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Cancer during pregnancy is rare (about 1/1000 pregnancies) and its diagnosis raises the question of whether or not to continue the pregnancy.The primary objective of our study was to evaluate associated factors with termination of pregnancy in cases of cancer during pregnancy. Secondary objectives were to evaluate maternal and neonatal outcomes when pregnancy is continued.We conducted a retrospective, single-center study between January 2009 and December 2019 including 2 groups of patients those who underwent termination of pregnancy and those who continued pregnancy. Patients were distributed in 3 categories breast cancer, blood cancer and other cancers.A total of 71 pregnancies associated with cancer were included. Twenty patients (28.16 %) underwent termination of pregnancy. The median gestational age at diagnosis was significantly earlier in the termination of pregnancy group compared with the ongoing pregnancy group (9 vs 22 weeks, p0.01). Blood cancer was more frequent in the termination group 7 (35 %) compared to continuous pregnancy 8 (15.7 %) as other cancers 8 (40 %) in the termination group vs 5 (9,8 %). Conversely breast cancer what was less frequent in the termination group 5 (25 %) vs 38 (74,5 %) (p0.01). In the continued pregnancy group, there was a high rate of induced prematurity (35.5 %) and scheduled delivery to optimize maternal oncologic management (78.4 %).The rate of termination of pregnancy remains high particularly in case of non-breast cancer and early pregnancy detection. Scheduled preterm birth is frequent when pregnancy is continued in order to optimize of cancer management.

Objective(s) Every year in France, 10% to 20% of the 600 000 women given epidural analgesia during labor experience hypotension, which in 15% of cases is associated with fetal heart rate abnormalities. The efficiency of lower limbs venous compression in preventing the occurrence of maternal hypotension after neuraxial anesthesia has already been demonstrated, but only in the context of scheduled cesarean section. We assessed the preventive effect of medical lower limbs venous compression on the incidence of maternal hypotension after epidural analgesia during spontaneous term labor. Study design This before/after, single-center study in a university hospital included 93 women in spontaneous labor at term who between 1 January and 31 March 2015 with epidural analgesia plus lower limbs compression and 202 women in spontaneous labor at term who delivered between 1 and 31 December 2014 with epidural analgesia without lower limbs compression (control group). The main outcome was maternal hypotension (systolic blood pressure 20%) in the 15 min after epidural analgesia. Results In the lower limbs compression group the incidence of hypotension 15 min after epidural analgesia was significantly lower than in the control group (3.23% versus 23.3%, adjusted odds ratio = 0.1 [0.03; 0.35]). The incidence of fetal heart rate abnormalities was unsignificantly lower in the lower limbs compression group than in the control group (10.7% versus 16.34%, p = 0.22). Conclusion The results suggest that medical lower limbs compression (20–36 mmHg) in women in spontaneous labor at term, could significantly reduce the incidence of maternal hypotension following epidural analgesia. A prospective, randomized, open trial would allow confirmation of these preliminary results.

Objective Examine the predictive value for maternal-fetal infection of routine bedside tests detecting the proinflammatory cytokines, TNFα and IL-6, in the vaginal secretions of women with premature rupture of the membranes (PROM). Study design This prospective two-center cohort study included all women hospitalized for PROM over a 2-year period. A bedside test assessed IL-6 and TNFα in vaginal secretions. Both centers routinely tested CRP and leukocytes, assaying both in maternal serum, and analyzed vaginal bacterial flora; all samples were repeated twice weekly until delivery. Results The study included 689 women. In cases of preterm PROM (PPROM) before 37 weeks (n = 184), a vaginal sample positive for one or more bacteria was the only marker associated with early neonatal infection (OR 5.6, 95%CI; 2.0–15.7). Its sensitivity was 82% (95%CI; 62–94) and its specificity 56% (95%CI; 47–65). All positive markers of infection were associated with the occurrence of chorioamnionitis. In cases of PROM from 37 weeks onward (n = 505), only CRP >5 mg/dL was associated with early neonatal infection (OR = 8.3, 95%CI; 1.1–65.4) or clinical chorioamnionitis (OR = 6.8, 95%CI; 1.5–30.0). The sensitivity of CRP >5 mg/dL was 91% (95%CI; 59–100) and its specificity 45% (95%CI; 40–51) for predicting early neonatal infection, and 89% (95%CI; 65–99) and 46% (95%CI; 41–51), respectively, for predicting clinical chorioamnionitis. Conclusion The association of vaginal cytokines with maternal-fetal infection is weak and thus prevents their use as a good predictor of maternal-fetal infection. CRP and vaginal samples may be useful for identifying a group of women at low risk of infection.

