149 results on '"Patrick Rozenberg"'
Search Results
2. Impact of <scp>SARS‐CoV‐</scp> 2 infection on risk of prematurity, birthweight and obstetric complications: A multivariate analysis from a nationwide, population‐based retrospective cohort study
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Emmanuel Simon, Jean‐Bernard Gouyon, Jonathan Cottenet, Sonia Bechraoui‐Quantin, Patrick Rozenberg, Anne‐Sophie Mariet, Catherine Quantin, HAL UVSQ, Équipe, CHU Dijon, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre d'Études Périnatales de l'Océan Indien (CEPOI), Université de La Réunion (UR)-Centre Hospitalier Universitaire de La Réunion (CHU La Réunion), Service Biostatistiques et Informatique Médicale (CHU de Dijon) (DIM), Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy], Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques (CIC-EC), Université de Bourgogne (UB)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Agence Nationale de la Recherche, ANR, and The project was funded by the French National Research Agency.
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[SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases ,[SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases ,hypertension ,pre-eclampsia ,SARS-CoV-2 ,prematurity ,Infant, Newborn ,COVID-19 ,Obstetrics and Gynecology ,[SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,Fetal Macrosomia ,Cohort Studies ,small for gestational age ,[SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,Pregnancy ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Multivariate Analysis ,[SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Birth Weight ,Humans ,Female ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Pregnancy Complications, Infectious ,Retrospective Studies - Abstract
To determine the impact of maternal coronavirus disease 2019 (COVID-19) on prematurity, birthweight and obstetric complications.Nationwide, population-based retrospective cohort study.National Programme de Médicalisation des Systèmes d'Information database in France.All single births from March to December 2020: 510 387 deliveries, including 2927 (0.6%) with confirmed COVID-19 in the mother and/or the newborn.The group with COVID-19 was compared with the group without COVID-19 using the chi-square test or Fisher's exact test, and the Student's t test or Mann-Whitney U test. Logistic regressions were used to study the effect of COVID-19 on the risk of prematurity or macrosomia (birthweight ≥4500 g).Prematurity less than 37, less than 28, 28-31, or 32-36 weeks of gestation; birthweight; obstetric complications.In singleton pregnancies, COVID-19 was associated with obstetric complications such as hypertension (2.8% versus 2.0%, p 0.01), pre-eclampsia (3.6% versus 2.0%, p 0.01), diabetes (18.8% versus 14.4%, p 0.01) and caesarean delivery (26.8% versus 19.7%, p 0.01). Among pregnant women with COVID-19, there was more prematurity between 28 and 31 weeks of gestation (1.3% versus 0.6%, p 0.01) and between 32 and 36 weeks of gestation (7.7% versus 4.3%, p 0.01), and more macrosomia (1.0% versus 0.7%, p = 0.04), but there was no difference in small-for-gestational-age newborns (6.3% versus 8.7%, p = 0.15). Logistic regression analysis for prematurity showed an adjusted odds ratio (aOR) of 1.77 (95% CI 1.55-2.01) for COVID-19. For macrosomia, COVID-19 resulted in non-significant aOR of 1.38 (95% CI 0.95-2.00).COVID-19 is a risk factor for prematurity, even after adjustment for other risk factors.The risk of prematurity is twice as high in women with COVID-19 after adjustment for factors usually associated with prematurity.
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- 2022
3. Hospitalisation for non‐lethal self‐harm and premature mortality in the 3 years following adolescent pregnancy: Population‐based nationwide cohort study
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Karine Goueslard, Fabrice Jollant, Jonathan Cottenet, Sonia Bechraoui‐Quantin, Patrick Rozenberg, Emmanuel Simon, and Catherine Quantin
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Obstetrics and Gynecology - Published
- 2023
4. Cesarean section rate changes after audit and feedback with the Ten Group Classification System in a French perinatal network: A retrospective pre–post study
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Thibaud Quibel, Marion Chesnais, Camille Bouyer, Patrick Rozenberg, and Jean Bouyer
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Cesarean Section ,Pregnancy ,Parturition ,Humans ,Infant ,Obstetrics and Gynecology ,Female ,General Medicine ,Hospitals ,Feedback ,Retrospective Studies - Abstract
The rise in the number of cesarean sections (CS) is a major health public problem which concerns nearly all countries. It is suggested that the Ten Group Classification System be adapted to a procedure of audit/feedback cycles, which could have an effect on CS practice. Therefore, we aimed to study changes in CS rates between maternity wards in a perinatal network after implementation of the Ten Group Classification System in an audit with feedback.This was a retrospective pre-post study of all births from 1 January 2012 to 31 December 2018, in a French perinatal network of 10 maternity wards in the Yvelines district of France. All live births occurring at a gestational age ≥24 weeks in the network were included. During the pre-period (1 January 2012 to 31 December 2014), the audit and feedback provided only overall CS rates. During the post-period (1 January 2015 to 31 December 2018), CS rates for each Robson Ten Group Classification System group were provided. Regression models, adjusted for maternal characteristics and maternity ward, were used to compare CS rates globally and for each group of the system. Variability of CS rates between maternity wards was analyzed using the coefficients of variation.There were 51 082 women who delivered during the pre-period and 63 964 during the post-period. The overall CS rate did not decrease (24.5% during the pre-period vs 25.1% during the post-period). There were no significant differences in CS rates for any group of the Ten Group Classification System after adjustment for maternity, maternal age and sociodemographic characteristics, nor did audit implementation decrease CS rate variability between maternity wards or within groups of the system.Implementation of an audit-and-feedback cycle using the Ten Group Classification System did not decrease either CS rates or variability between maternity wards.
