexed: 05/21/2024] Open
Abstract
This study aimed to explore the perception of an underutilised collaborative information system through qualitative research, utilizing semi-structured, in-depth interviews with independent midwives and physician. PROSPERO, is a collaborative information system designed to bridge the communication gap between community-based healthcare workers and hospital-based care teams for parturients in Lyon, France. Through 27 semi-structured in-depth interviews with midwives, obstetricians, and general practitioners, we identified key themes related to the system's adoption: implementation challenges, utilisation barriers, interprofessional dynamics, and hidden variables affecting system use. Participants recognised the potential of PROSPERO to improve information sharing and care coordination but expressed concerns about the system's integration into existing workflows, time constraints, and the need for adequate training and technical support. Interprofessional dynamics revealed differing perspectives between hospital and independent practitioners, emphasising the importance of trust-building and professional recognition. Hidden variables, such as hierarchical influences and confidentiality concerns, further complicated the system's adoption. Despite the consensus on the benefits of a collaborative information system, its implementation was hindered by mistrust between healthcare workers (i.e. between independent practitioners and hospital staff). Our findings suggest that fostering trust and addressing the identified barriers are crucial steps towards successful system implementation. The study contributes to understanding the complex interplay of factors influencing the adoption of collaborative healthcare technologies and highlights the need for strategies that support effective interprofessional collaboration and communication.ClinicalTrials ID NCT02593292.
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Affiliation(s)
- Laurent Gaucher
- Pôle de santé publique, Hospices Civils de Lyon, 69500, Bron, France.
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, 69008, Lyon, France.
- GENeva MIdwifery Research unit, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland.
| | - Céline Puill
- Independent Midwife, 94120, Val de Marne, France
| | - Sophie Baumann
- Midwifery Department, EA 7285, Versailles Saint Quentin University, 78180, Montigny-le-Bretonneux, France
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, 78300, Poissy, France
| | - Sophie Hommey
- Pôle de santé publique, Hospices Civils de Lyon, 69500, Bron, France
| | - Sandrine Touzet
- Pôle de santé publique, Hospices Civils de Lyon, 69500, Bron, France
| | | | - Marion Cortet
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, 69004, Lyon, France
| | - Cyril Huissoud
- Hospices Civils de Lyon, Hôpital Femme Mère Enfant, 69004, Lyon, France
| | - Pascal Gaucherand
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, 69008, Lyon, France
- Hospices Civils de Lyon, Hôpital Femme Mère Enfant, 69004, Lyon, France
| | - Corinne Dupont
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, 69008, Lyon, France
- Réseau Périnatal Aurore, 69004, Lyon, France
| | - Frédéric Mougeot
- Centre Max Weber, UMR 5283, Institut des Sciences de l'Homme, 69363, Lyon, France
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Sentilhes L, Seco A, Azria E, Beucher G, Bonnet MP, Branger B, Carbillon L, Chiesa C, Crenn-Hebert C, Dreyfus M, Dupont C, Fresson J, Huissoud C, Langer B, Morel O, Patrier S, Perrotin F, Raynal P, Rozenberg P, Rudigoz RC, Vendittelli F, Winer N, Deneux-Tharaux C, Kayem G. Conservative management or cesarean hysterectomy for placenta accreta spectrum: the PACCRETA prospective study. Am J Obstet Gynecol 2022; 226:839.e1-839.e24. [PMID: 34914894 DOI: 10.1016/j.ajog.2021.12.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 07/16/2021] [Revised: 11/24/2021] [Accepted: 12/09/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Placenta accreta spectrum is a life-threatening condition that has increased dramatically in recent decades along with cesarean rates worldwide. Cesarean hysterectomy is widely practiced in women with placenta accreta spectrum; however, the maternal outcomes after cesarean hysterectomy have not been thoroughly compared with the maternal outcomes after alternative approaches, such as conservative management. OBJECTIVE This study aimed to compare the severe maternal outcomes between women with placenta accreta spectrum treated with cesarean hysterectomy and those treated with conservative management (leaving the placenta in situ). STUDY DESIGN From a source population of 520,114 deliveries in 176 hospitals (PACCRETA study), we designed an observational cohort of women with placenta accreta spectrum who had either a cesarean hysterectomy or a conservative management (the placenta left in situ) during cesarean delivery. Clinicians prospectively identified women meeting the inclusion criteria and included them at delivery. Data collection started only after the women had received information and agreed to participate in the study in the immediate postpartum period. The primary outcome was the transfusion of >4 units of packed red blood cells within 6 months after delivery. Secondary outcomes were other maternal complications within 6 months. We used propensity score weighting to account for potential indication bias. RESULTS Here, 86 women had conservative management and 62 women had cesarean hysterectomy for placenta accreta spectrum during cesarean delivery. The primary outcome occurred in 14 of 86 women in the conservative management group (16.3%) and 36 of 61 (59.0%) in the cesarean hysterectomy group (risk ratio in propensity score weighted model, 0.29; 95% confidence interval, 0.19-0.45). The rates of hysterectomy, total estimated blood loss exceeding 3000 mL, any blood product transfusion, adjacent organ injury, and nonpostpartum hemorrhage-related severe maternal morbidity were lower with conservative management than with cesarean hysterectomy (all adjusted, P≤.02); but, the rates of arterial embolization, endometritis, and readmission within 6 months of discharge were higher with conservative management than with cesarean hysterectomy. CONCLUSION Among women with placenta accreta spectrum who underwent cesarean delivery, conservative management was associated with a lower risk of transfusion of >4 units of packed red blood cells within 6 months than cesarean hysterectomy.
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Affiliation(s)
- Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France.
| | - Aurélien Seco
- Obstetrical Perinatal and Paediatric Epidemiology Research Team, National Institute of Health and Medical Research, National Institute of Agronomic Research, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Paris University, Paris, France; Clinical Research Unit of Paris Descartes Necker Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Elie Azria
- Obstetrical Perinatal and Paediatric Epidemiology Research Team, National Institute of Health and Medical Research, National Institute of Agronomic Research, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Paris University, Paris, France; Maternité Notre-Dame de Bon Secours, Groupe Hospitalier Paris Saint-Joseph, Paris University, Paris, France
| | - Gaël Beucher
- Department of Obstetrics and Gynecology, Caen University Hospital, Caen, France
| | - Marie-Pierre Bonnet
- Department of Anesthesia and Critical Care, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Bernard Branger
- "Sécurité Naissance-Naître Ensemble" Perinatal Network of the Pays de la Loire, Pays de la Loire, France
| | - Lionel Carbillon
- "Naître dans l'Est Francilien" Perinatal Network, Sorbonne Paris North University, Villetaneuse, France
| | - Coralie Chiesa
- Obstetrical Perinatal and Paediatric Epidemiology Research Team, National Institute of Health and Medical Research, National Institute of Agronomic Research, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Paris University, Paris, France
| | - Catherine Crenn-Hebert
- Department of Obstetrics and Gynecology, Louis-Mourier University Hospital, Assistance Publique-Hôpitaux de Paris, Colombes, France; "Hauts de Seine" (PERINAT92) Perinatal Network, Issy-les-Moulineaux, Paris, France
| | - Michel Dreyfus
- Department of Obstetrics and Gynecology, Caen University Hospital, Caen, France
| | - Corinne Dupont
- Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France; "Aurore" Perinatal Network, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France
| | - Jeanne Fresson
- Obstetrical Perinatal and Paediatric Epidemiology Research Team, National Institute of Health and Medical Research, National Institute of Agronomic Research, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Paris University, Paris, France; Department of Medical Information, Nancy University Hospital, Nancy, France
| | - Cyril Huissoud
- Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France; Department of Obstetrics and Gynecology, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France
| | - Bruno Langer
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Olivier Morel
- Department of Obstetrics and Gynecology, Nancy University Hospital, Nancy, France
| | - Sophie Patrier
- Department of Pathology, Rouen University Hospital, Rouen, France
| | - Franck Perrotin
- Department of Obstetrics and Gynecology, Tours University Hospital, Tours, France
| | - Pierre Raynal
- Department of Obstetrics and Gynecology, Versailles Hospital, Versailles, France
| | - Patrick Rozenberg
- Department of Obstetrics and Gynecology, Poissy University Hospital, Poissy, France
| | - René-Charles Rudigoz
- Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France; Department of Obstetrics and Gynecology, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France
| | - Francoise Vendittelli
- Auvergne Perinatal Network, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France; Department of Obstetrics and Gynecology, University Hospital of Clermont-Ferrand, Scientific Research National Center, SIGMA Clermont, Institute Pascal, Clermont-Ferrand, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, Nantes University Hospital, Nantes, France
| | - Catherine Deneux-Tharaux
- Obstetrical Perinatal and Paediatric Epidemiology Research Team, National Institute of Health and Medical Research, National Institute of Agronomic Research, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Paris University, Paris, France
| | - Gilles Kayem
- Obstetrical Perinatal and Paediatric Epidemiology Research Team, National Institute of Health and Medical Research, National Institute of Agronomic Research, Centre for Epidemiology and Statistics Sorbonne Paris Cité, Paris University, Paris, France; Department of Obstetrics and Gynecology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Gaucher L, Huissoud C, Ecochard R, Rudigoz RC, Cortet M, Bouvet L, Bouveret L, Touzet S, Gonnaud F, Colin C, Gaucherand P, Dupont C. Women's dissatisfaction with inappropriate behavior by health care workers during childbirth care in France: A survey study. Birth 2021; 48:328-337. [PMID: 33686732 DOI: 10.1111/birt.12542] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Quality care during childbirth requires that health care providers have not only excellent skills but also appropriate and considerate attitudes and behavior. Few studies have examined the proportion of women in Western countries expressing dissatisfaction with such inappropriate or inconsiderate behavior. This study evaluated this proportion in a sample presumably representative of French maternity units. METHODS This prospective multicenter study, using data from a selfadministered questionnaire, took place in 25 French maternity units during one week in September 2018. The primary outcome measure was mothers' self-reported dissatisfaction with blatantly inappropriate behavior (ie, inappropriate attitude, inadequate respect for privacy, insufficient gentleness of care, and/or inappropriate language) by health care workers in the delivery room. The secondary outcome was their self-reported dissatisfaction with these workers' inconsiderate behavior (ie, unclear and inappropriate information, insufficient participation in decision-making, or deficient consideration of pain). RESULTS Of 803 potentially eligible women, 627 completed the questionnaire after childbirth; 5.62% (35/623, 95% CI: 3.94-7.73) reported dissatisfaction with blatantly inappropriate behaviors and 9.79% (61/623, 95% CI: 7.57-12.40) with inconsiderate behaviors. The main causes of dissatisfaction reported by women in this survey were the inadequate consideration of their pain and the failure to share decision-making. CONCLUSIONS Most of the women were satisfied with how health care workers behaved towards them in the delivery room. Nonetheless, health care staff must be aware of women's demands for greater consideration of their expressions of pain and of their voice in decisions.
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Affiliation(s)
- Laurent Gaucher
- Hôpital Femme - Mère-Enfant, Hospices Civils de Lyon, Bron, France.,Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France.,Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Cyril Huissoud
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Lyon, France.,Inserm U846, Stem Cell and Brain Research Institute, Bron, France
| | | | | | - Marion Cortet
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Lyon, France.,CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Lionel Bouvet
- Hôpital Femme - Mère-Enfant, Hospices Civils de Lyon, Bron, France.,Inserm U1032, Laboratory of Therapeutic Applications of Ultrasound, Lyon, France
| | | | - Sandrine Touzet
- Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France.,Pôle de Santé Publique, Hospices Civils de Lyon, Lyon, France
| | | | - Cyrille Colin
- Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France.,Pôle de Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Pascal Gaucherand
- Hôpital Femme - Mère-Enfant, Hospices Civils de Lyon, Bron, France.,Réseau Périnatal AURORE, Lyon, France
| | - Corinne Dupont
- Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France.,Réseau Périnatal AURORE, Lyon, France
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Kayem G, Seco A, Beucher G, Dupont C, Branger B, Crenn Hebert C, Huissoud C, Fresson J, Winer N, Langer B, Rozenberg P, Morel O, Bonnet MP, Perrotin F, Azria E, Carbillon L, Chiesa C, Raynal P, Rudigoz RC, Dreyfus M, Vendittelli F, Patrier S, Deneux-Tharaux C, Sentilhes L. Clinical profiles of placenta accreta spectrum: the PACCRETA population-based study. BJOG 2021; 128:1646-1655. [PMID: 33393174 DOI: 10.1111/1471-0528.16647] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe and compare the characteristics of women with placenta accreta spectrum (PAS) and their pregnancy outcomes according to the presence of placenta praevia and a prior caesarean section. DESIGN Prospective population-based study. SETTING All 176 maternity hospitals of eight French regions. POPULATION Two hundred and forty-nine women with PAS, from a source population of 520 114 deliveries. METHODS Women with PAS were classified into two risk-profile groups, with or without the high-risk combination of placenta praevia (or an anterior low-lying placenta) and at least one prior caesarean. These two groups were described and compared. MAIN OUTCOME MEASURES Population-based incidence of PAS, characteristics of women, pregnancies, deliveries and pregnancy outcomes. RESULTS The PAS population-based incidence was 4.8/10 000 (95% CI 4.2-5.4/10 000). After exclusion of women lost to follow up from the analysis, the group with placenta praevia and a prior caesarean included 115 (48%) women and the group without this combination included 127 (52%). In the group with both factors, PAS was more often suspected antenatally (77% versus 17%; P < 0.001) and more often percreta (38% versus 5%; P < 0.001). This group also had more hysterectomies (53% versus 21%, P < 0.001) and higher rates of blood product transfusions, maternal complications, preterm births and neonatal intensive care unit admissions. Sensitivity analysis showed similar results after exclusion of women who delivered vaginally. CONCLUSION More than half the cases of PAS occurred in women without the combination of placenta praevia and a prior caesarean delivery, and these women had better maternal and neonatal outcomes. We cannot completely rule out that some of the women who delivered vaginally had placental retention rather than PAS; however, we found similar results among women who delivered by caesarean. TWEETABLE ABSTRACT Half the women with PAS do not have both placenta praevia and a prior caesarean delivery, and they have better maternal outcomes.
