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1. Carbetocin versus Oxytocin for the Prevention of Postpartum Hemorrhage in Cesarean Deliveries: A Retrospective Study of Two Consecutive Periods

Author

Pierre Delorme, Gilles Kayem, Hélène Legardeur, Louise Anne Roux-Dessarps, Guillaume Girard, Geraldine Meunier, Hawa Keita, and Laurent Mandelbrot

Subjects
oxytocin, carbetocin, postpartum hemorrhage, cesarean delivery, Gynecology and obstetrics, RG1-991
Abstract

Objective The aim of the study is to investigate whether carbetocin prevents postpartum hemorrhage (PPH) more effectively than oxytocin Methods This historical retrospective single-center cohort study compares women who underwent cesarean deliveries during two periods. During period A, oxytocin was used as a 10-unit bolus immediately after delivery, with 20 units thereafter infused for 24 hours. During period B, carbetocin in a single 100-µg injection replaced this protocol. The main outcome was PPH, defined as a decline in hemoglobin of more than 2 g/dL after the cesarean. The analysis was performed on the overall population and then stratified by the timing of the cesareans (before or during labor). A logistic regression analysis was performed. Results This study included 1,796 women, 52% of whom had a cesarean before labor; 15% had a PPH. The crude PPH rate was lower in period B than in period A (13 vs. 17%, respectively, odds ratio 0.75, 95% confidence interval [CI]: 0.58–0.98). The difference was no longer significant in the multivariate analysis (adjusted odds ratio: 0.81, 95% CI 0.61–1.06). Results were similar when stratified by the timing of the cesareans (before or during labor). Conclusion Carbetocin is not superior to oxytocin in preventing PPH. However, it does provide the advantage of requiring a single injection.

Published
2020
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2. Monitoring quality of obstetric care from hospital discharge databases: A Delphi survey to propose a new set of indicators based on maternal health outcomes.

Author

Priscille Sauvegrain, Anne Alice Chantry, Coralie Chiesa-Dubruille, Hawa Keita, François Goffinet, and Catherine Deneux-Tharaux

Subjects
Medicine, Science
Abstract

ObjectivesMost indicators proposed for assessing quality of care in obstetrics are process indicators and do not directly measure health effects, and cannot always be identified from routinely available databases. Our objective was to propose a set of indicators to assess the quality of hospital obstetric care from maternal morbidity outcomes identifiable in permanent hospital discharge databases.MethodsVarious maternal morbidity outcomes potentially reflecting quality of obstetric care were first selected from a systematic literature review. Then a three-round Delphi consensus survey was conducted online from 11/2016 through 02/2017 among a French panel of 37 expert obstetricians, anesthetists-critical-care specialists, midwives, quality-of-care researchers, and user representatives. For a given maternal outcome, several definitions could be proposed and the indicator (i.e. corresponding rate) could be applied to all women or restricted to specific subgroup(s).ResultsOf the 49 experts invited to participate, 37 agreed. The response rate was 92% in the second round and 97% in the third. Finally, a set of 13 indicators was selected to assess the quality of hospital obstetric care: rates of uterine rupture, postpartum hemorrhage, transfusion incident, severe perineal lacerations, episiotomy, cesarean, cesarean under general anesthesia, post-cesarean site infection, anesthesia-related complications, postpartum pulmonary embolism, maternal readmission and maternal mortality. Six were considered in specific subgroups, with, for example, the postpartum hemorrhage rate assessed among all women and also among women at low risk of PPH.ImplicationsThis Delphi process enabled us to define consensually a set of indicators to assess the quality of hospital obstetrics care from routine hospital data, based on maternal morbidity outcomes. Considering 6 of them in specific subgroups of women is especially interesting. These indicators, identifiable through codes used in international classifications, will be useful to monitor quality of care over time and across settings.