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- 2022
5. Reducing neonatal morbidity by discontinuing oxytocin during the active phase: the STOPOXY trial
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Aude Girault, Loïc Sentilhes, Raoul Desbriere, Patrick Rozenberg, Diane Korb, Charline Bertholdt, Julie Carrara, Norbert Winer, Eric Verspyck, Eric Boudier, Tiphaine Barjat, Gilles Levy, Georges Emmanuel Roth, Gilles Kayem, Mona Massoud, Caroline Bohec, Paul Guerby, Elie Azria, Julie Blanc, Helene Heckenroth, Charles Garabedian, and Camille Le Ray
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Obstetrics and Gynecology - Published
- 2023
6. A cluster-randomized trial to reduce perinatal morbidity among women with a prior cesarean delivery (PRISMA)
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Nils Chaillet, Benoit Masse, William A. Grobman, Allison Shorten, Robert Gauthier, Patrick Rozenberg, Marylène Dugas, Jean-Charles Pasquier, Francois Audibert, Haim A. Abenhaim, Suzanne Demers, Bruno Piedboeuf, William Fraser, Robert Gagnon, Patricia Monnier, Guy-Paul Gagné, Diane Francoeur, Isabelle Girard, Louise Duperron, Marie-Josée Bédard, Mira Johri, Eric Dubé, Thierry Ducruet, Mario Girard, and Emmanuel Bujold
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Obstetrics and Gynecology - Published
- 2023
7. Déterminants des symptômes d’anxiété, de dépression et de détresse péri-traumatique chez les femmes en post-partum immédiat
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Patrick Rozenberg, Margaux Chabbert, Guillemot-Billaud A, and Jaqueline Wendland
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Symptoms depression ,medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,business.industry ,Peri ,Obstetrics and Gynecology ,030227 psychiatry ,03 medical and health sciences ,Distress ,0302 clinical medicine ,Reproductive Medicine ,medicine ,Anxiety ,medicine.symptom ,Psychiatry ,business - Published
- 2021
8. Tranexamic acid for the prevention of blood loss after cesarean among women with twins: a secondary analysis of the TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery randomized clinical trial
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Loïc Sentilhes, Hugo Madar, Maëla Le Lous, Marie Victoire Sénat, Norbert Winer, Patrick Rozenberg, Gilles Kayem, Eric Verspyck, Florent Fuchs, Elie Azria, Denis Gallot, Diane Korb, Raoul Desbrière, Camille Le Ray, Céline Chauleur, Fanny de Marcillac, Franck Perrotin, Olivier Parant, Laurent J. Salomon, Emilie Gauchotte, Florence Bretelle, Nicolas Sananès, Caroline Bohec, Nicolas Mottet, Guillaume Legendre, Vincent Letouzey, Bassam Haddad, Delphine Vardon, Aurélien Mattuizzi, Alizée Froeliger, Hanane Bouchghoul, Valérie Daniel, Sophie Regueme, Caroline Roussillon, Aurore Georget, Astrid Darsonval, Antoine Benard, and Catherine Deneux-Tharaux
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Tranexamic Acid ,Pregnancy ,Cesarean Section ,Postpartum Hemorrhage ,Obstetrics and Gynecology ,Humans ,Female ,Blood Transfusion ,Antifibrinolytic Agents - Abstract
Although prophylactic tranexamic acid administration after cesarean delivery resulted in a lower incidence of calculated estimated blood loss of1000 mL or red cell transfusion by day 2, its failure to reduce the incidence of hemorrhage-related secondary clinical outcomes (TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery trial) makes its use questionable. The magnitude of its effect may differ in women at higher risk of blood loss, including those with multiple pregnancies.This study aimed to compare the effect of tranexamic acid vs placebo to prevent blood loss after cesarean delivery among women with multiple pregnancies.This was a secondary analysis of the TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery trial data, a double-blind, randomized controlled trial from March 2018 to January 2020 in 27 French maternity hospitals, that included 319 women with multiple pregnancies. Women with a cesarean delivery before or during labor at ≥34 weeks of gestation were randomized to receive intravenously 1 g of tranexamic acid (n=160) or placebo (n=159), both with prophylactic uterotonics. The primary outcome was a calculated estimated blood loss of1000 mL or a red blood cell transfusion by 2 days after delivery. The secondary outcomes included clinical and laboratory blood loss measurements.Of the 4551 women randomized in this trial, 319 had a multiple pregnancy and cesarean delivery, and 298 (93.4%) had primary outcome data available. This outcome occurred in 62 of 147 women (42.2%) in the tranexamic acid group and 67 of 152 (44.1%) receiving placebo (adjusted risk ratio, 0.97; 95% confidence interval, 0.68-1.38; P=.86). No significant between-group differences occurred for any hemorrhage-related clinical outcomes: gravimetrically estimated blood loss, provider-assessed clinically significant hemorrhage, additional uterotonics, postpartum blood transfusion, arterial embolization, and emergency surgery (P.05 for all comparisons).Among women with a multiple pregnancy and cesarean delivery, prophylactic tranexamic acid did not reduce the incidence of any blood loss-related outcomes.
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- 2022
9. Alternative to intensive management of the active phase of the second stage of labor: a multicenter randomized trial (Phase Active du Second STade trial) among nulliparous women with an epidural
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Camille Le Ray, Patrick Rozenberg, Gilles Kayem, Thierry Harvey, Jeanne Sibiude, Muriel Doret, Olivier Parant, Florent Fuchs, Delphine Vardon, Elie Azria, Marie-Victoire Sénat, Pierre-François Ceccaldi, Aurélien Seco, Charles Garabedian, and Anne Alice Chantry
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Labor Stage, Second ,Pregnancy ,Placenta ,Postpartum Hemorrhage ,Infant, Newborn ,Lactates ,Obstetrics and Gynecology ,Humans ,Female ,Delivery, Obstetric ,Infant, Newborn, Diseases - Abstract
There is no consensus on an optimal strategy for managing the active phase of the second stage of labor. Intensive pushing could not only reduce pushing duration, but also increase abnormal fetal heart rate because of cord compression and reduced placental perfusion and oxygenation resulting from the combination of uterine contractions and maternal expulsive forces. Therefore, it may increase the risk of neonatal acidosis and the need for operative vaginal delivery.This study aimed to assess the effect of the management encouraging "moderate" pushing vs "intensive" pushing on neonatal morbidity.This study was a multicenter randomized controlled trial, including nulliparas in the second stage of labor with an epidural and a singleton cephalic fetus at term and with a normal fetal heart rate. Of note, 2 groups were defined: (1) the moderate pushing group, in which women had no time limit on pushing, pushed only twice during each contraction, and observed regular periods without pushing, and (2) the intensive pushing group, in which women pushed 3 times during each contraction and the midwife called an obstetrician after 30 minutes of pushing to discuss operative delivery (standard care). The primary outcome was a composite neonatal morbidity criterion, including umbilical arterial pH of7.15, base excess of10 mmol/L, lactate levels of6 mmol/L, 5-minute Apgar score of7, and severe neonatal trauma. The secondary outcomes were mode of delivery, episiotomy, obstetrical anal sphincter injuries, postpartum hemorrhage, and maternal satisfaction.The study included 1710 nulliparous women. The neonatal morbidity rate was 18.9% in the moderate pushing group and 20.6% in the intensive pushing group (P=.38). Pushing duration was longer in the moderate group than in the intensive group (38.8±26.4 vs 28.6±17.0 minutes; P.001), and its rate of operative delivery was 21.1% in the moderate group compared with 24.8% in the intensive group (P=.08). The episiotomy rate was significantly lower in the moderate pushing group than in the intensive pushing group (13.5% vs 17.8%; P=.02). We found no significant difference for obstetrical anal sphincter injuries, postpartum hemorrhage, or maternal satisfaction.Moderate pushing has no effect on neonatal morbidity, but it may nonetheless have benefits, as it was associated with a lower episiotomy rate.