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Affiliation(s)
- G Kayem
- Trousseau Hospital, APHP, Sorbonne University, Paris, France.,CRESS U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France
| | - A Seco
- CRESS U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France.,Clinical Research Unit Necker Cochin, APHP, Paris, France
| | - G Beucher
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, CHU de Caen, Caen Cedex, France
| | - C Dupont
- Réseau Périnatal Aurore, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon, France.,Health Services and Performance Research HESPER EA 7425, Université de Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - B Branger
- Réseau « Sécurité Naissance - Naître ensemble » des Pays-de-la-Loire, France
| | - C Crenn Hebert
- Louis Mourier University Hospital, APHP, Colombes, France.,Réseau Périnatal des Hauts de Seine, PERINAT92, Issy-les-Moulineaux, France
| | - C Huissoud
- Health Services and Performance Research HESPER EA 7425, Université de Lyon, University Claude Bernard Lyon 1, Lyon, France.,Maternité de la Croix Rousse, Lyon, France
| | - J Fresson
- CRESS U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France.,CHRU Nancy, Réseau Périnatal Lorrain, France
| | - N Winer
- Service de Gynécologie Obstétrique HME Université de Nantes, NUN, INRA, UMR 1280, Phan, Université de Nantes, Nantes, France
| | - B Langer
- CHU de Strasbourg, Strasbourg, France
| | | | - O Morel
- CHRU de Nancy, Nancy, France
| | - M P Bonnet
- Anaesthesia and Critical Care department, Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | | | - E Azria
- CRESS U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France.,Maternity Unit, Paris Saint Joseph Hospital, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - L Carbillon
- Réseau Périnatal NEF Naître dans l'Est Francilien, Paris 13 University, France
| | - C Chiesa
- CRESS U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France
| | - P Raynal
- CH de Versailles, Site Andre Mignot, Versailles, France
| | - R C Rudigoz
- Health Services and Performance Research HESPER EA 7425, Université de Lyon, University Claude Bernard Lyon 1, Lyon, France.,Maternité de la Croix Rousse, Lyon, France
| | - M Dreyfus
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, CHU de Caen, Caen Cedex, France
| | - F Vendittelli
- Réseau de Santé en Périnatalité d'Auvergne, CHU de Clermont-Ferrand, France.,CNRS, SIGMA Clermont, Institut Pascal, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | | | - C Deneux-Tharaux
- CRESS U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France
| | - L Sentilhes
- Department of Obstetrics and Gynaecology, Bordeaux University Hospital, Bordeaux, France
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Le Mitouard M, Gaucher L, Huissoud C, Gaucherand P, Rudigoz RC, Dupont C, Cortet M. Decision-delivery intervals: Impact of a colour code protocol for emergency caesareans. Eur J Obstet Gynecol Reprod Biol 2019; 246:29-34. [PMID: 31927407 DOI: 10.1016/j.ejogrb.2019.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Assess the impact of implementation by simple distribution of a "colour code" protocol for emergency caesareans on the course over time of the "decision-delivery interval" (DDI) and neonatal outcome. DESIGN Observational study in 26 maternity units of the AURORE perinatal network, conducted between October 1, 2017, and April 30, 2018. Each maternity ward́ was supposed to prospectively include 20 consecutive cases of caesareans performed either as an emergency, that is, as a code orange, or an extreme emergency, that is, code red. We compared the DDIs observed in 2017 to those in 2007 according to the degree of emergency, the maternity unit level of care, and their adherence to the protocol. Neonatal outcome in 2007 and 2017, assessed from laboratory and clinical indicators, was also compared, overall and according to the degree of emergency. RESULTS The DDI was significantly lower in 2017 (n = 478) than in 2007 (n = 447), regardless of the degree of emergency and the level of care (p < 0.0001). In 2017, all code red caesareans were performed in less than 15 min in level 3 maternity units compared with 73 % (p = 0.039) in 2007. Fewer than 20 % of the caesareans in the 2007 study period were performed in less than 15 min in level 1 and 2 maternity units. Today, this is the case for 83 % of these caesareans in level 2 units (p < 0.001) and 36 % in level 1 (p = 0.01). In 2017, code orange caesareans were performed in less than 30 min in 96 % of cases in level 3 units, 67 % in level 2, and 33 % in level 1, compared respectively with 67 % (p = 0.015), 25 % (p < 0.0001) and 16 % (p = 0.0003) in 2007. We did not observe any difference in the neonatal outcome between 2007 and 2017 or as a function of the DDI expected based on the caesarean colour code. CONCLUSION The implementation of the colour code protocols was associated with an improved DDI and better adherence to the recommendations in all 26 maternity units in this perinatal network.
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Affiliation(s)
- Marine Le Mitouard
- Hospices civils de Lyon, Service de Gynécologie-Obstétrique, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.
| | - Laurent Gaucher
- Hospices civils de Lyon, Service de Gynécologie-Obstétrique, Hôpital Femme Mère Enfant, 59 boulevard Pinel, 69500, Bron-Lyon, France; Health Services and Performance Research - HESPER EA 7425, F-69008, Lyon, France
| | - Cyril Huissoud
- Hospices civils de Lyon, Service de Gynécologie-Obstétrique, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France; Université Claude-Bernard Lyon 1, 43, boulevard du 11-Novembre-1918, 69100, Villeurbanne, France
| | - Pascal Gaucherand
- Hospices civils de Lyon, Service de Gynécologie-Obstétrique, Hôpital Femme Mère Enfant, 59 boulevard Pinel, 69500, Bron-Lyon, France
| | - René-Charles Rudigoz
- Hospices civils de Lyon, Service de Gynécologie-Obstétrique, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France
| | - Corinne Dupont
- Hospices civils de Lyon, Service de Gynécologie-Obstétrique, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France; Health Services and Performance Research - HESPER EA 7425, F-69008, Lyon, France
| | - Marion Cortet
- Hospices civils de Lyon, Service de Gynécologie-Obstétrique, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France; UMR CNRS 5558, laboratoire de biométrie et biologie évolutive, équipe biostatistiques santé, « adresse Lacassagne », 69008, Lyon, France
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Panchbhaya N, Bats AS, Bonsang-Kitzis H, Ray-Coquard I, Lauraine EP, Colombo E, Fabbro M, Rouzier R, Pautier P, Le Gall E, Classe JM, Loaec C, Floquet A, Guyon F, Babin G, Lanse F, Renaudin M, Joly F, Huchon C, Dubot C, Provansal M, Lavau-Denes S, Pomel C, Cornou C, Augereau P, Lecomte LL, Kurtz JE, Remoue P, Sterkers N, Uzan C, Marchand E, Nadeau C, Iurisci I, Barletta H, Aleba A, Blanchot J, Rudigoz RC, Philip CA, Lecuru F. Surgical management of Low-Grade Serous Carcinoma of the ovary: Results of a multicenter study from The French National Network dedicated to Ovarian Malignant Rare Tumors (TMRO). Eur J Obstet Gynecol Reprod Biol 2019. [DOI: 10.1016/j.ejogrb.2018.08.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ancel J, Rault E, Fernandez MP, Huissoud C, Savidan A, Gaire C, Dupont C, Rudigoz RC. When can obstetric risk be predicted? J Gynecol Obstet Hum Reprod 2018; 48:179-186. [PMID: 30580069 DOI: 10.1016/j.jogoh.2018.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 12/06/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of the study was to assess the chronology of the appearance of perpartum obstetric risk factors (POR) in order to define the best moment to evaluate the type of management to which women will be oriented. We have secondarily studied the extent to which inappropriate medical interventions play a role in the genesis of some complications in the deliveries of women who are in principle at low risk. MATERIALS AND METHODS We conducted a prospective cohort study from January 1 to June 30, 2015 at the Croix-Rousse Hospital of Lyon, a level III maternity, and the Valence Hospital Center, a level II maternity, including all women giving birth at 24 to 42 weeks of gestation at hospital. The women were divided into two groups : one with no known perpartum obstetric risk (POR-) and the other with at least one obstetrical perpartum risk factor (POR+), defined at three different stages (at the last pregnancy monitoring consultation, at the onset of labor at the admission in the delivery room, and at the end of labor just before expulsive efforts). We observed medical interventions and foeto-maternal complications in each group. A non-simple delivery was a delivery involving a medical intervention, or a maternal or neonatal complication, or any combination of these. A secondary retrospective analysis of the practices and management was made for women initially considered POR- at the onset of labor but who had a non-simple delivery to assess adherence to current guidelines according to an audit schedule. RESULTS Among 1975 women, we identified 32% women as POR- at end of pregnancy, 21% at start of labor and 20% at end of labor. Among the POR- women at start of labor, 16% had a non-simple delivery. 35% of these non-simple deliveries might perhaps have been avoided by closer adherence to current recommendations. Nonetheless 54% of these women still had an unpredictable and inevitable non-simple delivery that in some cases required an extremely rapid intervention. CONCLUSION Determining and predicting pregnant women who will need additional resources in addition to the usual obstetric and neonatal care is difficult. This identification should be made at the admission for delivery and this risk should be reassessed during labor. There are no women at zero risk of intervention. Therefore, delivery in demedicalized units should not take place in isolated or distant free-standing facilities.
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Affiliation(s)
- Julie Ancel
- Service de gynécologie obstétrique CH de la Croix Rousse, France.
| | - Emmanuel Rault
- Service de gynécologie obstétrique CH de Valence, France
| | | | - Cyril Huissoud
- Service de gynécologie obstétrique CH de la Croix Rousse, France
| | - Anne Savidan
- Service de gynécologie obstétrique CH de Valence, France
| | - Coralie Gaire
- Service de gynécologie obstétrique CH de Valence, France
| | | | - R C Rudigoz
- Service de gynécologie obstétrique CH de la Croix Rousse, France
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Carrabin N, Benchaib M, Fontaine O, Levrat A, Massignon D, Touzet S, Rudigoz RC, Berland M, Huissoud C. Coagulation assessment by rotation thrombelastometry in normal pregnancy. Thromb Haemost 2017. [DOI: 10.1160/th08-06-0386] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryWe analysed changes in coagulation during normal pregnancy with a novel point-of-care device based on thrombelastometry (ROTEM®). We compared the results obtained with those of standard coagulation tests in 104 patients: 20 non-pregnant women (controls) and 84 women in the first (T1, n=17), second (T2, n=9) and third (T3, n=58) trimesters of pregnancy. We measured the clotting time (CT), the maximum clot firmness (MCF), the early clot amplitude at 5 and 15 minutes (CA5, CA15) and the clot lysis index (CLI30) with four tests containing specific reagents. (a) The INTEM® test involving ellagic acid activated the intrinsic pathway and (b) the EXTEM® test using tissue factor triggered the extrinsic pathway; (c) The FIBTEM® test based on a platelet inhibitor (cytochalasin D) evaluated the contribution of fibrinogen to clot formation and (d) the APTEM® test was similar to the EXTEM but was based on inhibition in vitro of fibrinolysis by aprotinin. CT and CLI30 were not significantly modified during pregnancy whereas MCF, CA5 and CA15 (INTEM, EXTEM, FIBTEM) increased significantly between the second and third trimesters (e.g. median [interquartile range]: MCF-FIBTEM, 13 [11–16] mm vs. 19 [17–23] mm, respectively, in controls and T3, p< 0.001). EXTEM values were not significantly different from those measured with APTEM. There were significant correlations between the results obtained with ROTEM and those from standard coagulation tests. ROTEM analysis showed a marked increase in coagulability during normal pregnancy. ROTEM values may serve as the basis for future studies in pregnant women.