Published
2019
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5. Anaesthesia and intensive care in obstetrics during the COVID-19 pandemic

Author

Estelle Morau, Lionel Bouvet, Hawa Keita, Florence Vial, Marie Pierre Bonnet, Martine Bonnin, Agnès Le Gouez, Dominique Chassard, Frédéric J. Mercier, Dan Benhamou, Marie Pïerre Bonnet, Anne Sophie Bouthors, Adeline Castel, Pierre Yves Dewandre, Catherine Fisher, Benjamin Julliac, Thibault Rackelboom, Anne Wernet, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service d'anesthésie-réanimation [Centre Hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service d'Anesthésie Réanimation [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Pharmacologie et évaluations thérapeutiques chez l'enfant et la femme enceinte (URP_7323), Université de Paris (UP), Service de Réanimation Médicale [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique (CRESS - U1153), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, AP-HP - Hôpital Antoine Béclère [Clamart], Université Paris-Saclay, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL), Université Paris Cité (UPCité), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Obstetric Anaesthesia and Critical Care Club Working Group: Dan Benhamou, Marie Pïerre Bonnet, Martine Bonnin, Anne Sophie Bouthors, Lionel Bouvet, Adeline Castel, Dominique Chassard, Pierre Yves Dewandre, Catherine Fisher, Benjamin Julliac, Hawa Keita, Frédéric J Mercier, Estelle Morau, Thibault Rackelboom, Florence Vial, Anne Wernet, and CCSD, Accord Elsevier

Subjects
Pregnancy, High-Risk, Critical Care and Intensive Care Medicine, Doulas, Anaesthesia, Health personnel, 0302 clinical medicine, 030202 anesthesiology, Pregnancy, Pandemic, Infection control, Thrombophilia, 030212 general & internal medicine, Pregnancy Complications, Infectious, Fetal Monitoring, ComputingMilieux_MISCELLANEOUS, Cross Infection, Respiratory Distress Syndrome, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Prenatal Care, General Medicine, Telemedicine, 3. Good health, Occupational Diseases, Female, Coronavirus Infections, medicine.medical_specialty, 2019-20 coronavirus outbreak, Infectious Disease Transmission, Patient-to-Professional, Coronavirus disease 2019 (COVID-19), Critical Care, Health Personnel, Pneumonia, Viral, Prenatal care, 03 medical and health sciences, Betacoronavirus, Intensive care, medicine, Disease Transmission, Infectious, Anesthesia, Obstetrical, Humans, Labor, Induced, Pandemics, Personal Protective Equipment, Patient Care Team, Infection Control, business.industry, Cesarean Section, Diagnostic Tests, Routine, SARS-CoV-2, Infant, Newborn, COVID-19, Obstetric, Delivery, Obstetric, Infectious Disease Transmission, Vertical, Anesthesiology and Pain Medicine, Emergency medicine, Analgesia, Obstetrical, Analgesia, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Maternal morbidity
Abstract

International audience; No abstract available

Published
2020
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6. Coagulation changes and thromboembolic risk in COVID-19 obstetric patients

Author

Dan Benhamou, Hawa Keita, Anne Sophie Ducloy-Bouthors, Marie Pïerre Bonnet, Martine Bonnin, Anne Sophie Bouthors, Lionel Bouvet, Adeline Castel, Dominique Chassard, Pierre Yves Dewandre, Catherine Fisher, Benjamin Julliac, Frédéric J. Mercier, Estelle Morau, Thibault Rackelboom, Florence Vial, Anne Wernet, Université de Paris (UP), CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Pharmacologie et évaluations thérapeutiques chez l'enfant et la femme enceinte (URP_7323), Groupe de Recherche sur les formes Injectables et les Technologies Associées - ULR 7365 (GRITA), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille, Université Paris Cité (UPCité), and Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)

Subjects
medicine.medical_treatment, [SDV]Life Sciences [q-bio], Critical Care and Intensive Care Medicine, Plasma, 0302 clinical medicine, Pregnancy, Thrombophilia, 030212 general & internal medicine, Pregnancy Complications, Infectious, Disseminated intravascular coagulation, medicine.diagnostic_test, Obstetrics, Blood Proteins, General Medicine, 3. Good health, hypercoagulability, Tranexamic Acid, Coagulation, Female, Partial Thromboplastin Time, fibrinolysis, Coronavirus Infections, Cytokine Release Syndrome, Tranexamic acid, Partial thromboplastin time, medicine.drug, medicine.medical_specialty, Pneumonia, Viral, Article, Betacoronavirus, 03 medical and health sciences, Thromboembolism, regional anaesthesia, Fibrinolysis, medicine, Humans, coagulation, Pandemics, Autoantibodies, SARS-CoV-2, business.industry, Postpartum Hemorrhage, Pregnancy Complications, Hematologic, Contraindications, Drug, Anticoagulants, COVID-19, Endothelial Cells, 030208 emergency & critical care medicine, Puerperal Disorders, Disseminated Intravascular Coagulation, Heparin, Low-Molecular-Weight, medicine.disease, Cerebrovascular Disorders, Anesthesiology and Pain Medicine, (haemorrhage), business, Postpartum period
Abstract