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- 2022
10. Is sonographic measurement of head-perineum distance useful to predict obstetrical anal sphincter injury in case of vacuum delivery?
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Charles Garabedian, Alix Plurien, Laure Benoit, Maeva Kyheng, Claire Thuillier, Maeva Sanchez, Anaïs Turcsak, Patrick Rozenberg, and Paul Berveiller
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Vacuum Extraction, Obstetrical ,Obstetrics and Gynecology ,Anal Canal ,General Medicine ,Perineum ,Delivery, Obstetric ,Lacerations ,Obstetric Labor Complications ,Cohort Studies ,Pregnancy ,Risk Factors ,Humans ,Female ,Retrospective Studies - Abstract
Determine if head-perineum distance (HPD) measurement before vacuum extraction (VE) was predictive of an obstetric anal sphincter injury (OASIS) occurrence.Retrospective, bicentric (Lille and Poissy, France) cohort study conducted from January 2019 to June 2020. All VE in singleton pregnancies of ≥34 weeks were included. HPD measurement was performed without compression of the tissues before each VE. The judgment criterion was the occurrence of an OASIS.Of 12 568 deliveries, VE was performed in 1093 (8.6%). Among these 1093 women undergoing VE, 675 (61.7%) with HPD measurement were included. OASIS was found in 6.5% of women (n = 44; 95% CI 4.5-8.7). HPD was not associated with OASIS (38.5 ± 12.6 mm in women with OASIS vs 37.4 ± 12.0 mm in women without; adjusted OR [aOR] per 5 mm increase = 0.92; 95% CI 0.79-1.06). Increased HPD was associated with higher risk of sequential extraction (aOR = 1.19; 95% CI 1.06-1.32), extraction duration10 min (aOR = 1.12; 95% CI 1.02-1.23) and shoulder dystocia (aOR = 1.20; 95% CI 1.03-1.40).Ultrasound-measured head-perineum distance does not predict the occurrence of obstetric anal sphincter injury during a VE. The interest of HPD is more about predicting the success or difficulty of VE rather its specific complications.
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- 2022
11. Evaluation of the usefulness of ultrasound measurement of the lower uterine segment before delivery of women with a prior cesarean delivery: a randomized trial
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Emmanuel Simon, Isabelle Boutron, Raphaël Porcher, Philippe Deruelle, Elodie Perrodeau, Raoul Desbriere, Yves Ville, Patrick Rozenberg, Norbert Winer, Marie-Victoire Senat, Gilles Kayem, Groupe de Recherche en Obstétrique et Gynécologie, HAL UVSQ, Équipe, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Service de Gynécologie - Obstétrique [Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre hospitalier universitaire de Nantes (CHU Nantes), Physiopathologie des Adaptations Nutritionnelles (PhAN), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), 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), 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), Centre d'épidémiologie Clinique [Hôtel-Dieu], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Hôtel Dieu, Hôpital Saint-Joseph [Marseille], Ministère des Affaires Sociales et de la Santé: PHRC R 12139, This study was funded by a research grant from the French Ministry of Health ( PHRC R 12139 ) and sponsored by the Département de la Recherche Clinique et du Développement de l’Assistance Publique-Hôpitaux de Paris. The sponsor did not participate in the study design, data analysis, data interpretation, or writing of the report. All authors confirm that they had full access to the data in the study and accept responsibility for submitting the article for publication., and This study was funded by a research grant from the French Ministry of Health (PHRC R 12139) and sponsored by the D?partement de la Recherche Clinique et du D?veloppement de l'Assistance Publique-H?pitaux de Paris. The sponsor did not participate in the study design, data analysis, data interpretation, or writing of the report. All authors confirm that they had full access to the data in the study and accept responsibility for submitting the article for publication.