Postpartum haemorrhage (PPH) is defined as blood loss >= 500 mL after a delivery and severe PPH as blood loss >= 1000 mL, regardless of the a route of delivery (professional consensus). The preventive a administration of uterotonic agents just after delivery is effective in a reducing the incidence of PPH and its systematic use is recommended, a regardless of the route of delivery (Grade A). Oxytocin is the first a line prophylactic drug, regardless of the route of delivery (Grade A); a a slowly dose of 5 or 10 IU can be administered (Grade A) either IV or IM a (professional consensus).After vaginal delivery, routine cord drainage a (Grade B), controlled cord traction (Grade A), uterine massage (Grade a A), and routine bladder voiding (professional consensus) are not a systematically recommended for PPH prevention. After caesarean delivery, a placental delivery by controlled cord traction is recommended (grade B). a The routine use of a collector bag to assess postpartum blood loss at a vaginal delivery is not systematically recommended (Grade B), since the a incidence of severe PPH is not affected by this intervention. In cases a of overt PPH after vaginal delivery, placement of a blood collection bag a is recommended (professional consensus). The initial treatment of PPH a consists in a manual uterine examination, together with antibiotic a prophylaxis, careful visual assessment of the lower genital tract, a a uterine massage, and the administration of 5-10 IU oxytocin injected a slowly IV or IM, followed by a maintenance infusion not to exceed a a cumulative dose of 40 IU (professional consensus). If oxytocin fails to a control the bleeding, the administration of sulprostone is recommended a within 30 minutes of the PPH diagnosis (Grade C). Intrauterine balloon a tamponade can be performed if sulprostone fails and before recourse to a either surgery or interventional radiology (professional consensus). a Fluid resuscitation is recommended for PPH persistent after first line a uterotonics, or if clinical signs of severity (Grade B). The objective a of RBC transfusion is to maintain a haemoglobin concentration (Hb) >8 a g/dL. During active haemorrhaging, it is desirable to maintain a a fibrinogen level >= 2 g/L (professional consensus). RBC, fibrinogen and a fresh frozen plasma (FFP) may be administered without awaiting a laboratory results (professional consensus). Tranexamic acid may be used a at a dose of 1 g, renewable once if ineffective the first time in the a treatment of PPH when bleeding persists after sulprostone administration a (professional consensus), even though its clinical value has not yet a been demonstrated in obstetric settings. It is recommended to prevent a and treat hypothermia in women with PPH by warming infusion solutions a and blood products and by active skin warming (Grade C). Oxygen a administration is recommended in women with severe PPH (professional a consensus). If PPH is not controlled by pharmacological treatments and a possibly intra-uterine balloon, invasive treatments by arterial a embolization or surgery are recommended (Grade C). No technique for a conservative surgery is favoured over any other (professional a consensus). Hospital-to-hospital transfer of a woman with a PPH for a embolization is possible once hemoperitoneum is ruled out and if the a patient's hemodynamic condition so allows (professional consensus). (C) a 2015 Elsevier Ireland Ltd. All rights reserved.

Objective To report the outcomes of 38 monoamniotic twin pregnancies managed homogeneously to assess whether continuing the pregnancy past 32 weeks of gestation and vaginal delivery are reasonable options. Study design Single-centre retrospective study including all monoamniotic pregnancies managed over a 20-year period at Port-Royal Obstetrics Department, Paris, France. Methods In the study department, both continuation of the pregnancy up to 36 weeks of gestation and vaginal delivery are allowed for monoamniotic pregnancies in some conditions. Perinatal outcomes are described and then compared according to mode of delivery for patients who gave birth at or after 32 weeks of gestation. Results Three of the 38 pregnancies included fetal malformations; in two of these cases, both fetuses died in utero at 26 weeks of gestation. In cases without malformations, one twin died in utero in two women at 28.0 and 29.2 weeks of gestation, and both fetuses died in two other women at 24.0 and 24.5 weeks of gestation. Mean gestational age at delivery was 32.9 weeks (range 24.0–36.3). Five women gave birth between 22 and 26 weeks of gestation, six women gave birth between 27 and 31 weeks of gestation, and 27 women gave birth at or after 32 weeks of gestation (26 after excluding those with fetal malformations). No intrauterine or neonatal deaths were observed at or after 32 weeks of gestation. The 28 infants delivered vaginally did not differ significantly from the 22 infants born by caesarean section in terms of umbilical artery pH or 5-min Apgar scores. Conclusion Continuation of monoamniotic pregnancies beyond 32 weeks of gestation and trial of vaginal delivery are both reasonable options if the parents agree, and optimal surveillance is provided.