Thromboembolic events may occur both during and after pregnancy Pregnancy in itself increases the thromboembolic risk, which is even greater during the postpartum period Due to additional coagulation changes induced by COVID-19 infection, this risk may even be greater

Published
2020
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7. An IgG-induced neutrophil activation pathway contributes to human drug-induced anaphylaxis

Author

Friederike Jönsson, Caroline Sauvan, Florence Tubach, Skander Necib, Catherine Paugam-Burtz, Qianqian Zhu, Christelle Ganneau, Vanessa Granger, Bernard Cholley, Hawa Keita-Meyer, Marc Fischler, Philippe Montravers, Dan Longrois, Laurent Jacob, Matthieu Le Dorze, C. Neukirch, Pascale Nicaise-Roland, Sylvie Chollet-Martin, Olivier Langeron, Caitlin M. Gillis, Pierre Bruhns, Sylvie Bay, Luc de Chaisemartin, Aurélie Gouel-Chéron, Michel Aubier, Benoit Plaud, Maria Hurtado-Nedelec, Marie-Thérèse Guinnepain, Fadia Dib, Jönsson, Friederike, Role of myeloid cells, their mediators and their antibody receptors in allergic shock (anaphylaxis) using humanized mouse models and clinical samples - MYELOSHOCK - - EC:FP7:ERC2014-09-01 - 2019-08-31 - 616050 - VALID, Anticorps en thérapie et pathologie - Antibodies in Therapy and Pathology, Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Inflammation, Chimiokines et Immunopathologie [Châtenay-Malabry], Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Chimie des Biomolécules - Chemistry of Biomolecules, Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), Hôpital Beaujon, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon [AP-HP], Université Paris Diderot - Paris 7 (UPD7), Hôpital Louis Mourier - AP-HP [Colombes], Recherche Clinique ville-hôpital, Méthodologies et Société (REMES), Hôpital Lariboisière-Fernand-Widal [APHP], Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Histopathologie humaine et Modèles animaux, Institut Pasteur [Paris] (IP), Hôpital Saint-Louis, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Hôpital Foch [Suresnes], Lab Excellence Inflamex, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), The NASA study was funded by AP-HP (Direction de la Recherche Clinique et de l’Innovation) through a 'Contrat de Recherche Clinique 2011' to S.C.-M. by INSERM and the French Ministry of Health (Direction Générale de l’Offre de Soin, Paris, France) through a 'Recherche Clinique translationnelle 2012' grant to P.B., by the European Research Council (ERC)–Seventh Framework Program (ERC-2013-CoG 616050) to P.B., by the Institut Pasteur, and by the INSERM. A.G.-C. benefited from a stipend provided by AP-HP, Paris, France and by the Institut Pasteur, Paris, France and from a grant provided by INSERM, SFAR (Société Française d’Anesthésie et de Réanimation), and SRLF (Société de Réanimation de Langue Française) through the 'Bourse de Recherche du Comité d’interface INSERM-SFAR-SRLF 2012.' C.M.G. was supported partly by a stipend from the Pasteur-Paris University (PPU) International PhD program and by the Institut Carnot Pasteur Maladies Infectieuses. P.B. benefited from an additional support from AP-HP through a 'Contral Local d’Interface 2014' and the 'Département Hospitalo-Universitaire' (DHU) FIRE. The sponsor of the NASA study was the Direction de la Recherche Clinique et de l’Innovation de l’AP-HP (France). F.J. is an employee of the CNRS., We are thankful to the team of the Pharmacoepidemiology Center of the Assistance Publique-Hôpitaux de Paris (AP-HP) and, in particular, N. Yelles, K. Chandirakumaran, and I. Younes at the Bichat Hospital for help with the NASA study logistics. We thank all clinicians from the NASA study group for help with patient recruitment, in particular, V. Faitot, A. Mebazaa, J. Mantz (deceased), S. Roche, C. Chahine, J. Bresson, and A. Mignon. From the Institut Pasteur, Paris, France, we thank B. Iannascoli for help with antibody purification, D. A. Mancardi for flow cytometry setups, F. Bonhomme for mass and nuclear magnetic resonance analyses of carboxylated rocuronium and suxamethonium, and B. Baron and P. England for MST. We thank V. Guérineau (Institut de Chimie des Substances Naturelles, Gif-sur-Yvette, France) for the mass analyses of bioconjugates and M. Parent, S. Peltier, L. Gaillanne, and C. S. Louis-Augustin (Immunology Laboratory, Bichat Hospital, Paris) for help with sample management and immunology diagnostic tests. We thank M. Pallardy (Toxicology department, UFR de Pharmacie de l’Université Paris-Sud and INSERM UMR996) for discussions on NMBA allergy., European Project: 616050,EC:FP7:ERC,ERC-2013-CoG,MYELOSHOCK(2014), Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS)-Institut Pasteur [Paris], Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Institut Pasteur [Paris], and Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Adult, Male, 0301 basic medicine, Down-Regulation, Immunoglobulin E, medicine.disease_cause, Severity of Illness Index, Neutrophil Activation, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Allergen, Antibody Specificity, medicine, Humans, Myeloid Cells, Platelet Activating Factor, [SDV.IMM.ALL]Life Sciences [q-bio]/Immunology/Allergology, Receptor, Anaphylaxis, Aged, biology, business.industry, Receptors, IgG, Degranulation, General Medicine, Middle Aged, medicine.disease, 3. Good health, Hypersensitivity reaction, 030104 developmental biology, chemistry, Immunoglobulin G, Immunology, biology.protein, Female, Neuromuscular Blocking Agents, Antibody, business, Biomarkers, Histamine, [SDV.IMM.ALL] Life Sciences [q-bio]/Immunology/Allergology, 030215 immunology
Abstract