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medicine.medical_specialty ,[SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging ,medicine.medical_treatment ,[SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,law.invention ,Randomized controlled trial ,law ,cesarean delivery ,medicine ,Contraindication ,uterine rupture ,Hysterectomy ,Vaginal delivery ,business.industry ,Obstetrics ,ultrasound ,Absolute risk reduction ,Obstetrics and Gynecology ,medicine.disease ,lower uterine segment thickness ,Confidence interval ,Uterine rupture ,[SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,[SDV.IB.IMA] Life Sciences [q-bio]/Bioengineering/Imaging ,vaginal birth after cesarean ,Relative risk ,business - Abstract
International audience; Background: The main reason to avoid trial of labor after cesarean delivery is the possibility of uterine rupture. Identifying women at risk is thus an important aim, for it would enable women at low risk to proceed with a secure planned vaginal birth. bjective: To evaluate the impact of proposing mode of delivery based on the ultrasound measurement of the lower uterine segment thickness on a composite outcome of maternal-fetal mortality and morbidity, compared with usual management, among pregnant women with a previous cesarean delivery.Study Design: This multicenter, randomized, controlled, parallel-group, unmasked trial was conducted at 8 referral university hospitals with a neonatal intensive care unit and enrolled 2948 women at 36 weeks 0 days to 38 weeks 6 days of gestation with 1 previous low transverse cesarean delivery and no contraindication to trial of labor. Women in the study group had their lower uterine segment thickness measured by ultrasound. Those with measurements >3.5 mm, were encouraged to choose a planned vaginal delivery, and those with measurements ≤3.5 mm, were encouraged to choose a planned repeat cesarean delivery. This measurement was not taken in the control group; their mode of delivery was decided according to standard management. The primary outcome was a composite criterion comprising maternal mortality, uterine rupture, uterine dehiscence, hysterectomy, thromboembolic disease, transfusion, endometritis, perinatal death, or neonatal encephalopathy. Prespecified secondary outcomes were repeat cesarean deliveries, elective or after trial of labor.Results: The study group included 1472 women, and the control group included 1476 women. These groups were similar at baseline. The primary outcome occurred in 3.4% of the study group and 4.3% of the control group (relative risk, 0.78; 95% confidence interval, 0.54–1.13: risk difference, −1.0%; 95% confidence interval, −2.4 to 0.5). The uterine rupture rate in the study group was 0.4% and in the control group 0.9% (relative risk, 0.43; 95% confidence interval, 0.15–1.19). The planned cesarean delivery rate was 16.4% in the study group and 13.7% in the control group (relative risk, 1.21; 95% confidence interval, 1.00–1.47), whereas the rates of cesarean delivery during labor were 25.1% and 25.0% (relative risk, 1.01; 95% confidence interval, 0.89–1.14) in the study and control groups, respectively.Conclusion: Ultrasound measurements of lower uterine segment thickness did not result in a statistically significant lower frequency of maternal and perinatal adverse outcomes than standard management. However, because this study was underpowered, further research should be encouraged.
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- 2022
12. Clinical Profiles of Placenta Accreta Spectrum: The PACCRETA Population-based Study
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René-Charles Rudigoz, B. Langer, Elie Azria, A. Seco, Olivier Morel, Corinne Dupont, C. Huissoud, G Beucher, Françoise Vendittelli, Loïc Sentilhes, C Crenn Hebert, Norbert Winer, Bernard Branger, S Patrier, Catherine Deneux-Tharaux, C Chiesa, Pierre Raynal, Franck Perrotin, Michel Dreyfus, L Carbillon, Patrick Rozenberg, J Fresson, Marie-Pierre Bonnet, Gilles Kayem, Service de Gynécologie-Obstétrique, Hôpital Louis-Mourier, AP-HP, 92701 Colombes, France., Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), 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)), Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA), CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Réseau Sécurité Naissance, Naître ensemble' des Pays de la Loire, Partenaires INRAE, Hospices Civils de Lyon (HCL), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, Institut Pascal (IP), Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne (UCA)-Institut national polytechnique Clermont Auvergne (INP Clermont Auvergne), Université Clermont Auvergne (UCA)-Université Clermont Auvergne (UCA), 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), Physiopathologie des Adaptations Nutritionnelles (PhAN), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), and Université de Nantes (UN)-Université de Nantes (UN)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)
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Adult ,medicine.medical_specialty ,Neonatal intensive care unit ,Placenta accreta ,medicine.medical_treatment ,Population ,Placenta Previa ,Placental Retention ,Placenta Accreta ,[SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,placenta accreta spectrum ,03 medical and health sciences ,prior caesarean ,0302 clinical medicine ,Pregnancy ,Placenta ,Management of Technology and Innovation ,neonatal outcomes ,medicine ,Humans ,Caesarean section ,Prospective Studies ,Lost to follow-up ,education ,ComputingMilieux_MISCELLANEOUS ,education.field_of_study ,030219 obstetrics & reproductive medicine ,Cesarean Section ,Obstetrics ,business.industry ,Incidence (epidemiology) ,Pregnancy Outcome ,Obstetrics and Gynecology ,medicine.disease ,placenta praevia ,3. Good health ,medicine.anatomical_structure ,Female ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,France ,business ,Maternal morbidity - Abstract
International audience; 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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- 2022
13. Arabin pessary to prevent adverse perinatal outcomes in twin pregnancies with a short cervix: a multicenter randomized controlled trial (PESSARONE)
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Marion Groussolles, Norbert Winer, Loïc Sentilhes, Florence Biquart, Mona Massoud, Alexandre J. Vivanti, Hanane Bouchghoul, Patrick Rozenberg, Pascale Olivier, Raoul Desbriere, Celine Chauleur, Franck Perrotin, Frederic Coatleven, Florent Fuchs, Florence Bretelle, Vassilis Tsatsaris, Laurent J. Salomon, Nicolas Sananes, Gilles Kayem, Veronique Houflin-Debarge, Thomas Schmitz, Guillaume Benoist, Catherine Arnaud, Virginie Ehlinger, Christophe Vayssière, Fuchs, Florent, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre d'Epidémiologie et de Recherche en santé des POPulations (CERPOP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL), AP-HP - Hôpital Antoine Béclère [Clamart], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris-Sud - Paris 11 (UP11), Hôpital Bicêtre, Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy], Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Hôpital Saint-Joseph [Marseille], Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Bordeaux [Bordeaux], CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital Nord [CHU - APHM], Maternité Port-Royal [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], CHU Necker - Enfants Malades [AP-HP], Université Paris Descartes - Paris 5 (UPD5), CHU Strasbourg, CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Jeanne de Flandres, Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital Robert Debré, Université Paris Diderot - Paris 7 (UPD7), Service de Gynécologie-Obstétrique et Médecine de la Reproduction [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), and The French Ministry of Health (Programme Hospitalier de Recherche Clinique, AOM2013) supported this study,which was sponsored by the Department of Clinical Research of the Toulouse University Hospital Center, France
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adverse neonatal outcomes ,pessary ,Infant, Newborn ,preterm birth ,Obstetrics and Gynecology ,Cervix Uteri ,[SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,Pessaries ,twin pregnancies ,[SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,Cervical Length Measurement ,Pregnancy ,Pregnancy, Twin ,Humans ,Premature Birth ,Female ,short cervix ,Progesterone - Abstract