Objective To compare neonatal morbidity and mortality rates in preterm singleton breech deliveries from 26 0/7 to 29 6/7 weeks of gestation in centers with a policy of either planned vaginal delivery (PVD) or planned cesarean delivery (PCD). Study design Women with preterm singleton breech deliveries occurring after preterm labor or preterm premature rupture of membranes (pPROM) were identified from the databases of five perinatal centers and classified as PVD or PCD according to the center's management policy. The independent association between planned mode of delivery and the risk of neonatal hospital death or morbidity was tested and quantified with ORs through two-level multivariable logistic regression modeling. Results Of 142 782 deliveries during the study period, 626 (0.4%) were singletons in breech presentation from 26 0/7 to 29 6/7 weeks of gestation: after exclusions, 130 were in the PVD group and 173 in the PCD group. Severe newborn morbidity was similar in the two groups. Newborn mortality was 12% in the PCD group and 16% in the PVD group. Three neonates (1.7%, 95% CI: 0.34–5.0) died from head entrapment after vaginal delivery in the PVD group. Nonetheless, the policy of PVD was not associated with increased risks of neonatal death (aOR: 1.01, 95% CI: 0.33–2.92) or severe morbidity. Conclusion Risks of mortality and severe morbidity in preterm breech were not increased by a policy of vaginal delivery. Head entrapment leading to death is however possible in cases of vaginal delivery but its rarity should be balanced with the maternal consequences of early preterm cesarean delivery.

To assess the impact of extreme preterm premature rupture of membranes (PPROM)25 weeks of gestation on preterm child outcome.Retrospective study comparing the neonatal and 2-year outcomes of infants exposed to extremely PPROM25 weeks with a non-exposed group of neonates in a tertiary care referral centre located in Paris, France, between 2003 and 2007. All women with singleton pregnancy and PPROM between 15(0/7) and 24(6/7) weeks of gestation were recruited. For each infant born alive, the next inborn neonate matched for gestational age and sex was selected as a control among neonates born alive after spontaneous preterm labour with intact membranes. The main outcome measures were neonatal outcome assessed by a combined criterion of adverse neonatal outcomes and the two-year neurodevelopmental outcome assessed by developmental Brunet-Lézine tests and neurological examinations.In 78 cases of extremely PPROM, 22 live births occurred at a mean gestational age of 26(5/7) weeks. The percentage of neonates with adverse neonatal outcomes was significantly higher among PPROM than non-exposed cases (68.2 versus 27.3%). At 2 years of age, children from the PPROM group were more likely to have delayed acquisitions (64.3 versus 15.8%) and behavioural disorders (57.1 versus 15.8%). Mean Brunet-Lézine language score was significantly lower among those infants (78.9 versus 96.8).PPROM25 weeks is associated with increased neonatal mortality and morbidity and with increased risks of delayed acquisitions, behavioural disorders and lower language performance scores at 2 years in comparison with matched preterm neonates born after spontaneous preterm labour with intact membranes.

Objective To describe pregnancy outcomes for pregnant women with sickle cell disease (SCD) receiving prophylactic transfusions. Study design This retrospective case–control study compared pregnancy outcomes among women with SCD receiving prophylactic transfusions and women without any hemoglobinopathy, matched for ethnicity, parity, age and hospital. Results The study included two groups of pregnancies: 128 in women with SCD (95 with SS phenotype and 33 with SC) and 128 in women with AA phenotype. No woman died. Two perinatal deaths (2.1%) and five alloimmunizations (5.3%) occurred, all in the SS group. Compared with the control group, HbSS disease was more often associated with pre-eclampsia (9.4% versus 2.3%, p =.03), preterm delivery (15.8% versus 6.2%, p =.01), birth weight p =.008) and caesarean delivery (73.6% versus 26.4%, p Conclusion Despite prophylactic blood transfusions, SCD remains a severe complicating factor in pregnancy. The policy of systematic transfusions should be analyzed in a sufficiently large randomized trial.