International audience; Anaphylaxis is a systemic acute hypersensitivity reaction that is considered to depend on allergen-specific immunoglobulin E (IgE) antibodies and histamine release by mast cells and basophils. Nevertheless, allergen-specific IgG antibodies have been proposed to contribute when the allergen is an abundant circulating large molecule, e.g., after infusions of therapeutic antibodies or dextran. Data from animal models demonstrate a pathway involving platelet-activating factor (PAF) release by monocytes/macrophages and neutrophils activated via their Fc gamma receptors (FcγRs). We hypothesized that such a pathway may also apply to small drugs and could be responsible for non-IgE-mediated anaphylaxis and influence anaphylaxis severity in humans. We prospectively conducted a multicentric study of 86 patients with suspected anaphylaxis to neuromuscular-blocking agents (NMBAs) during general anesthesia and 86 matched controls. We found that concentrations of anti-NMBA IgG and markers of FcγR activation, PAF release, and neutrophil activation correlated with anaphylaxis severity. Neutrophils underwent degranulation and NETosis early after anaphylaxis onset, and plasma-purified anti-NMBA IgG triggered neutrophil activation ex vivo in the presence of NMBA. Neutrophil activation could also be observed in patients lacking evidence of classical IgE-dependent anaphylaxis. This study supports the existence of an IgG-neutrophil pathway in human NMBA-induced anaphylaxis, which may aggravate anaphylaxis in combination with the IgE pathway or underlie anaphylaxis in the absence of specific IgE. These results reconcile clinical and experimental data on the role of antibody classes in anaphylaxis and could inform diagnostic approaches to NMBA-induced acute hypersensitivity reactions.

Published
2019
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8. Postpartum hemorrhage: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF): in collaboration with the French Society of Anesthesiology and Intensive Care (SFAR)