International audience; Background: The number of twin pregnancies continues to increase worldwide as both the number of pregnancies obtained by medically assisted reproduction and age at first pregnancy keep rising. Preterm delivery is the major complication associated with twin pregnancies. The effectiveness of preventive treatments such as progesterone or cervical cerclage for women with a short cervix is doubtful in twin pregnancies. The effectivity of cervical pessaries in preventing preterm birth and its associated morbidity and mortality is also controversial.Objective: We sought to investigate if the Arabin pessary reduces adverse neonatal outcomes in twin pregnancies with a short cervix.Study design: This open-label, multicenter, randomized controlled trial on twin pregnancies with a cervical length of
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- 2022
14. Comparison of measured and calculated postpartum blood loss after vaginal delivery
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Hugo Madar, Loïc Sentilhes, François Goffinet, Marie-Pierre Bonnet, Patrick Rozenberg, and Catherine Deneux-Tharaux
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Obstetrics and Gynecology - Published
- 2022
15. Cervical dilators concurrently with misoprostol to shorten labor in termination of pregnancy: a randomized trial
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Olivia Anselem, Jean-Marie Jouannic, Norbert Winer, Hanane Bouchghoul, Alexandre Vivanti, Patrick Rozenberg, Vanina Castaigne, Estelle Perdriolle-Galet, Jerôme Massardier, Catherine Thong Vanh, Pierre-Yves Ancel, François Goffinet, and Vassilis Tsatsaris
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Obstetrics and Gynecology - Published
- 2022
16. Alternative to intensive management of the active phase of the second stage: multicenter randomized trial
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Camille Le Ray, Patrick Rozenberg, Gilles Kayem, Thierry Harvey, Laurent Mandelbrot, Muriel Doret, Olivier PARANT, Florent Fuchs, Delphine Vardon, Elie Azria, Hanane Bouchghoul, Pierre-François Ceccaldi, Aurélien Seco, Charles Garabedian, and anne Chantry
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Obstetrics and Gynecology - Published
- 2022
17. Conservative management or cesarean hysterectomy for placenta accreta spectrum: the PACCRETA prospective study
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Loïc Sentilhes, Aurélien Seco, Elie Azria, Gaël Beucher, Marie-Pierre Bonnet, Bernard Branger, Lionel Carbillon, Coralie Chiesa, Catherine Crenn-Hebert, Michel Dreyfus, Corinne Dupont, Jeanne Fresson, Cyril Huissoud, Bruno Langer, Olivier Morel, Sophie Patrier, Franck Perrotin, Pierre Raynal, Patrick Rozenberg, René-Charles Rudigoz, Francoise Vendittelli, Norbert Winer, Catherine Deneux-Tharaux, Gilles Kayem, Isabelle Avril, Sophie Bazire, Sophie Bedel, Fanny De Marcillac, Laurent Gaucher, Maëlle Guitton, Catherine Guerin, Laurence Lecomte, Marine Pranal, Laetitia Rault, Anne Viallon, Myriam Virlouvet, Justine Schwanka, CHU Bordeaux [Bordeaux], 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)), Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA), Service de Gynécologie-Obstétrique et Médecine de la Reproduction [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Service d'anesthésie-réanimation [CHU Trousseau], CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Réseau Sécurité Naissance des Pays de la Loire, Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, Institut Pascal (IP), Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne (UCA)-Institut national polytechnique Clermont Auvergne (INP Clermont Auvergne), Université Clermont Auvergne (UCA)-Université Clermont Auvergne (UCA), 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), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Physiopathologie des Adaptations Nutritionnelles (PhAN), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), and Université de Nantes (UN)-Université de Nantes (UN)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)
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030219 obstetrics & reproductive medicine ,Cesarean Section ,conservative management ,Obstetrics and Gynecology ,Placenta Accreta ,[SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,Conservative Treatment ,Hysterectomy ,placenta accreta spectrum ,03 medical and health sciences ,0302 clinical medicine ,postpartum hemorrhage ,Pregnancy ,cesarean hysterectomy ,Humans ,Female ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Prospective Studies ,030212 general & internal medicine ,ComputingMilieux_MISCELLANEOUS ,Retrospective Studies ,transfusion - Abstract
International audience; 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 4 units of packed red blood cells within 6 months than cesarean hysterectomy.
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- 2022
18. Facteurs organisationnels associés à la réalisation d’une césarienne dans une population à bas risque
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François Goffinet, C. Bouyer, Patrick Rozenberg, A. Rousseau, and C. Duvillier
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Gynecology ,03 medical and health sciences ,medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,0302 clinical medicine ,Reproductive Medicine ,Low risk population ,Political science ,medicine ,Obstetrics and Gynecology ,030212 general & internal medicine ,Cesarean delivery - Abstract
Resume Objectif Il existe des differences considerables du taux de cesariennes entre les maternites d’une meme region. Le taux de cesarienne a augmente ces dernieres annees dans la population a bas risque. L’objectif de cette etude etait d’etudier l’impact des facteurs organisationnels sur le taux de cesarienne dans une population a bas risque. Methodes Nous avons realise une etude de cohorte retrospective en population dans les dix maternites du reseau MYPA de 2009 a 2015. Nous avons selectionne une population a bas risque en ne conservant que les groupes 1 et 3 de la classification de Robson. Le critere de jugement principal etait l’accouchement par cesarienne. Les facteurs organisationnels etudies ont regroupe les caracteristiques structurelles des maternites (universitaire ou non, public ou privee, nombre d’accouchement annuel, unite de soins intensifs maternels, unite de soins intensifs neonatals, nombre de salle de naissance) et l’organisation de l’equipe soignante (nombre de sages-femmes et d’obstetriciens, mode de garde, charge de travail et realisation d’une revue de morbi-mortalite). Nous avons realise une analyse multiniveau a intercept aleatoire, univariee puis multivariee en retenant les variables ayant un p Resultats Notre population d’etude a inclus 64 100 femmes. Le taux de cesarienne a varie de 5,5 a 11,3 % parmi les 10 maternites. En analyse univariee, les variables organisationnelles significativement associees a la realisation d’une cesarienne etaient le statut de la maternite (centre hospitalier universitaire, centre hospitalier public non universitaire et etablissement prive) et la realisation d’une revue de morbi-mortalite. Cependant, apres ajustement, aucun de ces facteurs organisationnels n’etait significativement associe a la realisation d’une cesarienne. Lorsque l’analyse multivariee a ete restreinte au sous-groupe des nullipares, le statut prive de la maternite etait significativement associe a un taux plus eleve de cesariennes (OR = 1,39 [1,09–1,76]). De meme, la probabilite de cesarienne etait plus importante lorsque le nombre d’accouchement par salle de naissance augmentait (OR = 1,15 [1,01–1,31]). Pour le sous-groupe des multipares, aucune variable n’etait significativement associee a la realisation d’une cesarienne. Conclusion Dans notre population globale a bas risque, aucun facteur organisationnel n’apparaissait associe a une augmentation du taux de cesarienne. En revanche, dans la population des nullipares a bas risque, le statut prive du centre et un nombre eleve d’accouchement par salle de naissance etaient associes a un plus grand nombre de cesariennes. Augmenter le nombre de salles de naissance pourrait donc etre une piste pour tenter de reduire le nombre de cesariennes. Les travaux a venir devraient egalement chercher a identifier les facteurs specifiques permettant de reduire les differences de taux de cesarienne entre maternites privees et publiques.