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Caloone J, Huissoud C, Kocot A, Vincenot J, Dehay C, Giroud P, Misery P, Allias F, Rudigoz RC, Melodelima D. Non-invasive high-intensity focused ultrasound treatment of the placenta: a preliminary in-vivo study using a simian model. Ultrasound Obstet Gynecol 2017; 50:635-641. [PMID: 27804180 DOI: 10.1002/uog.17350] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 10/23/2016] [Accepted: 10/24/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To demonstrate the feasibility and efficacy of high-intensity focused ultrasound (HIFU) for the non-invasive creation of placental lesions in a simian model. METHODS Eight pregnant monkeys were exposed to HIFU treatment after anesthesia, using a toroidal HIFU 2.5-MHz transducer with an integrated ultrasound imaging probe. Lesions on the placental tissue were created non-invasively by placing the HIFU probe on the skin surface. Fetal and maternal parameters, such as maternal heart rate, fetal heart rate and subcutaneous and intra-amniotic fluid temperature, were recorded during HIFU exposure. Cesarean section was performed immediately after the procedure to extract the placenta and examine the fetus and the maternal abdominal cavity. Placental HIFU lesions were assessed by ultrasound, gross pathology and histology. RESULTS The mean gestational age of the monkeys was 72 ± 4 days. In total, 13 HIFU procedures were performed. The acoustic power and exposure time were increased progressively. This gradual increase in total energy delivered was used to determine a set of parameters to create reproducible lesions in the placenta without complications. Five placental lesions were observed with average diameters of 6.4 ± 0.5 mm and 7.8 ± 0.7 mm and an average depth of 3.8 ± 1.5 mm. Ultrasound examination of the placentae revealed hyperechoic regions that correlated well with macroscopic analysis of the HIFU lesions. Necrosis of placental tissue exposed to HIFU was confirmed with macroscopic and microscopic analysis. There was no significant variation in maternal and fetal parameters during HIFU exposure. CONCLUSIONS This study demonstrates the feasibility of HIFU applied non-invasively to the placental unit in an in-vivo pregnant monkey model. The technique is safe in the immediate short term and is potentially translatable to human pregnancy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J Caloone
- Inserm, U1032, Laboratory of Therapeutic Applications of Ultrasound, Lyon, France
- Université de Lyon, Lyon, France
- Department of Obstetrics and Gynecology, Croix Rousse University Hospital, Lyon, France
| | - C Huissoud
- Department of Obstetrics and Gynecology, Croix Rousse University Hospital, Lyon, France
- Stem Cell and Brain Research Institute, Institut National de la Sante et de la Recherche Médicale U846, Bron, France
| | - A Kocot
- Inserm, U1032, Laboratory of Therapeutic Applications of Ultrasound, Lyon, France
- Université de Lyon, Lyon, France
| | - J Vincenot
- Inserm, U1032, Laboratory of Therapeutic Applications of Ultrasound, Lyon, France
- Université de Lyon, Lyon, France
| | - C Dehay
- Stem Cell and Brain Research Institute, Institut National de la Sante et de la Recherche Médicale U846, Bron, France
| | - P Giroud
- Stem Cell and Brain Research Institute, Institut National de la Sante et de la Recherche Médicale U846, Bron, France
| | - P Misery
- Stem Cell and Brain Research Institute, Institut National de la Sante et de la Recherche Médicale U846, Bron, France
| | - F Allias
- Université de Lyon, Lyon, France
- Department of Pathology, Croix Rousse University Hospital, Lyon, France
| | - R C Rudigoz
- Department of Obstetrics and Gynecology, Croix Rousse University Hospital, Lyon, France
| | - D Melodelima
- Inserm, U1032, Laboratory of Therapeutic Applications of Ultrasound, Lyon, France
- Université de Lyon, Lyon, France
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Dupont C, Winer N, Rabilloud M, Touzet S, Branger B, Lansac J, Gaucher L, Duclos A, Huissoud C, Boutitie F, Rudigoz RC, Colin C. Multifaceted intervention to improve obstetric practices: The OPERA cluster-randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2017. [PMID: 28649035 DOI: 10.1016/j.ejogrb.2017.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Suboptimal care contributes to perinatal morbidity and mortality. We investigated the effects of a multifaceted program designed to improve obstetric practices and outcomes. STUDY DESIGN A cluster-randomized trial was conducted from October 2008 to November 2010 in 95 French maternity units randomized either to receive an information intervention about published guidelines or left to apply them freely. The intervention combined an outreach visit with a morbidity/mortality conference (MMC) to review perinatal morbidity/mortality cases. Within the intervention group, the units were randomized to have MMCs with or without clinical psychologists. The primary outcome was the rate of suboptimal care among perinatal morbidity/mortality cases. The secondary outcomes included the rate of suboptimal care among cases of morbidity, the rate of suboptimal care among cases of mortality, the rate of avoidable morbidity and/or mortality cases, and the incidence of, morbidity and/or mortality. A mixed logistic regression model with random intercept was used to quantify the effect of the intervention on the main outcome. RESULTS The study reviewed 2459 cases of morbidity or mortality among 165,353 births. The rate of suboptimal care among morbidity plus mortality cases was not significantly lower in the intervention than in the control group (8.1% vs. 10.6%, OR [95% CI]: 0.75 [0.50-1.12], p=0.15. However, the cases of suboptimal care among morbidity cases were significantly lower in the intervention group (7.6% vs. 11.5%, 0.62 [0.40-0.94], p=0.02); the incidence of perinatal morbidity was also lower (7.0 vs. 8.1‰, p=0.01). No differences were found between psychologist-backed and the other units. CONCLUSIONS The intervention reduced the rate of suboptimal care mainly in morbidity cases and the incidence of morbidity but did not succeed in improving morbidity plus mortality combined. More clear-cut results regarding mortality require a longer study period and the inclusion of structures that intervene before and after the delivery room. (ClinicalTrials.gov ID: NCT02584166).
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Affiliation(s)
- Corinne Dupont
- Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France; Health Services and Performance Research - HESPER EA 7425, F-69008, Lyon, France.
| | - Norbert Winer
- Service de gynécologie-obstétrique/maternité, Centre Hospitalo-universitaire de Nantes, F-44300, Nantes, France
| | - Muriel Rabilloud
- Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, F-69003, Lyon, France; Université de Lyon, F-69000, Lyon, France; Université Lyon 1, F-69100, Villeurbanne, France; CNRS UMR 5558 Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, F-69100, Villeurbanne, France
| | - Sandrine Touzet
- Health Services and Performance Research - HESPER EA 7425, F-69008, Lyon, France; Pôle IMER, Hospices Civils de Lyon, F-69003, Lyon, France; Université de Lyon, F-69100, Lyon, France
| | - Bernard Branger
- Réseau Sécurité Naissance, Pays-de-la-Loire, F-44000, Nantes, France
| | - Jacques Lansac
- Réseau périnatal de la Région Centre, F-37000, Tours, France
| | - Laurent Gaucher
- Health Services and Performance Research - HESPER EA 7425, F-69008, Lyon, France; Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, F-69500 Lyon, France
| | - Antoine Duclos
- Health Services and Performance Research - HESPER EA 7425, F-69008, Lyon, France; Pôle IMER, Hospices Civils de Lyon, F-69003, Lyon, France; Université de Lyon, F-69100, Lyon, France
| | - Cyril Huissoud
- Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France
| | - Florent Boutitie
- Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, F-69003, Lyon, France; Université de Lyon, F-69000, Lyon, France; Université Lyon 1, F-69100, Villeurbanne, France; CNRS UMR 5558 Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, F-69100, Villeurbanne, France
| | | | - Cyrille Colin
- Health Services and Performance Research - HESPER EA 7425, F-69008, Lyon, France; Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, F-69003, Lyon, France; Université de Lyon, F-69000, Lyon, France; Université Lyon 1, F-69100, Villeurbanne, France; CNRS UMR 5558 Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, F-69100, Villeurbanne, France
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Dargaud Y, Rugeri L, Fleury C, Battie C, Gaucherand P, Huissoud C, Rudigoz RC, Desmurs-Clavel H, Ninet J, Trzeciak MC. Personalized thromboprophylaxis using a risk score for the management of pregnancies with high risk of thrombosis: a prospective clinical study. J Thromb Haemost 2017; 15:897-906. [PMID: 28231636 DOI: 10.1111/jth.13660] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Indexed: 12/30/2022]
Abstract
Essentials Pregnancy is a risk factor for thrombosis. Management of thrombosis risk in pregnancy remains a challenge. Prophylaxis needs to be personalized. Our score may be a helpful tool for the management of pregnancies at high risk of thrombosis. SUMMARY Background Patients with thrombophilia and/or a history of venous thromboembolism (VTE) are at risk of thrombosis during pregnancy. A risk score for pregnancies with an increased risk of VTE was previously described by our group (Lyon VTE score). Objectives The aim of this prospective study was to assess the efficacy and safety of our score-based prophylaxis strategy in 542 pregnancies managed between 2005 and 2015 in Lyon University Hospitals. Patients/Methods Of 445 patients included in the study, 36 had several pregnancies during the study period. Among these 445 patients, 279 had a personal history of VTE (62.7%), 299 patients (67.2%) had a thrombophilia marker, and 131 (29.4%) thrombophilic women had a personal history of VTE. During pregnancy, patients were assigned to one of three prophylaxis strategies according to the risk scoring system. Results In the antepartum period, low molecular weight heparin (LMWH) prophylaxis was prescribed to 64.5% of patients at high risk of VTE. Among them, 34.4% were treated in the third trimester only, and 30.1% were treated throughout pregnancy. During the postpartum period, all patients received LMWH for at least 6 weeks. Two antepartum-related VTEs (0.37%; one with a score of < 3 and the other with a score of > 6) and four postpartum-related VTEs (0.73%; three with scores of 3-5 and one with a score of > 6) occurred. No case of pulmonary embolism was observed during the study period. The rate of bleeding was 0.37%. No serious bleeding requiring transfusions or surgery occurred during the study period. Conclusion The use of a risk score may provide a rational decision process to implement safe and effective antepartum thromboprophylaxis in pregnant women at high risk of VTE.
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Affiliation(s)
- Y Dargaud
- Unite d'Hemostase Clinique, Hopital Cardiologique Louis Pradel, CHU de Lyon, France
| | - L Rugeri
- Unite d'Hemostase Clinique, Hopital Cardiologique Louis Pradel, CHU de Lyon, France
| | - C Fleury
- Laboratoire d'Explorations Vasculaires, pavillon M, Hopital Edouard Herriot, CHU de Lyon, France
| | - C Battie
- Service d'Obstetrique, Hopital Femme Mere Enfant, CHU de Lyon, France
| | - P Gaucherand
- Service d'Obstetrique, Hopital Femme Mere Enfant, CHU de Lyon, France
| | - C Huissoud
- Service d'Obstetrique, Hopital de la Croix Rousse, CHU de Lyon, France
| | - R C Rudigoz
- Service d'Obstetrique, Hopital de la Croix Rousse, CHU de Lyon, France
| | - H Desmurs-Clavel
- Service de Medecine Interne, pavillon O, Hopital Edouard Herriot, CHU de Lyon, France
| | - J Ninet
- Service de Medecine Interne, pavillon O, Hopital Edouard Herriot, CHU de Lyon, France
| | - M C Trzeciak
- Unite d'Hemostase Clinique, Hopital Cardiologique Louis Pradel, CHU de Lyon, France
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Pons L, Till M, Alix E, Abel C, Boggio D, Bordes A, Caloone J, Raskin FC, Chatron N, Cordier MP, Fichez A, Labalme A, Lajeunesse C, Liaras É, Massoud M, Miribel J, Ollagnon E, Schluth-Bolard C, Vichier-Cerf A, Edery P, Attia J, Huissoud C, Rudigoz RC, Massardier J, Gaucherand P, Sanlaville D. Prenatal microarray comparative genomic hybridization: Experience from the two first years of activity at the Lyon university-hospital. J Gynecol Obstet Hum Reprod 2017; 46:275-283. [PMID: 28403926 DOI: 10.1016/j.jogoh.2016.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/07/2016] [Accepted: 11/17/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study aims to describe how microarray comparative genomic hybridization (aCGH) has shifted to become a prenatal diagnosis tool at the Lyon university-hospital. MATERIALS AND METHODS This retrospective study included all patients who were referred in the 3 pluridisciplinary centers for prenatal diagnosis of the Lyon university-hospital and who received a prenatal aCGH between June 2013 and June 2015. aCGH was systematically performed in parallel with a karyotype, using the PréCytoNEM array design. RESULTS A total of 260 microarrays were performed for the following indications: 249 abnormal ultrasounds (95.8%), 7 characterizations of chromosomal rearrangements (2.7%), and 4 twins with no abnormal ultrasounds (1.5%). With a resolution of 1 mega base, we found 235 normal results (90.4%), 23 abnormal results (8.8%) and 2 non-returns (0.8%). For the chromosomal rearrangements visible on the karyotype, aCGH identified all of the 12 unbalanced rearrangements and did not identify the 2 balanced rearrangements. Among the fetuses with normal karyotypes, 11 showed abnormal microarray results, corresponding to unbalanced cryptic chromosomal rearrangements (4.2%). CONCLUSION Transferring aCGH to a prenatal diagnosis at the Lyon university-hospital has increased the detection rate of chromosomal abnormalities by 4.2% compared to the single karyotype.