Author

Loïc, Sentilhes, Christophe, Vayssière, Catherine, Deneux-Tharaux, Antoine Guy, Aya, Françoise, Bayoumeu, Marie-Pierre, Bonnet, Rachid, Djoudi, Patricia, Dolley, Michel, Dreyfus, Chantal, Ducroux-Schouwey, Corinne, Dupont, Anne, François, Denis, Gallot, Jean-Baptiste, Haumonté, Cyril, Huissoud, Gilles, Kayem, Hawa, Keita, Bruno, Langer, Alexandre, Mignon, Olivier, Morel, Olivier, Parant, Jean-Pierre, Pelage, Emmanuelle, Phan, Mathias, Rossignol, Véronique, Tessier, Frédéric J, Mercier, François, Goffinet, Service de Gynécologie-Obstétrique, CHU Bordeaux, 33076 Bordeaux, France, CHU Bordeaux [Bordeaux], Service de Gynécologie-Obstétrique, Hôpital Paule de Viguier, CHU Toulouse, 31059 Toulouse, France, UMR 1027 Inserm Université Toulouse III « Epidémiologie Périnatale et handicap de l'enfant, Santé des adolescents », 31000 Toulouse, France., Centre Hospitalier Universitaire de Toulouse - CHU Toulouse (FRANCE), Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique (CRESS - U1153), Université Paris Descartes - Paris 5 (UPD5) - Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A 1125)), Institut National de la Recherche Agronomique (INRA) - Université Sorbonne Paris Cité (USPC) - Institut National de la Santé et de la Recherche Médicale (INSERM) - Institut National de la Recherche Agronomique (INRA) - Université Sorbonne Paris Cité (USPC) - Institut National de la Santé et de la Recherche Médicale (INSERM), Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires (EA 2992), Université Montpellier 1 (UM1) - Université de Montpellier (UM), CHU de Toulouse, Pole d'anesthésie Réanimation, Hôpital Paule de Viguier, Toulouse F-31059, France, CHU Toulouse [Toulouse], Service d'Anesthésie-Réanimation (COCHIN - Anesthésie-Réanimation), Assistance publique - Hôpitaux de Paris (AP-HP) - Université Paris Descartes - Paris 5 (UPD5), Etablissement Français du Sang, 20, Avenue du Stade de France, 93218 La Plaine Saint-Denis Cedex, France, Etablissement Français du Sang (EFS), Service de Gynécologie-Obstétrique, CHU Caen et UFR de Médecine Caen, 14033 Caen, France., CHU Caen, Service de Gynécologie-Obstétrique, CHU Caen et UFR de Médecine Caen, 14033 Caen, France, UFR de Médecine Caen, 14033 Caen, France., Association d'usagers, Collectif interassociatif autour de la naissance (CIANE), Paris, France, Réseau périnatal Aurore - Hôpital de la Croix Rousse, université Lyon 1, Lyon, France, EA 4129, laboratoire « Santé, individu, société », faculté de médecine Laennec, 69372 Lyon, France., Université Claude Bernard Lyon 1 (UCBL), Université de Lyon - Université de Lyon, Etablissement Français du Sang Ile de France, site de l'Hôpital Européen Georges-Pompidou, APHP, Paris, France., Service de Gynécologie-Obstétrique, CHU Estaing [Clermont-Ferrand], Service de Gynécologie-Obstétrique, CHU Marseille, Hôpital Nord, AP-HM, 13015 Marseille, France., CHU Marseille, INSERM U846, Stem Cell and Brain Research Institute, Lyon, France., Service de Gynécologie-Obstétrique, Hôpital Louis-Mourier, AP-HP, 92701 Colombes, France., Hopital Louis Mourier - AP-HP [Colombes], Service d'Anesthésie, CHU Louis-Mourier, AP-HP/Université Paris-7, 178, rue des Renouilliers, 92700 Colombes, France, Université Paris-Diderot, Sorbonne Paris Cité, EA recherche clinique coordonnée ville-hôpital, méthodologies et société (REMES), 75010 Paris, France., CHU Louis Mourrier, Département de Gynécologie-Obstétrique, Hôpital de Hautepierre, Avenue Molière, 67098 Strasbourg, France., Hôpital de Hautepierre [Strasbourg], Service d'Obstétrique et de Médecine fœtale [CHRU Nancy], Pôle de Gynécologie-Obstétrique et Reproduction, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy) - Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy) - Université de Lorraine (UL), Inserm, UMR1027, Toulouse F-31073, France, Université de Toulouse III, UMR1027, Toulouse F-31073, France, CHU Toulouse, Pole de Gynécologie Obstétrique, Hôpital Paule de Viguier, Toulouse F-31059, France., Institut National de la Santé et de la Recherche Médicale (INSERM), Département de Radiologie, CHU Caen, 14033 Caen, France., Département d'Anesthésie Réanimation SMUR [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) - Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], DHU Risques Et Grossesse, Assistance publique - Hôpitaux de Paris (AP-HP) - Université Paris Descartes - Paris 5 (UPD5) - Institut National de la Santé et de la Recherche Médicale (INSERM) - Centre National de la Recherche Scientifique (CNRS), Société Française d'Anesthésie et de Réanimation, France, Département d'Anesthésie, Hôpital Antoine Béclère, APHP, Clamart, France, Faculté de Médecine de K. Bicêtre, Université Paris-Sud, France., Hôpital Antoine-Béclère AP-HP, and AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris]