Objective To predict maternal and neonatal clinical infection at admission in women hospitalized for preterm labour (PTL) with intact membranes. Study design Prospective study of 371 women hospitalized for preterm labour with intact membranes. The primary outcome was clinical infection, defined by clinical chorioamnionitis at delivery or early-onset neonatal infection. Results Clinical infection was identified in 21 cases (5.7%) and was associated with earlier gestational age at admission for PTL, elevated maternal C-reactive protein (CRP) and white blood cell count (WBC), shorter cervical length, and a cervical funnelling on ultrasound. We used ROC curves to determine the cut-off values that minimized the number of false positives and false negatives. The cut-off points chosen were 30 weeks for gestational age at admission, 25 mm for cervical length, 8 mg/l for CRP and 12,000 c/mm 3 for WBC. Each of these variables was assigned a weight on the basis of the adjusted odds ratios in a clinical infection risk score (CIRS). We set a threshold corresponding to a specificity close to 90%, and calculated the positive and negative predictive values and likelihood ratios of each marker and of the CIRS. The CIRS had a sensitivity of 61.9%, while the sensitivity of the other markers ranged from 19.0% to 42.9%. Internal cross-validation was used to estimate the performance of the CIRS in new subjects. The diagnostic values found remained close to the initial values. Conclusion A clinical infection risk score built from data known at admission for preterm labour helps to identify women and newborns at high risk of clinical infection.

Objective Identify the prenatal determinants associated with cesarean delivery during labor of term breech presentation for which vaginal delivery is planned. Study design Prospective study of 174 French and Belgian maternity units. Relations between cesarean and prenatal determinants were estimated with a multilevel logistic model and expressed as adjusted ORs. A prediction score for cesarean section was proposed and diagnostic values were estimated for different cutoff values. Results Of 2478 women meeting the inclusion criteria, 705 (28.5%) had cesarean deliveries. Nulliparity, complete breech, rupture of membranes before labor, fetal weight ≥ 3800 g, biparietal diameter >95 mm and university and public non-teaching hospital maternity units were significantly associated with cesarean delivery during labor. The rate of cesarean during labor was significantly higher in establishments where more than 80% of women had planned cesareans and in cases where mode of delivery had not been decided before labor. The prediction score values ranged from 9 to 21.4 (10th, 50th and 90th percentiles corresponded to 10.1, 12.2 and 14.7). The cesarean rate was 43% in women whose score was greater than the cutoff point of 12.9, and 15% for women whose score was below this value. Conclusion Our findings indicate that once vaginal delivery has been decided upon, the risk of cesarean delivery during labor for breech presentation at term depends not only on the progress of labor, but also on prenatal determinants both maternal and obstetrical. It also depends on some characteristics of the maternity units. Obstetricians should either plan cesarean delivery or define stringent rules for indications of cesarean during labor.

Objective To describe the changes in the rate of caesarean deliveries before labour among women with term breech presentations in France and to identify the factors associated with this change over two periods: 1972–1995/1998 and 1995/1998–2003. Population The study population consisted of 1479 women with a foetus in a breech presentation at term and without any previous caesarean delivery, from the population of births in the 1972, 1995, 1998 and 2003 national perinatal surveys ( N =53136). Data from the 1995 and 1998 surveys were pooled. Methods The principal endpoint was caesarean delivery before labour. Associations between the factors studied and caesarean before labour were estimated by odds ratios, both crude and adjusted with a logistic regression model. Results Between 1972 and 2003, the rate of caesareans before labour for women with term breech presentations rose sharply (from 14.5% in 1972 to 42.6% in 1995/1998 and to 74.5% in 2003). Between 1972 and 1995/1998, this increase was especially marked among the nulliparous women (16.7% versus 52.9%). From 1995/1998 to 2003, the increase was greatest for multiparas: in 2003 this rate among women with children was close to that for women who had never given birth (64.5% and 79.5%, respectively). After adjustment, the factors associated with a high rate of caesarean before labour were nulliparity, birth between 38 and 40 weeks' gestation, birth weight ≥3800g, delivery in the private sector and year of delivery. The rate of caesareans before labour was significantly higher in 2003 (ORa=19.04 [12.06–30.06]) and in 1995–1998 (ORa=4.30 [2.87–6.47]) than in 1972. Conclusion The increase in the rate of caesarean deliveries before labour in women with term breech presentations was associated principally with changes in obstetrical practices.

Objective : To compare neonatal morbidity and mortality at Port Royal Maternity between 1993 and 1999 for infants with a singleton breech presentation born after 37 weeks, according to planned mode of delivery. Study design : Retrospective study of 501 patients of whom vaginal delivery was planned in 322 (64%) or/and cesarean in 179 (36%). Results : Severe neonatal morbidity was similar in the two groups (13/322, 4.0% versus 8/179, 4.5%; P =0.82); severe trauma morbidity was not significantly higher in the "planned vaginal delivery" group (3/322, 0.9% versus 1/179, 0.06%; P =0.16); there were no long-term sequelae. Mortality was not higher when vaginal delivery was planned. Conclusion : We have not found in this series any excess of morbidity or mortality attributable to vaginal delivery of breech presentations. This work does not indicate that we should change our obstetrical practice in the light of other recently-published studies.