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Affiliation(s)
- L Pons
- Service de génétique, groupement hospitalier Est, HCL, 59, boulevard Pinel, 69677 Bron, France; Université Claude-Bernard Lyon 1, 69008 Lyon, France.
| | - M Till
- Service de génétique, groupement hospitalier Est, HCL, 59, boulevard Pinel, 69677 Bron, France
| | - E Alix
- Service de génétique, groupement hospitalier Est, HCL, 59, boulevard Pinel, 69677 Bron, France
| | - C Abel
- Service de génétique, groupement hospitalier Est, HCL, 59, boulevard Pinel, 69677 Bron, France
| | - D Boggio
- Service de génétique, groupement hospitalier Est, HCL, 59, boulevard Pinel, 69677 Bron, France
| | - A Bordes
- Département d'obstétrique et de gynécologie, groupement hospitalier Est, HCL, 69500 Bron, France
| | - J Caloone
- Département d'obstétrique et de gynécologie, centre hospitalier de la Croix-Rousse, HCL, 69004 Lyon, France
| | - F C Raskin
- Département d'obstétrique et de gynécologie, centre hospitalier Lyon Sud, HCL, 69310 Pierre-Bénite, France
| | - N Chatron
- Service de génétique, groupement hospitalier Est, HCL, 59, boulevard Pinel, 69677 Bron, France; Université Claude-Bernard Lyon 1, 69008 Lyon, France; Équipe Gendev, CNRS UMR 5292, Inserm U1028, centre de recherche en neuroscience de Lyon, 69500 Bron, France
| | - M-P Cordier
- Service de génétique, groupement hospitalier Est, HCL, 59, boulevard Pinel, 69677 Bron, France
| | - A Fichez
- Département d'obstétrique et de gynécologie, centre hospitalier de la Croix-Rousse, HCL, 69004 Lyon, France
| | - A Labalme
- Service de génétique, groupement hospitalier Est, HCL, 59, boulevard Pinel, 69677 Bron, France
| | - C Lajeunesse
- Département d'obstétrique et de gynécologie, groupement hospitalier Est, HCL, 69500 Bron, France
| | - É Liaras
- Département d'obstétrique et de gynécologie, centre hospitalier Lyon Sud, HCL, 69310 Pierre-Bénite, France
| | - M Massoud
- Département d'obstétrique et de gynécologie, groupement hospitalier Est, HCL, 69500 Bron, France
| | - J Miribel
- Département d'obstétrique et de gynécologie, groupement hospitalier Est, HCL, 69500 Bron, France
| | - E Ollagnon
- Service de génétique, groupement hospitalier Est, HCL, 59, boulevard Pinel, 69677 Bron, France
| | - C Schluth-Bolard
- Service de génétique, groupement hospitalier Est, HCL, 59, boulevard Pinel, 69677 Bron, France; Université Claude-Bernard Lyon 1, 69008 Lyon, France; Équipe Gendev, CNRS UMR 5292, Inserm U1028, centre de recherche en neuroscience de Lyon, 69500 Bron, France
| | - A Vichier-Cerf
- Service de génétique, groupement hospitalier Est, HCL, 59, boulevard Pinel, 69677 Bron, France
| | - P Edery
- Service de génétique, groupement hospitalier Est, HCL, 59, boulevard Pinel, 69677 Bron, France; Université Claude-Bernard Lyon 1, 69008 Lyon, France; Équipe Gendev, CNRS UMR 5292, Inserm U1028, centre de recherche en neuroscience de Lyon, 69500 Bron, France
| | - J Attia
- Université Claude-Bernard Lyon 1, 69008 Lyon, France; Département d'obstétrique et de gynécologie, centre hospitalier Lyon Sud, HCL, 69310 Pierre-Bénite, France
| | - C Huissoud
- Département d'obstétrique et de gynécologie, centre hospitalier de la Croix-Rousse, HCL, 69004 Lyon, France
| | - R C Rudigoz
- Université Claude-Bernard Lyon 1, 69008 Lyon, France; Département d'obstétrique et de gynécologie, centre hospitalier de la Croix-Rousse, HCL, 69004 Lyon, France
| | - J Massardier
- Département d'obstétrique et de gynécologie, groupement hospitalier Est, HCL, 69500 Bron, France
| | - P Gaucherand
- Université Claude-Bernard Lyon 1, 69008 Lyon, France; Département d'obstétrique et de gynécologie, groupement hospitalier Est, HCL, 69500 Bron, France
| | - D Sanlaville
- Service de génétique, groupement hospitalier Est, HCL, 59, boulevard Pinel, 69677 Bron, France; Université Claude-Bernard Lyon 1, 69008 Lyon, France; Équipe Gendev, CNRS UMR 5292, Inserm U1028, centre de recherche en neuroscience de Lyon, 69500 Bron, France
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Dionne MD, Deneux-Tharaux C, Dupont C, Basso O, Rudigoz RC, Bouvier-Colle MH, Le Ray C. Duration of Expulsive Efforts and Risk of Postpartum Hemorrhage in Nulliparous Women: A Population-Based Study. PLoS One 2015; 10:e0142171. [PMID: 26555447 PMCID: PMC4640501 DOI: 10.1371/journal.pone.0142171] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 10/07/2015] [Indexed: 11/19/2022] Open
Abstract
Objective To assess the specific association between the duration of expulsive efforts and the risk of postpartum hemorrhage. Methods Population-based cohort-nested case-control study of nulliparous women delivering vaginally in 106 French maternity units between December 2004 and November 2006, including 3,852 women with PPH (blood loss ≥ 500 mL and/or peripartum Hb decrease ≥ 2 g/dL), 1,048 of them severe (peripartum Hb decrease ≥ 4 g/dL or transfusion of ≥ 2 units of red blood cells), and 762 controls from a representative sample of deliveries without hemorrhage in the same population. The association between duration of expulsive efforts and postpartum hemorrhage was estimated by multilevel logistic regression models adjusted for individual and hospital characteristics. Results Median duration of expulsive efforts was 18 minutes among controls, 20 minutes among postpartum hemorrhage and 23 minutes among severe postpartum hemorrhage (p<0.01). Duration of expulsive efforts was significantly, positively, and linearly associated with both postpartum hemorrhage and severe postpartum hemorrhage. After adjustment for other risk factors, every additional 10 minutes of expulsive efforts was associated with about a 10% increase in the risk of postpartum hemorrhage (aOR = 1.11 [1.02–1.21]) and severe postpartum hemorrhage (aOR = 1.14 [1.03–1.27]). Oxytocin during labor, duration of active phase of labor, forceps use, episiotomy, perineal tears, and birth weight were also independently associated with both risks. Conclusion Duration of expulsive efforts was independently associated with postpartum hemorrhage and severe postpartum hemorrhage. Interventions to shorten the duration of this stage, such as oxytocin, forceps, and episiotomy, are also associated with higher risks of postpartum hemorrhage. Beyond duration, other aspects of the management of active second stage should be evaluated as some might allow it to last longer with a minimal increase in postpartum hemorrhage risk.
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Affiliation(s)
- Marie-Danielle Dionne
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
- Department of Obstetrics and Gynecology, McGill University, Montreal, Canada
- Montreal University Health Center, Montreal, Canada
| | - Catherine Deneux-Tharaux
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Corinne Dupont
- Aurore perinatal network, Hôpital de la Croix Rousse, Hospices Civils de Lyon, EA 4129 Université Lyon1, Lyon, France
| | - Olga Basso
- Department of Obstetrics and Gynecology, McGill University, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - René-Charles Rudigoz
- Aurore perinatal network, Hôpital de la Croix Rousse, Hospices Civils de Lyon, EA 4129 Université Lyon1, Lyon, France
| | - Marie-Hélène Bouvier-Colle
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Camille Le Ray
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
- Port Royal Maternity, Cochin-Broca-Hôtel Dieu Hospital, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France
- * E-mail:
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Kayem G, Dupont C, Bouvier-Colle MH, Rudigoz RC, Deneux-Tharaux C. Invasive therapies for primary postpartum haemorrhage: a population-based study in France. BJOG 2015; 123:598-605. [DOI: 10.1111/1471-0528.13477] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2015] [Indexed: 11/28/2022]
Affiliation(s)
- G Kayem
- Inserm UMR 1153; Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé); Centre for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in Pregnancy; Paris Descartes University; Paris France
- Department of Obstetrics and Gynaecology; APHP; Trousseau Hospital; Université Pierre et Marie Curie; Paris France
| | - C Dupont
- Aurore Perinatal Network; Hôpital de la Croix Rousse; Hospices Civils de Lyon; Lyon France
| | - MH Bouvier-Colle
- Inserm UMR 1153; Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé); Centre for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in Pregnancy; Paris Descartes University; Paris France
| | - RC Rudigoz
- Aurore Perinatal Network; Hôpital de la Croix Rousse; Hospices Civils de Lyon; Lyon France
| | - C Deneux-Tharaux
- Inserm UMR 1153; Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé); Centre for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in Pregnancy; Paris Descartes University; Paris France
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Philip CA, Bisch C, Coulon A, de Saint-Hilaire P, Rudigoz RC, Dubernard G. Correlation between three-dimensional rectosonography and magnetic resonance imaging in the diagnosis of rectosigmoid endometriosis: a preliminary study on the first fifty cases. Eur J Obstet Gynecol Reprod Biol 2015; 187:35-40. [DOI: 10.1016/j.ejogrb.2015.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 01/26/2015] [Accepted: 02/06/2015] [Indexed: 10/24/2022]
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Caloone J, Huissoud C, Vincenot J, Kocot A, Dehay C, Chapelon JY, Rudigoz RC, Melodelima D. High-intensity focused ultrasound applied to the placenta using a toroidal transducer: a preliminary ex-vivo study. Ultrasound Obstet Gynecol 2015; 45:313-319. [PMID: 24723334 DOI: 10.1002/uog.13374] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 03/04/2014] [Accepted: 03/14/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To demonstrate in an ex-vivo model the feasibility of applying high-intensity focused ultrasound (HIFU) using a toroidal transducer for the creation of placental lesions. METHODS In this study we used a toroidal transducer, composed of 32 ring-shaped emitters with an ultrasound probe at the center, operating at a frequency of 2.5 MHz. We examined 45 human placentae, following either normal vaginal delivery or medical termination of pregnancy between 17 and 40 gestational weeks. First, the attenuation coefficients of 12 human placentae were measured and integrated into a numerical model for simulating HIFU lesions. Then, using acoustic parameters from this preliminary study, we performed ex-vivo experiments with 33 human placentae, each overlain with an animal abdominal wall to simulate the maternal wall. We created single HIFU lesions in 25 of these placentae, and a series of six juxtaposed lesions in eight, studying these both sonographically and macroscopically. RESULTS Human placental attenuation coefficients of the 12 human placentae ranged from 0.072 to 0.098 Np/cm/MHz, according to gestational age. The 25 single HIFU lesions created had an average diameter of 7.1 ± 3.2 mm and an average depth of 8.2 ± 3.1 mm. The average diameter of the eight series of six juxtaposed HIFU lesions was 23.0 ± 5.0 mm and the average depth was 11.0 ± 4.7 mm. The average thickness of the abdominal walls was 10.5 ± 1.8 mm. No lesions or damage were observed in intervening tissues. CONCLUSION This study demonstrates, using an ex-vivo model, the feasibility, reproducibility, harmlessness and effectiveness of HIFU applied to the human placenta.