- Published
- 2018
19. Cervical ripening in prolonged pregnancies by silicone double balloon catheter versus vaginal dinoprostone slow release system: The MAGPOP randomised controlled trial
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Raoul Desbriere, Olivier Parant, Caroline Diguisto, Chloé Arthuis, Norbert Winer, Bruno Giraudeau, Patrick Rozenberg, Gael Beucher, Guillaume Ducarme, Christophe Poncelet, Cyrille Faraguet, René Gabriel, Jacob Hannigsberg, Denis Gallot, Franck Perrotin, Céline Chauleur, Amélie Le Gouge, Helene Isly, Lallemant, Christopher, 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), 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), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre d’Investigation Clinique [Tours] CIC 1415 (CIC ), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Physiopathologie des Adaptations Nutritionnelles (PhAN), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université Paris 13 (UP13), Centre Hospitalier René Dubos [Pontoise], INSERM U1059, SAINBIOSE - Santé, Ingénierie, Biologie, Saint-Etienne (SAINBIOSE-ENSMSE), Centre Ingénierie et Santé (CIS-ENSMSE), École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), CHU - BREST - Service de Gynécologie-Obstétrique et Chirurgie, Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Génétique, Reproduction et Développement (GReD), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne (UCA), CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims (CHU Reims), Hôpital Saint-Joseph [Marseille], Service de Gynécologie-Obstétrique et Médecine de la Reproduction [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Service de Gynécologie Obstétrique, Centre hospitalier de Chartres (Chartres), Hôpitaux de Chartres [Chartres], Service de Gynécologie et Obstétrique [Rennes] = Gynaecology [Rennes], CHU Pontchaillou [Rennes], Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Imagerie et cerveau (iBrain - Inserm U1253 - UNIV Tours ), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Gynécologie-Obstétrique [CHRU Tours], 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 Toulouse [Toulouse], Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, Service de gynécologie-obstétrique [Tours], CIC Tours, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Ingénierie et Santé (CIS-ENSMSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT), Service de Gynécologie et Obstétrique [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CHU Pontchaillou [Rennes]-hôpital Sud, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Tours, Santé Ingénierie Biologie Saint-Etienne (SAINBIOSE), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), and Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)
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Maternal Health ,Peptide Hormones ,Silicones ,Cardiovascular Medicine ,Oxytocin ,Biochemistry ,law.invention ,0302 clinical medicine ,Randomized controlled trial ,law ,Pregnancy ,Heart Rate ,Oxytocics ,Medicine and Health Sciences ,Pregnancy, Prolonged ,030212 general & internal medicine ,030219 obstetrics & reproductive medicine ,[SDV.MHEP] Life Sciences [q-bio]/Human health and pathology ,Vaginal delivery ,Obstetrics ,Compilcation ,Obstetrics and Gynecology ,food and beverages ,Ripening ,Neurochemistry ,General Medicine ,3. Good health ,Chemistry ,medicine.anatomical_structure ,Obstetric Procedures ,Physical Sciences ,Gestation ,Engineering and Technology ,Medicine ,Female ,France ,Neurochemicals ,Research Article ,Biotechnology ,Pessary ,Adult ,medicine.medical_specialty ,Catheters ,Bishop score ,Cardiology ,Bioengineering ,Surgical and Invasive Medical Procedures ,Guidelines ,Dinoprostone ,Cardiovascular Pharmacology ,03 medical and health sciences ,medicine ,Humans ,Labor, Induced ,Cervix ,Pharmacology ,business.industry ,Cesarean Section ,Chemical Compounds ,Biology and Life Sciences ,Pessaries ,medicine.disease ,Delivery, Obstetric ,Hormones ,Health Care ,Women's Health ,Medical Devices and Equipment ,Health Statistics ,Morbidity ,business ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology ,Cervical Ripening ,Neuroscience - Abstract
Background Prolonged pregnancies are a frequent indication for induction of labour. When the cervix is unfavourable, cervical ripening before oxytocin administration is recommended to increase the likelihood of vaginal delivery, but no particular method is currently recommended for cervical ripening of prolonged pregnancies. This trial evaluates whether the use of mechanical cervical ripening with a silicone double balloon catheter for induction of labour in prolonged pregnancies reduces the cesarean section rate for nonreassuring fetal status compared with pharmacological cervical ripening by a vaginal pessary for the slow release of dinoprostone (prostaglandin E2). Methods and findings This is a multicentre, superiority, open-label, parallel-group, randomised controlled trial conducted in 15 French maternity units. Women with singleton pregnancies, a vertex presentation, ≥41+0 and ≤42+0 weeks’ gestation, a Bishop score, In this trial, Caroline Diguisto and colleagues compare two methods for addressing non-reassuring fetal status in caesarian deliveries., Author summary Why was this study done? Induction of labour may be necessary when pregnancies reach 41 weeks of gestation. Ripening methods include mechanical and pharmacological options and both are currently used in pregnancies that reach 41 weeks of gestation. Mechanical cervical ripening leads to less uterine tachysystole and less fetal heart rate anomalies than pharmacological methods. Whether mechanical methods are associated with reduced perinatal morbidity in prolonged pregnancies in comparison with pharmacological methods needed to be investigated by a sufficiently powered randomised trial. What did the researchers do and find? We conducted a trial to compare cervical ripening with a silicone double-balloon catheter (mechanical method) to cervical ripening with a vaginal dinoprostone slow-release system (pharmacological method) among women with prolonged pregnancies. We did not find that cervical ripening with a silicone double-balloon catheter was superior to cervical ripening with a vaginal dinoprostone slow-release system to reduce the rate of cesarean for nonreassuring fetal heart rate and overall maternal and neonatal morbidity. What do these findings mean? There is no evidence to justify preferring mechanical cervical ripening over pharmacological cervical ripening in pregnancies that have reached 41 weeks.
