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Objective: To evaluate short-term outcomes of pregnancies complicated by preterm premature rupture of membranes (PPROM) before 26 weeks of gestation (wg)., Patients and Methods: Forty patients were included in a retrospective study from 1998 to 2008., Results: Fifty percent of PPROM occurred before 23 wg. Survival rate was 21.4% when PPROM occurred before 22 wg versus 54.5% when it occurred between 22 and 23+6 wg and reached 80% after 24 wg (P=0.006). Perinatal mortality affected more frequently primigravida women (OR=5.16; IC9 5% [0.99-36.59]). Invasive procedures before PPROM did not affect survival rates. Smoking induced shorter latency (19.1±13.8 vs. 40.3±2.3j; P=0.01). Chorioamnionitis complicated all pregnancies terminated before 26 wg versus 50% of pregnancies terminated after 26 wg (P=0.02). In case of chorioamnionitis, 70% of the germs were identified prenatally. Patients whose CRP was higher than 6 mg/L at the time of PPROM had a higher fetal mortality rate (63.6% vs. 27.8%; P=0.02; OR=4.3; IC95% [0,99-22,1]). No significant difference was found in the occurrence of chorioamnionitis based on gestational age at PPROM, result of the vaginal swab on admission or the amount of amniotic fluid., Discussion and Conclusion: The gestational age of PPROM and the one of delivery are the major prognostic factors. Primigravida women are more exposed to perinatal mortality. CRP appears to be a predictive factor of perinatal mortality., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Objective: With the increased use of invasive fetal procedures, the number of patients facing postprocedure membrane rupture is increasing. We aimed to describe the use of platelets and fresh frozen plasma for sealing iatrogenic fetal membrane defects., Patients and Methods: We describe the mechanisms of action of the amniopatch procedure as well as published experience., Results: Amniopatch effectively sealed the fetal membranes in over two thirds of published cases (n=44). There is a risk of 17% of in utero fetal death, which may occur remotely from the procedure and is often unexplained., Discussion and Conclusion: In case of early onset but persistent amniotic fluid leakage following an invasive fetal procedure, amniopatch may be offered., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Aim: To evaluate maternal and fetal complications resulting from the use of the Kiwi vacuum extractor and to compare them with those resulting from the use of forceps or spatula., Patients and Methods: Patients who had instrumental extraction between November 2006 and April 2007 were included in a unicentric retrospective study. Complications resulting from the use of Kiwi vacuum extractor and those of other instruments were compared., Results: One hundred and sixty-nine patients where included, 79 had extraction with Kiwi vacuum extractor. The two populations (women having extraction with Kiwi and woman having extraction with spatula or forceps) were similar in terms of maternal characteristics, progress of labour and delivery. The rate of episiotomies was significantly lower with KIWI (73.1% versus 94.4%; P=0.0001), as well as was postpartum haemorrhage rate (8.9 % versus 18.9%; P=0.04). No perineal tear of second or third degree occurred with Kiwi. Kiwi vacuum extractor was associated with a higher rate of shoulder dystocia (12.8% versus 6.7%, NS), but related fetal complication rates were similar in the two groups. The extraction failure rate was significantly higher with Kiwi (11.4% versus 4.4%; P=0.04), but cesarean section rate was similar for the two groups (1.3 % versus 4.4%)., Discussion and Conclusion: This study is the first comparing complications occurring after extraction with KIWI vacuum extractor to those occurring with other instruments. Although the results are limited by the retrospective nature of the study and the small size of the workforce, our study suggests that Kiwi vacuum extractor is associated with a lower rate of maternal complications and a rate of fetal complication similar to other kind of instruments. This instrument should be promoted and taught to younger patricians. Our study also revealed higher failure and shoulder dystocia rates. Larger studies are needed to better evaluate risks factor concerning these two complications in order to optimise the use of Kiwi vacuum extractor., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Our study has for aim to describe the practices of screening of the gestational diabetes mellitus. Screening test was realised at 61% of the women included in the study. The HGPO in 50 g was prescribed in 47% of the cases, a single fasting blood glucose in 28% of the cases; 13,4% of the detected women had a glycaemia included between 1,30 and 2 g/L one hour after a load of 50 g of glucose. Among these patients, 52,63% did not realize test HGPO in 100 g. Gestational diabetes mellitus complicates about 7,7% of pregnancies in our study. In statistical analysis united varied, are considered as risk factors: the age, the family history of diabetes and the histories of macrocosmic during previous pregnancy.