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Affiliation(s)
- J Caloone
- Inserm, U1032, LabTau, Lyon, France; Université de Lyon, Lyon, France; Department of Obstetrics and Gynecology, Croix Rousse University Hospital, Lyon, France
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Galusca N, Charvier K, Courtois F, Rode G, Rudigoz RC, Ruffion A. [Antibioprophylaxy and urological management of women with spinal cord injury during pregnancy]. Prog Urol 2015; 25:489-96. [PMID: 25684392 DOI: 10.1016/j.purol.2015.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 10/02/2014] [Revised: 01/14/2015] [Accepted: 01/15/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE More and more women with spinal cord injury (SCI) can have a pregnancy. Few data have been published on these pregnancies and their urological impact. We report a series of these cases illustrating the urological experience of specialized centers. METHODS This is a retrospective study that identified pregnancies in women with SCI followed-up between 2000 and 2014. Data covering all urological and obstetric events during pregnancies, before and after implementation of weekly oral cyclic antibiotics (WOCA) program, were collected from medical records. RESULTS Fifteen women with SCI who gave birth to 20 children were included. Three of them were quadriplegics and 12 were paraplegics. All of them performed themselves intermittent catheterization: 11 by urethral way and 4 by high way because carrying a continent cystostomy. Mean follow-up period before pregnancy was 14.6 years [3-27 years IC 95%] and the mean follow-up for the study was 8.5 months [6.5-9 IC 95%]. We observed a reduction of symptomatic urinary tract infections after WOCA onset (13/13 before vs. 0/7 after, P=0.001), a reduction of recurrent urinary infections (6/13 vs. 0/7, P=0.03), a reduction of threats to premature births (8/13 vs. 0/7, P=0.001). Multi-resistant bacteria appeared to increase (0/13 vs. 3/7, P=0.01). We also observed a trend to significant reduction of premature births number (4/13 vs. 0/13, P=0.1) and that of low birth weight (3/13 versus 0/7, P=0.1). The overall neonatal survival rate was 100%. CONCLUSION Our study before/after introduction of a weekly oral cycle antibiotic prophylaxis during pregnancy for women with spinal cord injury showed a significant reduction in symptomatic urinary tract infections and a tendency to improve pregnancy outcomes. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- N Galusca
- Service d'urologie, CHU de Saint-Étienne, avenue Albert-Raimond, 42055 Saint-Étienne, France; Service de rééducation neuropérinéale et sexologique, hôpital Henry-Gabrielle, hospices civils de Lyon, 69230 Saint-Genis-Laval, France.
| | - K Charvier
- Service de rééducation neuropérinéale et sexologique, hôpital Henry-Gabrielle, hospices civils de Lyon, 69230 Saint-Genis-Laval, France
| | - F Courtois
- Department of sexology, université du Québec, CP 8888 succursale centre-ville, H3C 3P8 Montreal, Quebec, Canada
| | - G Rode
- Service de médecine physique et réadaptation, hôpital Henry-Gabrielle, 69230 Saint-Genis-Laval, France
| | - R C Rudigoz
- Service de gynécologie-obstétrique, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, Grande-Rue de la Croix-Rousse, 69317 Lyon cedex 4, France
| | - A Ruffion
- Service d'urologie, centre hospitalier Lyon Sud, hospices civils de Lyon, 69495 Pierre-Bénite, France
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Cortet M, Maucort-Boulch D, Deneux-Tharaux C, Dupont C, Rudigoz RC, Roy P, Huissoud C. Severity of post-partum hemorrhage after vaginal delivery is not predictable from clinical variables available at the time post-partum hemorrhage is diagnosed. J Obstet Gynaecol Res 2014; 41:199-206. [PMID: 25303234 DOI: 10.1111/jog.12528] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 06/30/2014] [Indexed: 11/29/2022]
Abstract
AIM Identify women at risk of severe post-partum hemorrhage (PPH) by building a prediction model based on clinical variables available at PPH diagnosis. METHODS We analyzed data on a cohort of 7236 women with PPH after vaginal delivery from 106 maternity units. Severe PPH was defined as the loss of more than 2000 mL of blood, peripartum drop in hemoglobin of 4 g/dL or more, transfusion of at least four packed red blood cells, embolization, hemostasis surgery, transfer to an intensive care unit or death. The Akaike criterion helped selecting the covariates of a multivariate logistic regression model. The performance of the model was studied through building a receiver-operator curve (ROC). The relative utility of the final model was used to determine the importance of the model in decision-making. RESULTS Among all PPH, the prevalence of severe cases was 18.5%. Several clinical variables were significantly associated with severe PPH (e.g. parity, multiple pregnancy, labor induction, instrumental delivery). The multivariate prediction model was built. The area under the ROC for prediction of severe cases was 0.63 (95% confidence interval, 0.62-0.65). Nevertheless, the sensitivity and specificity of the prediction model were 0.49 and 0.70, respectively, for a threshold at 0.20 (near prevalence). The relative utility was 0.19 for a threshold near prevalence (20%). CONCLUSION Because of important misclassifications, even the best model we could build with the available clinical data cannot be reasonably recommended for routine use. Every patient with PPH should receive most optimal management. Other types of information, possibly laboratory data, are probably needed.
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Affiliation(s)
- Marion Cortet
- Department of Biostatistics, Hospices Civils de Lyon, Lyon, France; University of Lyon, Lyon, France; University of Lyon 1, Villeurbanne, France; UMR 5558, Laboratory of Biometry and Evolutionary Biology, Team of Health and Biostatistics, National Center for Scientific Research, Villeurbanne, France
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Rubio-Gurung S, Putet G, Touzet S, Gauthier-Moulinier H, Jordan I, Beissel A, Labaune JM, Blanc S, Amamra N, Balandras C, Rudigoz RC, Colin C, Picaud JC. In situ simulation training for neonatal resuscitation: an RCT. Pediatrics 2014; 134:e790-7. [PMID: 25092937 DOI: 10.1542/peds.2013-3988] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [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: 11/24/2022] Open
Abstract
OBJECTIVES High-fidelity simulation is an effective tool in teaching neonatal resuscitation skills to professionals. We aimed to determine whether in situ simulation training (for ∼80% of the delivery room staff) improved neonatal resuscitation performed by the staff at maternities. METHODS A baseline evaluation of 12 maternities was performed: a random sample of 10 professionals in each unit was presented with 2 standardized scenarios played on a neonatal high-fidelity simulator. The medical procedures were video recorded for later assessments. The 12 maternities were then randomly assigned to receive the intervention (a 4-hour simulation training session delivered in situ for multidisciplinary groups of 6 professionals) or not receive it. All maternities were evaluated again at 3 months after the intervention. The videos were assessed by 2 neonatologists blinded to the pre-/postintervention as well as to the intervention/control groups. The performance was assessed using a technical score and a team score. RESULTS After intervention, the median technical score was significantly higher for scenarios 1 and 2 for the intervention group compared with the control group (P = .01 and 0.004, respectively), the median team score was significantly higher (P < .001) for both scenarios. In the intervention group, the frequency of achieving a heart rate >90 per minute at 3 minutes improved significantly (P = .003), and the number of hazardous events decreased significantly (P < .001). CONCLUSIONS In situ simulation training with multidisciplinary teams can effectively improve technical skills and teamwork in neonatal resuscitation.
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Affiliation(s)
- Sophie Rubio-Gurung
- Gyneco-Obstetrical Unit, Croix-Rousse University Hospital, NICU, Croix-Rousse University Hospital, and
| | - Guy Putet
- NICU, Croix-Rousse University Hospital, and Centre Lyonnais d'Enseignement par la Simulation en Santé, Claude Bernard Lyon1 University
| | - Sandrine Touzet
- Medical Information, Evaluation and Research Unit, Lyon University Hospital, Hospices Civils de Lyon, Lyon, France; and
| | | | | | - Anne Beissel
- NICU, HFME University Hospital, Hospices Civils de Lyon, Bron, France and
| | | | - Sébastien Blanc
- NICU, HFME University Hospital, Hospices Civils de Lyon, Bron, France and
| | - Nassira Amamra
- Medical Information, Evaluation and Research Unit, Lyon University Hospital, Hospices Civils de Lyon, Lyon, France; and
| | | | | | - Cyrille Colin
- Medical Information, Evaluation and Research Unit, Lyon University Hospital, Hospices Civils de Lyon, Lyon, France; and
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Rudigoz RC, Huissoud C, Delecour L, Thevenet S, Dupont C. [Non elective cesarean section: use of a color code to optimize management of obstetric emergencies]. Bull Acad Natl Med 2014; 198:1123-1140. [PMID: 26983190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The medical team of the Croix Rousse teaching hospital maternity unit has developed, over the last ten years, a set of procedures designed to respond to various emergency situations necessitating Caesarean section. Using the Lucas classification, we have defined as precisely as possible the degree of urgency of Caesarian sections. We have established specific protocols for the implementation of urgent and very urgent Caesarean section and have chosen a simple means to convey the degree of urgency to all team members, namely a color code system (red, orange and green). We have set time goals from decision to delivery: 15 minutes for the red code and 30 minutes for the orange code. The results seem very positive: The frequency of urgent and very urgent Caesareans has fallen over time, from 6.1 % to 1.6% in 2013. The average time from decision to delivery is 11 minutes for code red Caesareans and 21 minutes for code orange Caesareans. These time goals are now achieved in 95% of cases. Organizational and anesthetic difficulties are the main causes of delays. The indications for red and orange code Caesarians are appropriate more than two times out of three. Perinatal outcomes are generally favorable, code red Caesarians being life-saving in 15% of cases. No increase in maternal complications has been observed. In sum: Each obstetric department should have its own protocols for handling urgent and very urgent Caesarean sections. Continuous monitoring of their implementation, relevance and results should be conducted Management of extreme urgency must be integrated into the management of patients with identified risks (scarred uterus and twin pregnancies for example), and also in structures without medical facilities (birthing centers). Obstetric teams must keep in mind that implementation of these protocols in no way dispenses with close monitoring of labour.
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Maillet L, Rudigoz RC, Buffin R, Massardier J, Gaucherand P, Huissoud C. [Neonatal outcome of fetal hyperechogenic bowel]. ACTA ACUST UNITED AC 2014; 42:383-6. [PMID: 24533992 DOI: 10.1016/j.gyobfe.2014.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Echogenic bowel (EB) represents 1 % of pregnancy and is a risk factor of fetal pathology (infection, cystic fibrosis, aneuploidy). The aim of our study was to determine the fetuses' outcomes with isolated EB. PATIENTS AND METHODS This is a retrospective study of all patients who presented singleton gestations with a fetal isolated echogenic bowel between 2004 and 2011 in two prenatal diagnosis centers. Search of aneuploidy, infection and cystic fibrosis was systematically proposed as well as an ultrasound monitoring. RESULTS On 109 fetus addressed for isolate echogenic bowel five had other signs associated and 74 had a real isolated echogenic bowel (without dilatation, calcification, intrauterine growth restriction). In 30 cases, the EB was not found. Eighty-five percent of the patients had in the first trimester a screening for trisomy 21. None fetus with isolated EB had trisomy, infection or cystic fibrosis. One fetus died in utero and one newborn died of a metabolic disease without digestive repercussions. DISCUSSION AND CONCLUSION The risk of trisomy 21 and the risk to have a serious disease appear low for the fetus with EB. It does not seem necessary to propose a systematic amniocentesis in case of isolated echogenic bowel.
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Affiliation(s)
- L Maillet
- Service de gynécologie-obstétrique, hospices civils de Lyon, hôpital de la Croix-Rousse, 104, grande rue de la Croix-Rousse, 69004 Lyon cedex 04, France.
| | - R C Rudigoz
- Service de gynécologie-obstétrique, hospices civils de Lyon, hôpital de la Croix-Rousse, 104, grande rue de la Croix-Rousse, 69004 Lyon cedex 04, France; Université Claude-Bernard - Lyon 1, 8, avenue Rockefeller, 69373 Lyon cedex 08, France
| | - R Buffin
- Service de gynécologie-obstétrique, hospices civils de Lyon, hôpital de la Croix-Rousse, 104, grande rue de la Croix-Rousse, 69004 Lyon cedex 04, France
| | - J Massardier
- Service de gynécologie-obstétrique, hospices civils de Lyon, hôpital Femme-Mère-Enfants, 59, boulevard Pinel, 69500 Bron, France
| | - P Gaucherand
- Service de gynécologie-obstétrique, hospices civils de Lyon, hôpital Femme-Mère-Enfants, 59, boulevard Pinel, 69500 Bron, France
| | - C Huissoud
- Service de gynécologie-obstétrique, hospices civils de Lyon, hôpital de la Croix-Rousse, 104, grande rue de la Croix-Rousse, 69004 Lyon cedex 04, France; Inserm U846, Stem Cell and Brain Research Institute, 18, avenue Doyen-Lepine, 69500 Bron, France; UMR-S 846, université Lyon 1, 69003 Lyon, France
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Bonnet MP, Basso O, Bouvier-Colle MH, Dupont C, Rudigoz RC, Fuhrer R, Deneux-Tharaux C. Postpartum haemorrhage in Canada and France: a population-based comparison. PLoS One 2013; 8:e66882. [PMID: 23826165 PMCID: PMC3691240 DOI: 10.1371/journal.pone.0066882] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 05/12/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Maternal mortality ratio due to postpartum haemorrhage (PPH) is higher in France than in Canada. We explored this difference by comparing PPH features between these two countries. METHODS Using data between 2004 and 2006, we compared the incidence, risk factors, causes and use of second-line treatments, of PPH between France (N = 6,660 PPH) and Canada (N = 9,838 PPH). We assessed factors associated with PPH through multivariate logistic models. RESULTS PPH incidence, overall (4.8% (95% CI 4.7-4.9) in Canada and 4.5% (95% CI 4.4-4.7) in France), and after vaginal delivery (5.3% (95%CI 5.2-5.4) in Canada and 4.8 (95%CI 4.7-4.9) in France), were significantly higher in Canada than in France, but not after caesarean delivery. Women delivering without PPH were similar between the two populations, except for macrosomia (11% in Canada, 7% in France, p<0.001), caesarean delivery (27% in Canada, 18% in France, p<0.001), and episiotomy (17% in Canada, 34% in France, p<0.001). After vaginal delivery, factors strongly associated with PPH were multiple pregnancy, operative delivery and macrosomia in both populations, and episiotomy only in France (Odds Ratio 1.39 (95% CI 1.23-1.57)). The use of second-line treatments for PPH management was significantly more frequent in France than in Canada after both vaginal and caesarean delivery. CONCLUSION PPH incidence was not higher in France than in Canada and there was no substantial difference in PPH risk factors between the 2 countries. Greater use of second-line treatments in PPH management in France suggests a more frequent failure of first-line treatments and a higher rate of severe PPH, which may be involved in the higher maternal mortality ratio due to PPH.