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- 2021
20. L’antibiothérapie comme traitement des insuffisances cervicales en lien avec une infection / inflammation intra-amniotique ?
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Anne Leostic, Paul Berveiller, Edouard Lecarpentier, Patrick Rozenberg, Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Centre Hospitalier Intercommunal de Créteil (CHIC), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Biologie de la Reproduction, Environnement, Epigénétique & Développement (BREED), and Université Paris-Saclay-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-École nationale vétérinaire d'Alfort (ENVA)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)
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medicine.medical_specialty ,Cervical insufficiency ,medicine.drug_class ,Antibiotics ,insuffisance cervicale ,Inflammation ,grossesse ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,antibiotherapy ,cervical insufficiency ,ComputingMilieux_MISCELLANEOUS ,030304 developmental biology ,0303 health sciences ,Pregnancy ,030219 obstetrics & reproductive medicine ,business.industry ,inflammation intra-amniotique ,intra-uterine inflammation ,Obstetrics and Gynecology ,[SDV.BDLR]Life Sciences [q-bio]/Reproductive Biology ,medicine.disease ,3. Good health ,infection intra-amniotique ,Reproductive Medicine ,Intra-amniotic infection ,antibiothérapie ,pregnancy ,medicine.symptom ,business ,intra-amniotic infection - Abstract
International audience
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- 2021
21. Perinatal outcome after planned vaginal delivery in monochorionic compared with dichorionic twin pregnancy
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François Goffinet, M. V. Senat, Loïc Sentilhes, Norbert Winer, Charles Garabedian, Patrick Rozenberg, Elie Azria, Christophe Vayssière, Diane Korb, Thomas Schmitz, Hôpital Robert Debré, Hôpital Robert Debré-Centre Hospitalier Universitaire de Reims (CHU Reims), 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), Centre hospitalier Saint-Joseph [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy], Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), CHU Bordeaux [Bordeaux], Université de Bordeaux (UB), Centre d'investigation clinique de Toulouse (CIC 1436), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Nantes (CHU Nantes), Maternité Port-Royal [CHU Cochin], Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), DHU Risques Et Grossesse, Centre National de la Recherche Scientifique (CNRS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), AOM2012 Ministère des Affaires Sociales et de la Santé, The authors thank URC-CIC Paris Descartes Necker/Cochin (Laurence Lecomte) for the study implementation, monitoring and data management. This work was funded by a grant from the French Ministry of Health (PHRC, AOM2012). L.S. carried out consultancy work and was a lecturer for Ferring Laboratories in the previous 3 years., and The authors thank URC‐CIC Paris Descartes Necker/Cochin (Laurence Lecomte) for the study implementation, monitoring and data management. This work was funded by a grant from the French Ministry of Health (PHRC, AOM2012).
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Adult ,medicine.medical_specialty ,Population ,Twins ,Reproductive technology ,[SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,Labor Presentation ,03 medical and health sciences ,0302 clinical medicine ,Obstetrics and gynaecology ,dichorionic twins ,Pregnancy ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,030212 general & internal medicine ,education ,Perinatal Mortality ,Twin Pregnancy ,education.field_of_study ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,business.industry ,Vaginal delivery ,Obstetrics ,Cephalic presentation ,Infant, Newborn ,Pregnancy Outcome ,Obstetrics and Gynecology ,Gestational age ,Chorion ,General Medicine ,neonatal morbidity ,twin pregnancy ,Delivery, Obstetric ,Obstetric Labor Complications ,3. Good health ,Reproductive Medicine ,Vagina ,monochorionic twins ,Pregnancy, Twin ,Female ,planned vaginal delivery ,France ,Monochorionic twins ,business - Abstract
OBJECTIVE To assess, according to chorionicity, the perinatal outcome of twin pregnancy in which vaginal delivery is planned. METHODS JUMODA (JUmeaux MODe d'Accouchement) was a national prospective population-based cohort study of twin pregnancies, delivered in 176 maternity units in France, from February 2014 to March 2015. In this planned secondary analysis, we assessed, according to chorionicity, the perinatal outcome of twin pregnancies, in which vaginal delivery was planned, that delivered at or after 32 weeks of gestation with the first twin in cephalic presentation. In order to select a population with well-recognized indications for planned vaginal delivery, we applied the same exclusion criteria as those in the Twin Birth Study, an international randomized trial. Monochorionic twin pregnancies with twin-to-twin transfusion syndrome or twin anemia-polycythemia sequence were defined as complicated and were excluded. The primary outcome was a composite of intrapartum mortality and neonatal morbidity and mortality. Multivariable logistic regression models were used to control for potential confounders. Subgroup analyses were conducted according to birth order (first or second twin) and gestational age at delivery (
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- 2021
22. Induction of labor at term with vaginal misoprostol or a prostaglandin E2 pessary: a noninferiority randomized controlled trial
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Cedric Lavergne, Patrick Rozenberg, Emmanuel Roth, Emma Orusco, Sophie Javoise, Mathieu Morin, Adeline Gallini, Pascale Olivier, Virginie Ehlinger, Julie Fort, Groupe de Recherche en Obstétrique rt Gynécologie, Marie-Victoire Senat, Catherine Arnaud, Adrien Gaudineau, Christophe Vayssière, CHU Strasbourg, Service de Gynécologie [Hôpital Princesse Grace, Monaco], Hôpital Princesse Grace [Monaco], Hôpital Bicêtre, Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Centre d'Epidémiologie et de Recherche en santé des POPulations (CERPOP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'épidémiologie [Toulouse], CHU Toulouse [Toulouse], Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Ministère des Affaires Sociales et de la Santé, Centre Hospitalier Universitaire de Toulouse, This study was supported by a grant from the French Ministry of Health under its Clinical Research Hospital Program (Programme Hospitalier de Recherche Clinique, June 18, 2010) and promoted by the Departement of Clinical Research of the Toulouse University Hospital Center., and Hôpital Paule de Viguier