Subjects
Postpartum hemorrhage, [SDV] Life Sciences [q-bio], Pregnancy, Oxytocics, Placenta accreta, Transfusion, Humans, Female, Peripartum hysterectomy, Delivery, Obstetric, Oxytocin
Abstract

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

Published
2016

9. High-dose tranexamic acid reduces blood loss in postpartum haemorrhage

Author

Anne-Sophie Ducloy-Bouthors, Laurent Mandelbrot, Hawa Keita-Meyer, Sandrine Depret-Mosser, Cyril Huissoud, Brigitte Jude, Nadia Tillouche, Sophie Susen, Sylvie Fontaine, Françoise Le Goueff, Benoit Vallet, F. Broisin, and Alain Duhamel

Subjects
Adult, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Loading dose, law.invention, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Randomized controlled trial, law, Pregnancy, Antifibrinolytic agent, medicine, Humans, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Dose-Response Relationship, Drug, Vaginal delivery, business.industry, Research, Postpartum Hemorrhage, medicine.disease, Antifibrinolytic Agents, 3. Good health, Treatment Outcome, Tranexamic Acid, Anesthesia, Injections, Intravenous, Female, Packed red blood cells, business, Tranexamic acid, medicine.drug
Abstract

Introduction Our purpose in conducting this study was to determine whether administration of high-dose tranexamic acid (TA) at the time of diagnosis of postpartum haemorrhage (PPH) could reduce blood loss. Methods This was a randomised, controlled, multicentred, open-label trial. Women with PPH >800 mL following vaginal delivery were randomly assigned to receive TA (loading dose 4 g over 1 hour, then infusion of 1 g/hour over 6 hours) or not. In both groups, packed red blood cells (PRBCs) and colloids could be used according to French guidelines. The use of additional procoagulant treatments was permitted only in cases involving intractable bleeding. The primary objective was to assess the efficacy of TA in the reduction of blood loss in women with PPH, and the secondary objectives were the effect of TA on PPH duration, anaemia, transfusion and the need for invasive procedures. Results A total of 144 women fully completed the protocol (72 in each group). Blood loss between enrolment and 6 hours later was significantly lower in the TA group than in the control group (median, 173 mL; first to third quartiles, 59 to 377) than in controls (221 mL; first to third quartiles 105 to 564) (P = 0.041). In the TA group, bleeding duration was shorter and progression to severe PPH and PRBC transfusion was less frequent than in controls (P < 0.03). Invasive procedures were performed in four women in the TA group and in seven controls (P = NS). PPH stopped after only uterotonics and PRBC transfusion in 93% of women in the TA group versus 79% of controls (P = 0.016). Mild, transient adverse manifestations occurred more often in the TA group than in the control group (P = 0.03). Conclusions This study is the first to demonstrate that high-dose TA can reduce blood loss and maternal morbidity in women with PPH. Although the study was not adequately powered to address safety issues, the observed side effects were mild and transient. A larger international study is needed to investigate whether TA can decrease the need for invasive procedures and reduce maternal morbidity in women with PPH. Trial registration Controlled Trials ISRCTN09968140.