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Affiliation(s)
- Marie-Pierre Bonnet
- INSERM, U953, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Université Pierre et Marie Curie Paris 6, Paris, France.
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Dionne MD, Deneux-Tharaux C, Dupont C, Basso O, Rudigoz RC, Bouvier-Colle MH, Ray CL. 136: Duration of expulsive efforts and postpartum hemorrhage risk in nulliparous women. Am J Obstet Gynecol 2013. [DOI: 10.1016/j.ajog.2012.10.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Huissoud C, Cortet M, Dubernard G, Tariel O, Fichez A, Escalon J, Rudigoz RC. A stitch in time: Layers of circular sutures can staunch postpartum hemorrhage. Am J Obstet Gynecol 2012; 206:177.e1-2. [PMID: 22284157 DOI: 10.1016/j.ajog.2011.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Revised: 12/01/2011] [Accepted: 12/12/2011] [Indexed: 11/28/2022]
Affiliation(s)
- Cyril Huissoud
- Department of Obstetrics and Gynecology, Croix Rousse University Hospital, Lyon, France
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Dupont C, Deneux-Tharaux C, Touzet S, Colin C, Bouvier-Colle MH, Lansac J, Thevenet S, Boberie-Moyrand C, Piccin G, Fernandez MP, Rudigoz RC. Clinical audit: a useful tool for reducing severe postpartum haemorrhages? Int J Qual Health Care 2011; 23:583-9. [PMID: 21733978 DOI: 10.1093/intqhc/mzr042] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Reducing the rate of severe postpartum haemorrhage (PPH) is a major challenge in obstetrics today. One potentially effective tool for improving the quality of care is the clinical audit, that is, peer evaluation and comparison of actual practices against explicit criteria. Our objective was to assess the impact of regular criteria-based audits on the prevalence of severe PPH. DESIGN Quasi-experimental before-and-after survey. SETTING Two French maternity units in the Rhône-Alpes region, with different organization of care. PARTICIPANTS All staff of both units. INTERVENTION Quarterly clinical audit meetings at which a team of reviewers analysed all cases of severe PPH and provided feedback on quality of care and where all staff actively participated. MAIN OUTCOME MEASURES The primary outcome was the prevalence of severe PPH. Secondary outcomes included the global quality of care for women with severe PPH, including the performance rate for each recommended procedure. Differences in these variables between 2005 and 2008 were tested. RESULTS The prevalence of severe PPH declined significantly in both units, from 1.52 to 0.96% of deliveries in the level III hospital (P = 0.048) and from 2.08 to 0.57% in the level II hospital (P < 0.001). From 2005 to 2008, the proportion of deliveries with severe PPH that was managed consistently with the guidelines increased for all of its main components, in both units. CONCLUSION Regular clinical audits of cases severe PPH were associated with a persistent reduction in the prevalence of severe PPH.
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Affiliation(s)
- Corinne Dupont
- Re´seau pe´rinatal Aurore, Hoˆpital de la Croix Rousse, Universite´ Lyon 1, Lyon, France
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Belghiti J, Kayem G, Dupont C, Rudigoz RC, Bouvier-Colle MH, Deneux-Tharaux C. Oxytocin during labour and risk of severe postpartum haemorrhage: a population-based, cohort-nested case-control study. BMJ Open 2011; 1:e000514. [PMID: 22189353 PMCID: PMC3334825 DOI: 10.1136/bmjopen-2011-000514] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objectives Postpartum haemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. Experimental studies support the hypothesis that oxytocin administration during labour, a common although not evidence-based practice, may increase the risk of atonic PPH. The clinical studies, however, are inconclusive. The objectives of this study was to investigate the association between the level of oxytocin exposure during labour and the risk of severe PPH and to explore whether the prophylactic use of oxytocin after birth modifies this association. Design Population-based, cohort-nested case-control study. Setting 106 French hospitals from December 2004 through November 2006. Participants Women with term singleton vaginal deliveries, after an uncomplicated pregnancy. Cases were 1483 women with severe PPH, defined by peripartum change in haemoglobin of ≥4 g/dl or need for blood transfusion. Controls were 1758 women from a random sample of parturients without PPH. Main outcome measures The independent association between the level of oxytocin during labour and the risk of severe PPH was tested and quantified with ORs through two-level multivariable logistic regression modelling. Results Oxytocin was administered during labour to 73% of cases and 61% of controls (crude OR: 1.7, 95% CI 1.5 to 2.0). After adjustment for all potential confounders, oxytocin during labour was associated with a significantly higher risk of severe PPH (adjusted OR: 1.8, 95% CI 1.3 to 2.6) in women who did not receive prophylactic oxytocin after delivery; the OR for haemorrhage increased from 1 to 5 according to the level of oxytocin exposure. In women who had prophylactic oxytocin after delivery, this association was significant only for the highest exposure categories. Conclusions Oxytocin during labour appears to be an independent risk factor for severe PPH. The results emphasise the need for guidelines clarifying the evidence-based indications for this procedure and the minimal useful regimens.
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Affiliation(s)
- Jérémie Belghiti
- INSERM U953 Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Université Pierre et Marie Curie Paris 6, Paris, France
| | - Gilles Kayem
- INSERM U953 Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Université Pierre et Marie Curie Paris 6, Paris, France
| | - Corinne Dupont
- Aurore Perinatal Network, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - René-Charles Rudigoz
- Aurore Perinatal Network, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Marie-Hélène Bouvier-Colle
- INSERM U953 Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Université Pierre et Marie Curie Paris 6, Paris, France
| | - Catherine Deneux-Tharaux
- INSERM U953 Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Université Pierre et Marie Curie Paris 6, Paris, France
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Huissoud C, Dupont C, Canoui-Poitrine F, Touzet S, Dubernard G, Rudigoz RC. Decision-to-delivery interval for emergency caesareans in the Aurore perinatal network. Eur J Obstet Gynecol Reprod Biol 2010; 149:159-64. [PMID: 20079963 DOI: 10.1016/j.ejogrb.2009.12.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Revised: 11/26/2009] [Accepted: 12/24/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the interval between decision and delivery (DDI) for urgent and very urgent caesarean deliveries within a perinatal network, to compare the results according to maternity ward level and organisation, and to assess the impact of DDI on neonatal outcome. STUDY DESIGN Prospective observational study in the 31 maternity units of the Aurore perinatal network (17 Level I, 12 Level II, and two Level III). The obstetric team defined the degree of urgency for the caesareans, measured the DDI, and reported neonatal outcome. RESULTS The study includes 666 unplanned caesarean sections. The median DDI for emergency caesareans (n=365) was 48 min for Level I units, 40 min for Level II, and 22 min for Level III (P<0.05). For the very urgent caesareans (n=82), the median DDI was respectively 35, 24, and 13 min (P<0.05) and the percentage with a DDI<or=30 min were 45%, 62%, and 100% (P<0.05). The proportion of DDI<or=30 min was 0% in maternity units where obstetricians and anaesthetists were not always onsite, 67% when only the anaesthetist was always present (P<0.05) and 88% for units where both were always present. The neonate's condition did not differ significantly according to DDI. CONCLUSIONS DDI varies very substantially according to the level and organisation of the maternity units in the Aurore network. It was not significantly correlated with neonatal outcome in our population.
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Affiliation(s)
- Cyril Huissoud
- Hospices Civils de Lyon Service de Gynécologie-Obstétrique, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69317 Lyon Cedex 04, France.
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Huissoud C, Carrabin N, Benchaib M, Fontaine O, Levrat A, Massignon D, Touzet S, Rudigoz RC, Berland M. Coagulation assessment by rotation thrombelastometry in normal pregnancy. Thromb Haemost 2009; 101:755-761. [PMID: 19350122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We analysed changes in coagulation during normal pregnancy with a novel point-of-care device based on thrombelastometry (ROTEM). We compared the results obtained with those of standard coagulation tests in 104 patients: 20 non-pregnant women (controls) and 84 women in the first (T1, n = 17), second (T2, n = 9) and third (T3, n = 58) trimesters of pregnancy. We measured the clotting time (CT), the maximum clot firmness (MCF), the early clot amplitude at 5 and 15 minutes (CA(5), CA(15)) and the clot lysis index (CLI(30)) with four tests containing specific reagents. (a) The INTEM test involving ellagic acid activated the intrinsic pathway and (b) the EXTEM test using tissue factor triggered the extrinsic pathway; (c) The FIBTEM test based on a platelet inhibitor (cytochalasin D) evaluated the contribution of fibrinogen to clot formation and (d) the APTEM test was similar to the EXTEM but was based on inhibition in vitro of fibrinolysis by aprotinin. CT and CLI(30) were not significantly modified during pregnancy whereas MCF, CA(5) and CA(15) (INTEM, EXTEM, FIBTEM) increased significantly between the second and third trimesters (e.g. median [interquartile range]: MCF-FIBTEM, 13 [11-16] mm vs. 19 [17-23] mm, respectively, in controls and T3, p < 0.001). EXTEM values were not significantly different from those measured with APTEM. There were significant correlations between the results obtained with ROTEM and those from standard coagulation tests. ROTEM analysis showed a marked increase in coagulability during normal pregnancy. ROTEM values may serve as the basis for future studies in pregnant women.
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Affiliation(s)
- Cyril Huissoud
- Department of Obstetrics and Gynecology, Croix Rousse University Hospital, Lyon, Hospices civils de Lyon, France.
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Abstract
We sought to identify prenatal predictive factors for perinatal outcome and to estimate fetal hemoglobin (Hb) levels in large fetomaternal hemorrhages (transfused blood volume [TBV] > 20 mL) by performing a case-series study ( N = 32). Perinatal outcome was favorable (F group, N = 22) and poor (P group, N = 10: four fetal deaths, three postnatal deaths, three cases of severe anemia). Median TBV was 25 mL for the F group and 325 mL for the P group ( P < 0.0001) and median Hb concentration at birth was 15 g/dL for the F group and 5 g/dL for the P group ( P < 0.0001). Receiver operating characteristic analysis revealed that a Kleihauer-Betke test value above 2.5% was the best threshold for predicting adverse outcome, with sensitivity of 100% (95% confidence interval [CI] 76 to 100) and specificity of 96% (95% CI 77 to 100). In utero estimated Hb concentration best correlated with Hb level at birth when calculated using TBV corrected for fetoplacental weight ( P < 0.0001, R(2) = 0.874). The value obtained in the Kleihauer-Betke test was a prognostic factor, and TBV corrected for fetoplacental weight was the best biological marker for assessing fetal Hb level.
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Affiliation(s)
- Cyril Huissoud
- Department of Obstetrics and Gynecology, Hôpital de la Croix Rousse, France Université de Lyon, France.
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Massardier J, Roth P, Michel-Calemard L, Rudigoz RC, Bouvier R, Dijoud F, Arnould P, Combourieu D, Gaucherand P. Campomelic dysplasia: echographic suspicion in the first trimester of pregnancy and final diagnosis of two cases. Fetal Diagn Ther 2008; 24:452-7. [PMID: 19033726 DOI: 10.1159/000176299] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Accepted: 12/18/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Campomelic dysplasia (CD) is a rare skeletal dysplasia characterized by marked femoral and tibial angulations, hypoplasic scapulae, normal upper limbs and sex reversal in 3/4 of 46,XY fetuses. Most cases are lethal in the neonatal period. Heterozygous mutations in the SOX9 gene are responsible for CD. The diagnosis is not usually made until the mid-second trimester or later. METHODS We describe 2 cases of CD suspected by ultrasonography in the first trimester. RESULTS The 2 cases presented with hygroma colli along with anomalies in the lower but not the upper limbs. Terminations of pregnancy were obtained at 14+3 and 20+6 gestational weeks. Fetopathological examinations confirmed sonographic findings. CONCLUSION When first trimester hygroma colli is accompanied by specific findings of the lower limbs, the diagnosis of CD can be investigated through SOX9 mutation analysis.
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Affiliation(s)
- J Massardier
- Université de Lyon, Lyon, Hospices Civils de Lyon, Unités de Diagnostic Anténatal, Lyon, France.
