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Objectives: To update the epidemiologic data of pregnant women with type 2 diabetes and to assess obstetrical outcomes., Patients and Methods: The pregnant women with type 2 diabetes who delivered between 2002 and 2010 were systematically involved in an observational study. Maternal and fetal outcomes were reviewed, as well as the potential impact of preconceptional management. The presented data were compared with those from the 2010 French perinatal study., Results: A rise in the incidence of type 2 diabetes was observed during the study period (from 0.19% to 0.35% between 2002 and 2010). Women with diabetes (n=97) were older and had a higher BMI than the general population (>35years: 49% vs 19%, P<0.00001, BMI>25: 86% vs 27.2, P<0.00001). The delivery mode was, for half of these women with diabetes, a C-section. Pregnancy was scheduled in only 4% of cases. Compared to the general population, prematurity rate was multiplied by 6 (28.7% vs 4.7%, P<0.0001) and the malformation rate by 3.2 (7.22% vs 2.2%, P<0.00001)., Conclusion: Obstetrical complications were more frequent than in the general population. Preconception care was almost inexistent, despite its potential benefits for the mother and child., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Objective: To compare hospital discharge data (PMSI) with data in the reference databases: vital statistics and National Perinatal Surveys (NPS) for the principal perinatal indicators., Methods: Data concerning hospitalizations for delivery and childbirth were extracted from the PMSI 2010 database. The exhaustiveness was assessed by comparing discharge data with data from birth certificates. Indicators were compared with those in the 2010 NPS, which was based on a representative sample of births (n=15,000), using 95% confidence intervals., Results: About 823,360 hospital abstracts with delivery and 829,351 hospital abstracts with live births were considered. The exhaustiveness of the PMSI was 99.6% for live births in Metropolitan France. The distribution of maternal age, mode of delivery, birth weight and gestational age in the PMSI and NPS were very similar. In Metropolitan France, the prematurity rate was 6.9% (PMSI) vs. 6.6% [6.2-7.0] (NPS) and the rate of caesarean was 20.6% vs. 20.4% [19.8-21.1]. There were marked differences for the percentage of birth weights<2500g and for maternal diseases., Conclusion: The routine use of the PMSI for some indicators for follow-up purposes is foreseeable. Validation studies are still necessary for maternal diseases, for which recording is less standardized., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Objectives: Despite the implementation of prospective payment approach in France, induced legal abortion are still paid by capitation. Our aim was to evaluate the real cost of induced abortion in a public hospital in France., Materials and Methods: This study took place during the year 2008 in a public health hospital. Induced abortion cost was calculated according to national study cost's recommendations. The cost drawn from this was compared to what is paid by the medical insurance for spontaneous abortion., Results: Induced abortion calculated cost was 562 €, the capitation amount was 286.86 €, the spontaneous abortion compensation amount was 645 €., Conclusion: Induced abortion should be paid by a prospective payment evaluation similar to diagnosis related groups approaches rather than a capitation payment, in order to reduce misstatements., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

The level of maternal mortality appears to be higher in France than in other European countries according to the data collected in the 1995 European survey. We performed a retrospective analysis of severe hemorrhage, pregnancy induced hypertension, and maternal sepsis in 1995 in the Lorraine region and reviewed the management scheme used in each case. There was one maternal death and 223 cases of severe maternal morbidity (110 cases of hemorrhage, 105 cases of pregnancy induced hypertension, 8 cases of maternal sepsis). The frequency of these maternal diseases was an estimated 8 per 1000 births. Ninety percent of the children (90.7%) were living 7 days after birth. Pregnancy after the age of 35 years, obesity, and an intermediate level of vocational training were well-documented high risk factors in the Lorraine area. All of the women who developed complications had been followed regularly during their pregnancy. High parity and a scarred uterus were high risk factors for post partum hemorrhage. About 45% (45.5%) of the patients were transferred to an emergency unit for intensive care. Pregnancy-induced hypertension was treated within the normal hospital network, most of the mothers being transferred to a reference center prior to delivery. This retrospective study demonstrates the need for reporting more information on medical records. The data observed improved our knowledge of the prevalence and management of the main causes of direct maternal death in the Lorraine area. It improved our knowledge on the prevalence and management of the main causes of direct maternal death in Lorraine area.

Aims: The aim of the EPIPAGE survey is to study the future of very premature babies in France. This article describes the characteristics of the EPIPAGE cohort in Lorraine and the results in terms of early in-hospital mortality and morbidity., Method: The descriptive analysis concerns preterms born at [22-32] weeks (GP), LBW preterms (less than 1500 g) at > 33 weeks (H), and controls born at 33-34 weeks (T1) and at 39-40 weeks (T2) in Lorraine in 1997., Results: The sample consists of 572 infants: 433 GP, 36 H, 34 T1, and 69 T2. In group GP, 30% are from multiple pregnancies. 140 infants were stillborn (44 MTP, 72 fetal deaths, 17 prepartum deaths). The survival rate of livebirths is 89%. 293 pre-terms were admitted to neonatal care units, 18 (6%) had a serious neurological condition (grade III-IV intraventricular haemorrhage, leucomalacia). The average stay was 60 +/- 33.8 days. The follow-up rate at two years is 88%., Conclusions: The evaluation at 5 years will serve to determine the types of sequelae and family repercussions of the birth of a very preterm infant.

We report the French experience with high risk pregnancies and fetal heart rate monitoring at home. Data were recorded for 376 patients who underwent obstetrical home monitoring from 1992 to 1997 (12,649 recordings). In comparison with data in the literature, our findings show this method is technically reliable. Telemonitoring of high risk pregnancies is as about as safe as traditional hospitalization. Perinatal mortality was not higher in high risk pregnancies followed with home monitoring. We this method, we achieved a lower number of hospitalization days and stays.