Published
2011

10. CD32A-expressing platelets determine the severity of experimental anaphylaxis

Author

Beutier, Héloïse, Hechler, Béatrice, Godon, Ophélie, Wang, Yu, Gillis, Caitlin M., de Chaisemartin, Luc, Gouel-Chéron, Aurélie, Magnenat, Stéphanie, Macdonald, Lynn, Murphy, Andrew, Chollet-Martin, Sylvie, Longrois, Dan, Gachet, Christian, Bruhns, Pierre, Jönsson, Friederike, Anticorps en thérapie et pathologie - Antibodies in Therapy and Pathology, Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Université - Faculté de Médecine (SU FM), Sorbonne Université (SU), Biologie et Pharmacologie des Plaquettes sanguines : hémostase, thrombose, transfusion (BPP), Université de Strasbourg (UNISTRA)-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Diderot - Paris 7 (UPD7), Laboratoire d'Immunologie 'Autoimmunité et Hypersensibilités' [AP-HP Hôpital Bichat, Paris], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Cytokines, chimiokines et immunopathologie, Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département d'Anesthésie Réanimation [CHU Bichat-Claude-Bernard], Regeneron Pharmaceuticals [Tarrytown], Physiopathologie et Epidémiologie des Maladies Respiratoires (PHERE (UMR_S_1152 / U1152)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), We are thankful to our colleagues F. Abdallah, B. Iannascoli, and O. Richard-Le Goff at Institut Pasteur (Paris) for technical help. We are thankful to our colleagues for their gifts: M. P. Reilly and S. McKenzie (Jefferson Medical College, Philadelphia, PA) for FCGR2A transgenic mice and LFB Biomédicaments (Les Ulis, France) for human albumin and fibrinogen. Funding: This work was supported by the European Research Council (ERC)–Seventh Framework Program (ERC-2013-CoG 616050), by a Jeunes Chercheuses/Jeunes Chercheurs grant from the Agence National de la Recherche (ANR-16-CE15-0012-01), the Institut Pasteur, INSERM, the Société Française d’Allergologie (Soutien de la Recherche en Allergologie), and the Etablissement Français du Sang. H.B. was supported by a fellowship from the Université Pierre et Marie Curie. C.M.G. was supported partly by a stipend from the Pasteur-Paris University (PPU) International PhD program, by the Institut Carnot Pasteur Maladies Infectieuses, and partly by the Balsan company. Y.W. is part of the PPU International PhD Program that received funding from the European Union’s Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement no. 665807 and from the Labex Milieu Intérieur, Institut Pasteur. A.G.-C. benefited from a stipend provided by Assistance Publique–Hôpitaux de Paris (Paris, France) and by the Institut Pasteur (Paris, France) (Postes d’accueil pour Praticiens Hospitaliers) and from a grant provided by INSERM, SFAR (Société Francaise d’Anesthésie et de Reanimation), and SRLF (Société de Réanimation de Langue Francaise) through the 'Bourse de Recherche du Comité d’interface INSERM-SFAR-SRLF 2012'. F.J. is an employee of CNRS., NASA study group : Vanessa Granger (UF Auto-immunité et Hypersensibilités, Hôpital Bichat, APHP, Paris, France, UMR996 - Inflammation, Chemokines et Immunopathology -, INSERM, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France), Philippe Montravers (Département d’anesthésie-réanimation, Hôpital Bichat, AP-HP, Paris, France), Michel Aubier & Caroline Sauvan (Service de pneumologie et d’allergologie, Hôpital Bichat, AP-HP, Paris, France), Marc Fischler & Julie Bresson (Département d’anesthésie-réanimation, Hôpital Foch, Suresnes, France), Catherine Paugam-Burtz & Skander Necib (Département d’anesthésie-réanimation, Hôpital Beaujon, AP-HP, Clichy, France), Alexandre Mebazaa & Matthieu Le Dorze (Département d’anesthésie-réanimation, Hôpital Lariboisière, AP-HP, Paris, France), Laurent Jacob & Carole Chahine (Département d’anesthésie-réanimation, Hôpital Saint Louis, AP-HP, Paris, France), Hawa Keita-Meyer & Valentina Faitot (Département d’anesthésie-réanimation, Hôpital Louis Mourier, AP-HP, Colombes, France), Olivier Langeron & Sabrine Roche (Département d’anesthésie-réanimation, Hôpital Pitié Salpêtrière, AP-HP, Paris, France), Bernard Cholley & Jean Manz (Département d’anesthésie-réanimation, Hôpital Européen Georges Pompidou, AP-HP, Paris, France)., ANR-16-CE15-0012,PlanA,Rôle des plaquettes et leurs interactions dans les réactions anaphylactiques(2016), European Project: 616050,EC:FP7:ERC,ERC-2013-CoG,MYELOSHOCK(2014), European Project: 665807,H2020,H2020-MSCA-COFUND-2014,PASTEURDOC(2015), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Sud - Paris 11 (UP11), and Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
[SDV.IMM]Life Sciences [q-bio]/Immunology, [SDV.IMM.ALL]Life Sciences [q-bio]/Immunology/Allergology
Abstract