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Dupuis O, Sayegh I, Decullier E, Dupont C, Clément HJ, Berland M, Rudigoz RC. Red, orange and green Caesarean sections: A new communication tool for on-call obstetricians. Eur J Obstet Gynecol Reprod Biol 2008; 140:206-11. [DOI: 10.1016/j.ejogrb.2008.04.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Revised: 02/28/2008] [Accepted: 04/07/2008] [Indexed: 11/30/2022]
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Candito M, Rivet R, Herbeth B, Boisson C, Rudigoz RC, Luton D, Journel H, Oury JF, Roux F, Saura R, Vernhet I, Gaucherand P, Muller F, Guidicelli B, Heckenroth H, Poulain P, Blayau M, Francannet C, Roszyk L, Brustié C, Staccini P, Gérard P, Fillion-Emery N, Guéant-Rodriguez RM, Van Obberghen E, Guéant JL. Nutritional and genetic determinants of vitamin B and homocysteine metabolisms in neural tube defects: a multicenter case-control study. Am J Med Genet A 2008; 146A:1128-33. [PMID: 18386810 DOI: 10.1002/ajmg.a.32199] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Neural tube defects (NTDs) are severe congenital malformations due to failure of neural tube formation in early pregnancy. The proof that folic acid prevents NTDs raises the question of whether other parts of homocysteine (Hcy) metabolism may affect rates of NTDs. This French case-control study covered: 77 women aged 17-42 years sampled prior to elective abortion for a severe NTDs (cases) and 61 women aged 20-43 years with a normal pregnancy. Plasma and erythrocyte folate, plasma B6, B12 and Hcy were tested as five polymorphisms MTHFR 677 C --> T, MTHFR 1298 A --> C, MTR 2756 A --> G, MTTR 66 A --> G and TCN2 776 C --> G. Cases had significantly lower erythrocyte folate, plasma folate, B12 and B6 concentrations than the controls, and higher Hcy concentration. The odds ratio was 2.15 (95% CI: 1.00-4.59) for women with the MTRR 66 A --> G allele and it was decreased for mothers carrying the MTHFR 1298 A --> C allele. In multivariate analysis, only the erythrocyte folate concentration (P = 0.005) and plasma B6 concentration (P = 0.020) were predictors. Red cell folate is the main determinant of NTDs in France. Folic acid supplement or flour fortification would prevent most cases. Increased consumption of vitamins B12 and B6 could contribute to the prevention of NTDs. Genetic polymorphisms played only a small role. Until folic acid fortification becomes mandatory, all women of reproductive age should consume folic acid in a multivitamin that also contains B12 and B6.
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Affiliation(s)
- Mirande Candito
- Inserm U-145, Department of Biochemistry, CHU Nice Hôpital Pasteur, Nice, France.
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Dupont C, Touzet S, Rudigoz RC, Audra P, Gaucherand P, Colin C. Critical events in obstetrics: a confidential enquiry in four high-level maternities of the AURORE perinatal network. J Eval Clin Pract 2008; 14:165-8. [PMID: 18211664 DOI: 10.1111/j.1365-2753.2007.00809.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Peter L, Niel F, Catenoix H, Jung J, Demarquay G, Petiot P, Rudigoz RC, Boespflug-Tanguy O, Ryvlin P, Mauguière F. Acute neurological deterioration in ovarioleukodystrophy related to EIF2B mutations: pregnancy with oocyte donation is a potentially precipitating factor. Eur J Neurol 2007; 15:94-7. [PMID: 18005052 DOI: 10.1111/j.1468-1331.2007.01999.x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mutations in the eukaryotic translation initiation factor 2B (eIF2B) represent a heterogenous group of autosomal recessive leucodystrophy characterized by a diffuse CSF-like aspect of the white matter at MRI designed as vanishing white matter (VWM) and episodes of acute deterioration after stresses. The mild juvenile and adult forms are often associated with primary ovarian failure, a syndrome referred to as ovarioleukodystrophy (OLD). We reported case of a woman with OLD who successfully underwent in vitro fertilization with donated oocytes and embryo transfer. Pregnancy was complicated by a non-convulsive epileptic status leading to the identification of compound heterozygous EIF2B5 mutation (p.Arg113His and p.Arg299His). The patient gave birth to a healthy child by Caesarean section. In conclusion, we report for the first time that in vitro fertilization and embryo transfer can lead to a successful procreation in patients with OLD related to EIF2B mutations. However this procedure must be considered with cautiousness, because of its potential neurological risks.
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Affiliation(s)
- L Peter
- CHU de Lyon, Service d'Epileptologie, Hôpital Neurologique, Lyon Cedex 3, France.
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Bonadona V, Dussart-Moser S, Voirin N, Sinilnikova OM, Mignotte H, Mathevet P, Brémond A, Treilleux I, Martin A, Romestaing P, Raudrant D, Rudigoz RC, Lenoir GM, Lasset C. Prognosis of early-onset breast cancer based on BRCA1/2 mutation status in a French population-based cohort and review. Breast Cancer Res Treat 2006; 101:233-45. [PMID: 17061047 DOI: 10.1007/s10549-006-9288-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Accepted: 05/24/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE The debate concerning poorer survival for patients with breast cancer (BC) carrying a BRCA1 germline mutation is unresolved, and requires additional data from population-based studies. PATIENTS AND METHODS We followed 232 women with invasive BC under age 46, ascertained prospectively through a French population-based BC registry and tested for BRCA1/2 mutations (median follow-up: 82 months). We compared tumour characteristics and survival rates between 21 BRCA1/2 deleterious mutation carriers and 211 non-carriers. RESULTS As compared to sporadic tumours, BRCA1/2 tumours showed higher grade (P = 0.02), fewer ductal carcinoma in situ (P = 0.02), more frequent medullary histology (P = 0.02), more frequent negative oestrogen and progesterone receptors (P = 0.001 each). At 5 years, BC-specific survival, metastasis-free survival, ipsilateral recurrence-free survival and contralateral BC-free survival rates for BRCA1/2 mutation carriers were 95.0%, 94.7%, 100% and 90.0% respectively, compared with 89.6%, 78.2%, 88.8% and 94.4% respectively, for non-carriers (not significant). Rates for women carrying only a BRCA1 mutation were 93.3%, 93.3%, 100%, 86.7%, respectively. 76% of BRCA1/2 carriers received chemotherapy. CONCLUSION Despite unfavourable tumour features, we found no evidence for poorer short-term survival in BRCA1 mutation carriers compared to non-carriers in this prospective population-based cohort. The high rate of BRCA1 carriers who received chemotherapy for their BC should question the positive impact of this treatment, as suggested by preclinical studies showing increased chemosensitivity of BRCA1-associated tumours.
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Affiliation(s)
- Valérie Bonadona
- Centre Léon Bérard, Unit of Prevention and Genetic Epidemiology, 28 rue Laënnec, 69 373 Lyon cedex 08, France.
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Dupuis O, Moreau R, Silveira R, Pham MT, Zentner A, Cucherat M, Rudigoz RC, Redarce T. A new obstetric forceps for the training of junior doctors: a comparison of the spatial dispersion of forceps blade trajectories between junior and senior obstetricians. Am J Obstet Gynecol 2006; 194:1524-31. [PMID: 16579914 DOI: 10.1016/j.ajog.2006.01.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [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: 10/27/2005] [Revised: 12/13/2005] [Accepted: 01/10/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of this study was to create a new instrument for the training of doctors in the use of forceps and to compare the trajectories of forceps blades between junior and senior obstetricians. STUDY DESIGN We equipped a simulator and forceps with spatial location sensors. The head of the fetus was in an occipitoanterior location, at a "+5" station. Forceps blade trajectories were analyzed subjectively with the 3-dimensional spatial graph and objectively based on 3 points of special interest. Each obstetrician performed 4 forceps blades placements. We compared the trajectories of junior and senior obstetricians. RESULTS For senior operators, spatial dispersion was "excellent," "very good," or "good" in 92% of cases, whereas this was the case for only 38% of junior doctors (92% vs 38%; P < .001). CONCLUSION A new instrument has been designed to demonstrate the trajectory of forceps blades during application in a simulator. The instrument captures the difference in experience between senior and junior clinicians.
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Affiliation(s)
- Olivier Dupuis
- Service de Gynécologie et d'Obstétrique, Hôpital de la Croix Rousse, Hospices civils de Lyon, Lyon, France.
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Tramoni G, Clement HJ, Rudigoz RC, Viale JP. Prostaglandin F2α: French guidelines for uterine atony management. Int J Obstet Anesth 2006; 15:180-1. [PMID: 16488143 DOI: 10.1016/j.ijoa.2005.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2005] [Accepted: 10/28/2005] [Indexed: 11/23/2022]
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Catti M, Paccalin C, Rudigoz RC, Mouriquand P. Quality of life for adult women born with bladder and cloacal exstrophy: a long-term follow up. J Pediatr Urol 2006; 2:16-22. [PMID: 18947589 DOI: 10.1016/j.jpurol.2005.07.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2005] [Accepted: 07/06/2005] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the quality of life of 23 female patients over 18 years of age treated and followed in the same institution. METHODS Fifty questions were sent to this group of patients covering their uro-gynaecological history, education and profession, social life and related psychological issues, sexual life and fertility. All replies were kept anonymous. RESULTS Seventeen patients (74%) replied. Urine incontinence at various degrees was found in 65%. Genital prolapse was reported in 29.5%. Students accounted for 41%; 59% were actively working with a satisfactory professional life in 82% of cases. Seventy-six per cent did not consider that exstrophy affected their professional life, and 76% were happy with their social life. Psychological distress was reported by 41%, and the symptoms are detailed. Sixty-four per cent were married or had a stable partner. Seventy-six per cent were active sexually, all declaring heterosexual relations. Eighty-eight per cent had periods. Four pregnancies were reported and morbidity during gestation is described. All children were born by Caesarean section and were normal. These results are discussed and compared with the literature. CONCLUSION Despite many hurdles, this group of patients can expect a subnormal social, family and professional life. Urinary incontinence and poor body image were the most important factors altering quality of life.
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Affiliation(s)
- Massimo Catti
- Claude-Bernard University, Debrousse Hospital, 29, rue Soeur Bouvier, 69322 Lyon, Cedex 05, France
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Bonadona V, Sinilnikova OM, Chopin S, Antoniou AC, Mignotte H, Mathevet P, Brémond A, Martin A, Bobin JY, Romestaing P, Raudrant D, Rudigoz RC, Léoné M, Chauvin F, Easton DF, Lenoir GM, Lasset C. Contribution of BRCA1 and BRCA2 germ-line mutations to the incidence of breast cancer in young women: results from a prospective population-based study in France. Genes Chromosomes Cancer 2005; 43:404-13. [PMID: 15887246 DOI: 10.1002/gcc.20199] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [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: 01/06/2023] Open
Abstract
The prevalence of BRCA1/2 germ-line mutations was assessed in a prospective population-based series of early-onset breast cancer (BC) patients in France, and the usefulness of a clinical assessment of hereditary BC risk, based on multiple criteria including pedigree structure, was evaluated. Through the Rhone region BC registry, 232 women diagnosed with BC before 46 years of age were included. They were tested for BRCA1/2 mutations an average of 10 months after diagnosis. All the women were classified according to their family history of cancer: high risk of hereditary breast cancer (HBC), low risk of HBC, isolated BC, and unknown HBC risk. Deleterious mutations were observed in 21 women (9.1%): 15 (6.5%) BRCA1 and 6 (2.6%) BRCA2. Mutations were more prevalent in women who developed BC before age 41 than in women who developed BC between ages 41 and 45 (12.8% versus 5.2%, respectively, P = 0.04). A high prevalence of BRCA1/2 mutations was found among women in the high-risk category with particular family features (i.e., small family size, predominantly male pedigree, specific cancers; 23.5%) and among women with isolated BC before age 41 and with five or fewer close adult female relatives (16.6%). According to the 10% probability level recommended by the American Society of Clinical Oncology guidelines for genetic testing of cancer, BRCA1/2 mutation screening should be considered for all women diagnosed before age 41, except for those with isolated BC in a large pedigree including multiple unaffected female relatives. The clinical assessment of HBC risk that we have developed should help in the decision to perform genetic testing.