Background: New biochemical markers for the risk of spontaneous preterm birth (SPB) give a more precise and earlier diagnosis than the usual ones. We reviewed the data about the principal markers. Results: Using studies with good methodology and a large number of subjects, we observe that the predictive value of these new markers is somewhat higher than those of the usual markers. Fetal fibro-nectin (FNf) and cervical ultrasound undeniably improve the identification of patients at risk of preterm birth, both in the general population and in these threatened preterm delivery. However no management has yet been demonstrated efficacious, especially in a general population so any recommendations for their systematic utilisation is premature. Other biochemical markers (salivary estriol, serum CRH, etc.) are still under assessment and should not be used outside research protocols. Implication for practice: It is appropriate to integrate either FNf or cervical ultrasound into daily clinical practice for patients with signs of preterm labor. These new indicators are of special use when the diagnosis is uncertain with the standard markers (uterine contractions, digital examination). Among these patients, they should reduce the number of hospitalizations and of useless treatments, because of their good negative predictive value. At the same time, for patients poorly ‘labeled’ by the clinical examination, they should allow the application of intensive management (intravenous tocolysis, corticoids, in utero transfers). Conclusion: Future studies should evaluate these tests in everyday practice. The objective is not to predict preterm birth but to prevent either it or its negative consequences. This goal will be met when we have an effective treatment, without associated adverse effects, to offer patients after a positive test result.

Objective : The goal of this study was to determine the accuracy of an every-day practice for assessing gestational age by ultrasound measurement of the greatest embryonic length (GEL). Design : This retrospective study used measurements taken during the first trimester. Subjects : We considered all births in this hospital between 1 January 1992 and 31 December 1994 from pregnancies that began by an in-vitro fertilization procedure (IVF). We examined 143 consecutive files, containing 257 measurements made by 72 different operators. Methods : The precision of seven embryo growth curves was compared. We calculated for each curve its ability to predict (95% prediction interval) the date the pregnancy began, using these dated pregnancies. Result : For GEL measurements between 3 and 80 mm, which includes most of our population, Robinson and Wisser (2) were the most appropriate curves. The 95% prediction interval was 9.5 and 10.2 days respectively. Conclusion : Dating pregnancies in every-day practice with GEL is nearly as accurate as prospective studies with only one or two scanners.

Objective: To determine how ultrasound measurement of the lower uterine segment affects the decision about delivery for patients with previous cesarean sections (CS) and what are the consequences on cesarean section rates and uterine rupture or dehiscence. Design: Prospective open study. Patients: 198 patients: all women with a previous CS who gave birth in our department during 1995 and 1996 to an infant with a gestational age of at least 36 weeks and who underwent ultrasound measurement of their lower uterine segment (95–96 study group), compared with a similar population from 1989 to 1994 whose measurements were not provided to the treating obstetrician. Results: Among the patients with one previous CS, the vaginal delivery rate did not differ significantly during the two periods (70.3% for the 89–94 study period vs. 67.9% for the 95–96 study period, P=0.53), but the 95–96 study group experienced a significant increase in the rate of elective CS, compensated by a reduction in the rate of emergency CS (6.3% and 23.4%, respectively, for the 89–94 study period vs. 11.9% and 20.1% for the 95–96 study period, P=0.01). There was a very significant increase in the rate of vaginal delivery for the 95–96 study period among patients with two previous CS (26.7% vs. 8.0% for the 89–95 study period, P=0.01). The lower uterine segment was significantly thicker among women with a trial of labor than among those with an elective CS (4.5±1.4 mm compared with 3.8±1.5 mm; P=0.006); and the trial of labor group contained significantly fewer women with a lower uterine segment measurement less than 3.5 mm than did the elective CS group (24.0% compared with 56.6%; P

Objective : This study was designed to assess the changes in fetal oxygen saturation (FSp o 2 ) using fetal pulse oximetry when the fetal heart rate (FHR) monitoring became abnormal during stage II of labour. Study design : FSp o 2 was recorded with the Nellcor N400 Oximeter (FS-14 sensor) and was averaged over the last 10 min of the second stage of labour. Second stage FHR patterns were assessed according to Melchior's classification. Results : In terms of FHR patterns, FSp o 2 -10″ measured 41.4% in type 0 ( n =5), 42.4% in type 1 ( n =19), 43.3% in type 2 ( n =6), 34.0% in type 3 ( n =4) and 27.6% in type 4 ( n =7) ( P =0.03). Conclusions : FSp o 2 -10″ decreases in cases of severe FHR abnormality during the second stage of labour and could help to decide whether to perform an instrumental extraction. © 1997 Elsevier Science Ireland Ltd.