Introduction: The placental histological examination is essential in the assessment of stillbirths, especially those of third trimester, which are often of placental origin by chronic placental dysfunction and sometimes by acute dysfunction. The physiopathogenesis of the latter remains obscure., Material and Method: Three stillbirths, one per partum and two after 38 and 39 weeks gestation, caused by acute-placental dysfunction by villous maturation defect were studied. The maternal aetiological investigations and the fetal autopsies were normal. Placentas were pale. Villi were numerous, normal size but fibrous, showing a severely reduced vascularization and a lack of syncytium-capillary membranes., Results: Only one author studied the villous maturation defect. He defines this entity by the same characteristics as that noted in our observations. Its incidence would be of 5.7% and would be associated with fetal death only after the eighth month in 2.3 % of cases, with a risk of recurrence estimated at 10%., Conclusion: This entity, probably underestimated, must be indexed systematically in any late fetal death and any unexplained per partum asphyxia, in order to help the couple overcome a fetal death and to give doctors a medicolegal support.

Objectives: To assess amniocentesis practice of a network during one year., Materials and Methods: In a retrospective multicenter study of the south-west Francilian network, we have enrolled 2400 patients who underwent amniocentesis, from 1 January 2003 to 31 December 2003., Results: The rate of amniocentesis was 9.5%. The most frequent indication was a positive maternal serum screening test result (44%). The rate of global fetal losses (spontaneous miscarriage and intrauterine death) was 1.4%. Once the fetuses with aneuploidy and lethal pathology excluded, the rate of global fetal losses potentially related to amniocentesis was 1.21%. The rate of premature rupture of the membranes was 1.12% and prematurity affected 6.5% of the living births., Conclusion: Our study has highlighted several practices of amniocentesis within the network. Overall, amniocentesis potentially induces 1.12% of fetal losses. Screening tests are currently used sequentially, which leads to an increase number of amniocentesis and to an increase number of losses of "a priori" healthy fetus. Only the use of a combined screening could lower the frequency of amniocentesis without decreasing the detection rate of chromosome abnormalities.

Objective: To determine the etiologic factors, circumstances of diagnosis, obstetrical management and complications of face presentation and to value the maternal and foetal prognosis of this presentation., Patients and Methods: Thirty-two cases of face presentation have been observed in the maternity wards of Reims and Troyes over the last 12 years., Results: The incidence of face presentation was 0.7 per 1000 deliveries. Spontaneous vaginal delivery occurred with mento-anterior presentation 73% of the time and caesarean section was performed in 100% of mento-posterior presentation. There was no increasing rate of foetal or maternal mortality and morbidity with vaginal delivery., Discussion and Conclusion: Face presentation is an unusual complication of pregnancy with obstetric factors that predispose the foetus to face presentation. The low foetal and maternal mortality and morbidity substantiate the effectiveness of conservative management in face presentation.

Objective: to evaluate the socio-cultural determinants of the delay in having the first pre-natal exam (CPN) in order to make recommendations which aim to reduce maternal and fetal morbidity and mortality in the Richard-Toll health district in Senegal., Method: the study was cross-sectional, descriptive and analytical, and was conducted on the entire population of pregnant women who came in for a CPN between March 1st and April 30th, 2003. A questionnaire which was developed on the basis of studied variables steered the interview process which was carried out upon completion of each pregnant woman's CPN in 15 different health facilities. Data were recorded and analysed using Epi Info 6.04d software., Results: The sample population studied included 351 pregnant women. The cultural environment over the unexpected nature of the pregnancy, the discretion surrounding the pregnancy, the ignorance of the risks, and the refusal to be examined by male health workers all have a statistically significant influence on the tardiness of the first CPN. Similarly, the late CPN has a statistically strong link with three distinctive elements of the pregnant woman's social profile: namely, illiteracy, at risk age (< 18 or > 34 years old), and total number of deliveries (> 3 births). Illiteracy has a statistically significant link with the refusal to be examined by a male health worker, ignorance of the risks, unexpected pregnancies, and trying to hide one's pregnancy, which has an additional link with the age at risk., Discussion: the social profile of the pregnant women studied is quite similar to that of greater population from which they come. The early CPN allows the care provider to forecast the delivery date with greater presicion and to estimate the delivery conditions more accurately at the time of the fourth CPN at which time the risk for potential complications which may necessitate a Ceasarean section is thoroughly assessed (DRS). Thus, the delay of the first CPN constitutes a limiting factor in the correct monitoring and surveillance of the pregnancy. The various social and cultural factors are intricately intertwined, and this interaction supports the need for multi-sectoral and multi-disciplinary actions which are generally necessary for the resolution of public health problems. Three recommendations are proposed which aim to improve the frequency of the early CPN., Conclusion: the influence of socio-cultural factors on the CPN requires that the CPN be fully integrated into a more advanced strategy and that a behaviour change within the community be influenced and take place through health education.