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Affiliation(s)
- Valerie Bonadona
- Department of Public Health, Cancer Centre Léon Bérard, Lyon, France
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Dupuis O, Silveira R, Zentner A, Dittmar A, Gaucherand P, Cucherat M, Redarce T, Rudigoz RC. Birth simulator: reliability of transvaginal assessment of fetal head station as defined by the American College of Obstetricians and Gynecologists classification. Am J Obstet Gynecol 2005; 192:868-74. [PMID: 15746684 DOI: 10.1016/j.ajog.2004.09.028] [Citation(s) in RCA: 165] [Impact Index Per Article: 8.7] [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: 12/01/2022]
Abstract
OBJECTIVE This study was undertaken to investigate the reliability of transvaginal assessment of fetal head station by using a newly designed birth simulator. STUDY DESIGN This prospective study involved 32 residents and 25 attending physicians. Each operator was given all 11 possible fetal stations in random order. A fetal head mannequin was placed in 1 of the 11 American College of Obstetricians and Gynecologists (ACOG) stations (-5 to +5) in a birth simulator equipped with real-time miniaturized sensor. The operator then determined head position clinically using the ACOG classification. Head position was described as: (1) "engaged" or "nonengaged" (engagement code); (2) "high," "mid," "low," or "outlet" (group code); and (3) according to the 11 ACOG ischial spine stations (numerical code). Errors were defined as differences between the stations given by the sensor and by the operator. We determined the error rates for the 3 codes. RESULTS "Numerical" errors occurred in 50% to 88% of cases for residents and in 36% to 80% of cases for attending physicians, depending on the position. The mean "group" error was 30% (95% CI 25%-35%) for residents and 34% (95% CI 27%-41%) for attending physicians. In most cases (87.5% for residents and 66.8% for attending physicians) of misdiagnosis of "high" station, the "mid" station was retained. Residents and attending physicians made an average of 12% of "engagement" errors, equally distributed between false diagnosis of engagement and nonengagement. CONCLUSION Our results show that transvaginal assessment of fetal head station is poorly reliable, meaning clinical training should be promoted. The choice not to perform vaginal delivery when the fetus is in the "mid" position strongly decreases the risk of applying instruments on an undiagnosed "high" station. Conversely, obstetricians who perform only "low" operative vaginal deliveries also deliver unrecognized "mid" station fetuses. Therefore, residency programs should offer training in "mid" pelvic operative vaginal deliveries. Birth simulators could be used in training programs.
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Affiliation(s)
- Olivier Dupuis
- Unité de Gynécologie Obstétrique, Hôpital de la Croix Rousse, Lyon, France.
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Dupuis O, Silveira R, Dupont C, Mottolese C, Kahn P, Dittmar A, Rudigoz RC. Comparison of "instrument-associated" and "spontaneous" obstetric depressed skull fractures in a cohort of 68 neonates. Am J Obstet Gynecol 2005; 192:165-70. [PMID: 15672020 DOI: 10.1016/j.ajog.2004.06.035] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [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: 11/18/2022]
Abstract
OBJECTIVE A depressed skull fracture is an inward buckling of the calvarial bones and is referred to as a "ping-pong" fracture. This study aimed to look at differences between "spontaneous" and "instrument-associated" depressed skull fractures. STUDY DESIGN This retrospective, case-control analysis included every neonate who was admitted with a depressed skull fracture between 1990 and 2000. Cases after a spontaneous vaginal delivery, elective cesarean delivery, or cesarean delivery that was performed during labor without previous instrument use were classified as "spontaneous" (n = 18 cases). Cases after a delivery in which forceps or a vacuum cup had been used either successfully or unsuccessfully were classified as "instrument-associated" (n = 50 cases). Continuous data were analyzed with 2-tailed unpaired t tests; chi 2 analysis was used for nominal data. A probability value of <.05 was considered statistically significant. RESULTS Fifty depressed skull fractures were associated with an instrument delivery, and 18 depressed skull fractures were classified as "spontaneous." The only obstetric parameter that differed significantly between the 2 groups was the length of the active phase. Among the 68 neonates, 15 neonates underwent prolonged second stage, forceps or manual head rotation, or forceps use during elective cesarean delivery. All "instrument-associated" cases were caused by forceps application or sequential instrument use; depressed skull fractures never occurred after isolated vacuum extraction. Every type of forceps was involved. Intracranial lesions were significantly more frequent in the instrument-associated group (30% vs 0%; P = .02). Two infants sustained persistent severe motor disabilities. CONCLUSION Depressed skull fractures occur in the setting of spontaneous and operative deliveries, although the incidence is higher in the latter case. Depressed skull fractures that are associated with instrumental deliveries are significantly more likely to be associated with intracranial lesions. Persistent disabilities are rare.
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Affiliation(s)
- Olivier Dupuis
- Unité de Gynécologie Obstétrique, Hôpital de la Croix Rousse, Lyon, France.
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Tramoni G, Valentin S, Robert MO, Sergeant MV, Branche P, Duperret S, Clement HJ, Lopez F, Boisson C, Audra P, Rudigoz RC, Viale JP. Amniotic fluid embolism during caesarean section. Int J Obstet Anesth 2004; 13:271-4. [PMID: 15477060 DOI: 10.1016/j.ijoa.2004.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2004] [Indexed: 11/17/2022]
Abstract
Amniotic fluid embolism occurs rarely but is a leading cause of maternal mortality. A high index of clinical suspicion is necessary to make an early diagnosis to reduce morbidity and mortality. We report a non-fatal case of amniotic fluid embolism occurring during a caesarean section, with special emphasis on the mode of development and diagnosis. The initial presentation of this syndrome was a coagulopathy, followed by the usual complications of massive bleeding. Although non-specific, the diagnosis of amniotic fluid embolism was supported by the observation of amniotic fluid in the central venous blood as well as in the broncho-alveolar fluid.
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Affiliation(s)
- G Tramoni
- Département d'anesthésie réanimation, Service d'obstétrique and Fédération de Biochimie, Hôpital de la Croix Rousse, and Service d'obstétrique, Hôpital Edouard Herriot, Pavillon K, Lyon, France.
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Sayegh I, Dupuis O, Clement HJ, Rudigoz RC. Evaluating the decision-to-delivery interval in emergency caesarean sections. Eur J Obstet Gynecol Reprod Biol 2004; 116:28-33. [PMID: 15294363 DOI: 10.1016/j.ejogrb.2004.01.032] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the interval between the decision to carry out an emergency caesarean section and delivery, and to determine whether this interval can be shortened. STUDY DESIGN A retrospective study was performed in a French maternity hospital over a 6-month period. All caesarean sections performed during labour were included. These caesarean sections were divided into two groups according to Lucas's classification: (1) emergency and urgent caesarean sections and (2) scheduled caesarean sections. RESULTS The mean decision--to--delivery interval was 39.5 min in the first group and 55.9 min in the second group. It was mainly influenced by the time taken to get the patient into theatre. The mean decision-to-operating theatre interval accounted for 45.6 and 53.8% of the mean decision-to delivery-interval, respectively. CONCLUSION The recommended interval of 30 min is not routinely achieved. Improving communication within the perinatal team could decrease the decision--to--operating theatre interval and should be promoted.
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Affiliation(s)
- I Sayegh
- Service de gynécologie-obstétrique, Hôpital de la Croix-Rousse, 93 Grande rue de la Croix-Rousse, 69317 Lyon Cedex 04, France
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Dupuis O, Arsalane A, Dupont C, Janvier M, Laurenceau N, Louzas I, Mikala M, Gariod S, Beaumont G, Rudigoz RC, Gaucherand P. Évaluation de l'algorithme de prise en charge des appels pour menace d'accouchement prématuré utilisé par la cellule de transfert périnatal de la région Rhône-Alpes. ACTA ACUST UNITED AC 2004; 32:285-92. [PMID: 15123097 DOI: 10.1016/j.gyobfe.2004.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 10/25/2003] [Accepted: 02/11/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Preterm labor is one of the major causes of concern for level I and II obstetricians. The purpose of this study was to determine the incidence of in utero transfer performed for preterm labor. We also aimed to evaluate the algorithm we used in case of call for preterm labor. This algorithm allowed us to study the rate of endovaginal sonography use prior to in utero transfer, to calculate its predictive value and to evaluate the risk of delivery during transfer. PATIENTS AND METHOD We conducted an 8-months prospective study of all calls for preterm labor received at a regional call center in France (EU). All obstetrical data were entered in a computerized anonymous database. Three months after the first call midwives collected data from the receiving hospital. RESULTS Calls for preterm labor account for 40% of calls for in utero transfer. Two hundred and sixty-five calls have been received for preterm labor; among them 50 cases were associated with a preterm rupture of membrane, a maternal or fetal pathology and 14 cases were lost for follow-up. Those 64 cases were excluded leaving 201 cases for analysis. Twenty-eight had a cervix dilated 4 cm, or more, while 173 had a cervix dilated less than 4 cm. Fifty percent of woman that had a cervical dilatation of 4 cm or more delivered more than 4 h after the call. Among the 173 patients that had a cervix dilated less than 4 cm, 71% had not delivered 7 days after the hotline call and 26% had an endovaginal ultrasonography performed before the transfer. None of the women that had a cervical length longer than 27 mm delivered in the 7 following days. None of the 176 women that were transferred delivered during the transfer. DISCUSSION AND CONCLUSION In utero transfer for preterm labor is the leading cause of in utero transfer. Endovaginal ultrasonography prior to transfer should be performed in order to avoid unnecessary transfer. Women who have a preterm labor with a cervical dilatation of 4 cm or more are not an absolute contra-indication to in utero transfer. In those cases the transfer indication should be discussed on a case-to-case basis including the actual term and the distance between hospitals.
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Affiliation(s)
- O Dupuis
- Cellule des transferts périnataux de la région Rhône-Alpes, France.
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Gorincour G, Chotel F, Rudigoz RC, Guibal-Baggio AL, Berard J, Pracros JP, Guibaud L. Prenatal diagnosis of congenital genu recurvatum following amniocentesis complicated by leakage. Ultrasound Obstet Gynecol 2003; 22:643-645. [PMID: 14689540 DOI: 10.1002/uog.884] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Congenital genu recurvatum (CGR) is an extremely rare condition observed at birth. It is associated with, among other malformations, genetic entities such as the Larsen syndrome. When CGR is isolated, orthopedic treatment will usually lead to a good functional prognosis. We report the first case of isolated CGR diagnosed prenatally and suspected to be a consequence of reduced amniotic fluid volume due to leakage following amniocentesis. The etiology and management options for CGR are briefly discussed.
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Affiliation(s)
- G Gorincour
- Department of Pediatric and Fetal Imaging, Hôpital Debrousse, Lyon, France
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Candito M, Boisson C, Gaucherand P, Luton D, Oury JF, Burc L, Journel H, Rudigoz RC, Van Obberghen E. [Call for researchers associated with a biological study of neural tube defects: prospective study of the role of homocysteine in neural tube defects in France]. Ann Biol Clin (Paris) 2003; 61:615-6. [PMID: 14671761] [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] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Rudigoz RC. [Home delivery: opinion of French women and perinatal risk. Results of the DOM 2000 survey]. Gynecol Obstet Fertil 2003; 31:572. [PMID: 12865202 DOI: 10.1016/s1297-9589(03)00135-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sayegh I, Clément HJ, Gaucherand P, Rudigoz RC. [Cerebral vascular malformations and pregnancy: obstetrical and anesthetic management]. J Gynecol Obstet Biol Reprod (Paris) 2002; 31:379-86. [PMID: 12058144] [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: 02/25/2023]
Abstract
Obstetrical management of women known to have a cerebral vascular malformation is controversial. The risk of cerebral hemorrhage during pregnancy is difficult to assess. We report thirteen cases of pregnancy in women with known cerebral vascular malformations who had or had not undergone surgical treatment. The effect of pregnancy on these malformations and corresponding obstetrical care described in the literature were studied. Our conclusion is that the risk of bleeding from cerebral arteriovenous malformations is not significantly increased during pregnancy whereas the risk of cerebral hemorrhage is slightly increased at the end of pregnancy, but unchanged during labor and delivery, in women with arterial aneurysms. There is no reason to advise against pregnancy in most cases and vaginal delivery is often possible unless there is a risk of dystocia.
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Affiliation(s)
- I Sayegh
- Service de Gynécologie-Obstétrique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103, Grande-Rue de la Croix-Rousse, 69317 Lyon Cedex 04, France
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Bordes A, Bory AM, Benchaïb M, Rudigoz RC, Salle B. Reproducibility of transvaginal three-dimensional endometrial volume measurements with virtual organ computer-aided analysis (VOCAL) during ovarian stimulation. Ultrasound Obstet Gynecol 2002; 19:76-80. [PMID: 11851973 DOI: 10.1046/j.0960-7692.2001.00550.x] [Citation(s) in RCA: 30] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To calculate inter- and intraobserver reliabilities for three-dimensional endometrial volume measurements during in vitro fertilization using virtual organ computer-aided analysis (VOCAL). PATIENTS AND METHODS Three-dimensional ultrasound measurements of the endometrium using VOCAL software were performed on the day of oocyte retrieval in each of 79 consecutive patients undergoing in vitro fertilization or intracytoplasmic sperm injection. Endometrial volume was calculated every 15 degrees and every 30 degrees by two different observers in order to determine the reproducibility of the technique. RESULTS Intraobserver reliability for the 15 degrees measurements was 0.97 for both observers; for the 30 degrees measurements, it was 0.93 for one observer and 0.96 for the other. Interobserver reliability was 0.80 for the endometrial volumes calculated every 15 degrees and 0.83 for the volumes calculated every 30 degrees. The intra- and interobserver measurement agreement showed good reproducibility. However, the volumes calculated every 15 degrees were more accurate because the means of differences were close to zero. CONCLUSION VOCAL provides a reproducible method for the estimation of the endometrial volume.
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Affiliation(s)
- A Bordes
- Centre d'Aide Médicale à la Reproduction, Universitaire de la Croix Rousse, Lyon, France
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