International audience; Platelets are key regulators of vascular integrity; however, their role in anaphylaxis, a life-threatening systemic allergic reaction characterized by the loss of vascular integrity and vascular leakage, remains unknown. Anaphylaxis is a consequence of inappropriate cellular responses triggered by antibodies to generally harmless antigens, resulting in a massive mediator release and rapidly occurring organ dysfunction. Human platelets express receptors for immunoglobulin G (IgG) antibodies and can release potent mediators, yet their contribution to anaphylaxis has not been previously addressed in mouse models, probably because mice do not express IgG receptors on platelets. We investigated the contribution of platelets to IgG-dependent anaphylaxis in human IgG receptor-expressing mouse models and a cohort of patients suffering from drug-induced anaphylaxis. Platelet counts dropped immediately and markedly upon anaphylaxis induction only when they expressed the human IgG receptor FcγRIIA/CD32A. Platelet depletion attenuated anaphylaxis, whereas thrombocythemia substantially worsened its severity. FcγRIIA-expressing platelets were directly activated by IgG immune complexes in vivo and were sufficient to restore susceptibility to anaphylaxis in resistant mice. Serotonin released by activated platelets contributed to anaphylaxis severity. Data from a cohort of patients suffering from drug-induced anaphylaxis indicated that platelet activation was associated with anaphylaxis severity and was accompanied by a reduction in circulating platelet numbers. Our findings identify platelets as critical players in IgG-dependent anaphylaxis and provide a rationale for the design of platelet-targeting strategies to attenuate the severity of anaphylactic reactions.

Published
2018
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11. Intraosseous Meningioma of Spheno-Orbital Localization: A Case Report.

Author

Ansoumane Hawa K, Moussa C, Benzalim M, and Soumaya A

Abstract

Intracranial meningiomas are benign extra-axial brain tumors. Their etiology is undetermined and several hypotheses have been proposed to explain their genesis. The clinical symptomatology of intracranial meningiomas is atypical and varies according to the location of the lesion, its size, and its relationship with neighboring organs. Imaging is essential for establishing a positive diagnosis, but the way to a diagnosis of certainty remains histological. In this article, we describe the CT and magnetic resonance imaging aspects of an intraosseous meningioma discovered in a patient in her forties that presented with right proptosis, and whose brain MRI revealed a cranial lesion with adjacent meningeal involvement; the CT scan subsequently performed allowed a better analysis of the bone lesion, the appearance of which suggested an intraosseous meningioma. This diagnosis was confirmed by a histological exam. The purpose of this article is to illustrate the CT and MRI aspects of this entity by reporting a case of intraosseous meningioma of spheno-orbital location., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ansoumane Hawa et al.)

Published
2023
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12. Ureteral Hematoma: A Case Report on Complications During Anticoagulant Therapy.

Author

Moussa C, Ansoumane Hawa K, Benzalim M, and Soumaya A

Abstract

Ureteral hematoma is a rare complication occurring during anticoagulant therapy, with fewer than 10 cases reported in the literature. Bleeding complications are underestimated. They affect about 10% of patients treated with long-term anti-vitamin K (AVK). The appearance of macroscopic hematuria may indicate the presence of underlying organic damage. Clinically, ureteral hematoma is manifested by lumbar or abdominal pain often associated with macroscopic hematuria. Imaging plays a major role in its diagnosis. Clinical and radiological evolution is always rapidly favorable after the correction of coagulation disorders and the immediate discontinuation of anticoagulant treatment. We report in this work the case of a patient in her 50s who presented a ureteral hematoma during her anticoagulant treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Moussa et al.)

Published
2022
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13. Hemorrhagic Stroke Revealing a Snake Bite: A Case Report.

Author

Ansoumane Hawa K, Mhaili J, Boutakioute B, Ouali Idrissi M, and Idrissi El Ganouni N

Abstract

In Morocco, envenomations caused by viper bites and scorpion stings are frequent and associated with high lethality. It occurs mainly during the summer season with a peak between June and August. It is a medical emergency requiring intensive care. It is a life-threatening disease mainly due to the systemic hemorrhagic syndrome. Here, we present the clinical course of a patient in his 50s who suffered a snakebite and describe the neurological sequelae. The patient was admitted to the emergency room in a state of unconsciousness with gangrene on the right foot. An emergency brain scan showed meningeal hemorrhage and intracerebral hematomas. The biological assessment revealed disseminated intravascular coagulation. The evolution of the clinical course was rapidly unfavorable and the patient died within 24 hours of admission., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Ansoumane Hawa et al.)

Published
2022
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