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Adult ,Pessary ,induction of labor ,medicine.medical_specialty ,medicine.medical_treatment ,Bishop score ,[SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Obstetrics and gynaecology ,Pregnancy ,law ,Oxytocics ,medicine ,vaginal ,Humans ,dinoprostone ,Labor, Induced ,030212 general & internal medicine ,Cervix ,Misoprostol ,misoprostol ,030219 obstetrics & reproductive medicine ,Cesarean Section ,business.industry ,Vaginal delivery ,Obstetrics ,Obstetrics and Gynecology ,Pessaries ,Delivery, Obstetric ,3. Good health ,medicine.anatomical_structure ,Patient Satisfaction ,Labor induction ,term pregnancy ,Female ,prostaglandin E2 pessary ,business ,Cervical Ripening ,medicine.drug - Abstract
International audience; Background: Induction of labor is among the most common procedures for pregnant women. Only a few randomized clinical trials with relatively small samples have compared misoprostol with dinoprostone. Although their efficacy seems similar, their safety profiles have not been adequately evaluated, and economic data are sparse. Objective: This study aimed to test the noninferiority of vaginal misoprostol (prostaglandin E1) (25 μg) to a slow-release dinoprostone (prostaglandin E2) pessary (10 μg) for induction of labor with an unfavorable cervix at term. Study Design: This was an open-label multicenter randomized noninferiority trial at 4 university hospitals of the Research Group in Obstetrics and Gynecology between 2012 and 2015. We recruited women who underwent induction of labor for medical reasons, those with a Bishop score of ≤5 at ≥36 weeks’ gestation, and those with a cephalic-presenting singleton pregnancy with no previous cesarean delivery. Women were randomly allocated to receive either vaginal misoprostol at 4-hour intervals (25 μg) or a 10-mg slow-release dinoprostone pessary. The primary outcome was the total cesarean delivery rate. Noninferiority was defined as a difference in the cesarean delivery rates between the groups of no more than 5%. Secondary outcomes included neonatal and maternal morbidity, vaginal delivery at
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- 2021
23. Morbidity associated with planned cesarean deliveries performed before the scheduled date: A cohort study
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Antoine Koch, Patrick Rozenberg, Floriane Jochum, Lise Lecointre, Laure Haller, Nicolas Sananès, Biomatériaux et Bioingénierie (BB), Université de Strasbourg (UNISTRA)-Matériaux et nanosciences d'Alsace (FMNGE), Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Strasbourg, Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)-École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Réseau nanophotonique et optique, Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Matériaux et nanosciences d'Alsace (FMNGE), Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, and Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)
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medicine.medical_specialty ,Cesarean performed on the scheduled date ,Neonatal morbidity ,Maternal morbidity ,[SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Elective Cesarean Delivery ,Medicine ,Rupture of membranes ,Humans ,Vaginal bleeding ,030212 general & internal medicine ,reproductive and urinary physiology ,Planned cesarean delivery ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics ,Cesarean Section ,Medical record ,Infant, Newborn ,Obstetrics and Gynecology ,Gestational age ,Infant ,Cesarean performed before the scheduled date ,Delivery, Obstetric ,female genital diseases and pregnancy complications ,3. Good health ,Reproductive Medicine ,Elective cesarean delivery ,Female ,medicine.symptom ,Morbidity ,business ,Cohort study - Abstract
International audience; Objective: Women with planned cesareans can require delivery before the scheduled date. However, data describing the morbidity associated with planned cesarean deliveries performed before the originally scheduled date is lacking. The objective of this study was to compare the morbidity associated with planned cesarean delivery performed before compared with on the scheduled date. Study design: This retrospective single-center cohort study included all 3595 women with singleton pregnancies and cesarean deliveries after 36+6 weeks. All cases were reviewed individually to identify the initial intended mode of delivery, determined before 37 weeks. We excluded the 2145 (59.7%) unplanned cesareans initially planned as vaginal deliveries. Finally, the analysis included 1450 women with planned cesareans: 1232 (85.0%) performed as scheduled, and 218 (15.0%) before that date. The composite outcomes of maternal morbidity was one or more of the morbidity measures, including surgical complications, postpartum hemorrhage, infection and thrombo-embolism. Neonatal morbidity measures included 5 min Apgar score < 7, arterial cord blood pH < 7.00, and admission to the neonatal intensive care unit (NICU). Results: Reasons for performing planned cesarean delivery before the scheduled date were as follows: onset of labor (n = 109; 50.0%), rupture of membranes (n = 85; 39.0%), preeclampsia (n = 9; 4.1%), scar pain in women with a previous cesarean (n = 6; 2.8%), unexplained vaginal bleeding (n = 5; 2.3%), and nonreassuring fetal heart rate (n = 4; 1.8%). Mean gestational age for planned cesarean deliveries before the scheduled date was 38.7 weeks ± 0.8 versus 39.2 weeks ± 0.7 for those performed when scheduled (P < 0.0001). The maternal morbidity composite outcome rate was significantly higher among planned cesareans performed early compared with those on the scheduled date: 18.3% vs 9.7%, respectively, P = 0.0002. It was still higher in the multivariable analysis: aOR 2.17, 95% CI 1.46–3.21, P = 0.0001. The neonatal composite outcome did not differ significantly between the two groups. Conclusion: In planned cesarean deliveries, maternal morbidity is higher for cesareans performed before rather than on the scheduled date. Studies without accurate intent-to-treat analyses underestimate the morbidity associated with planned cesareans. Accordingly, medical records must make it possible to distinguish planned cesarean deliveries performed before the scheduled date from those performed as planned.
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- 2021
24. Variation between hospital caesarean delivery rates when Robson's classification is considered: An observational study from a French perinatal network
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Thibaud Quibel, Camille Bouyer, Jean Bouyer, Patrick Rozenberg, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, and HAL UVSQ, Équipe
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Epidemiology ,Maternal Health ,[SDV]Life Sciences [q-bio] ,Caesarean delivery ,Logistic regression ,Labor and Delivery ,0302 clinical medicine ,Pre-Eclampsia ,Pregnancy ,Risk Factors ,Perinatal network ,Medicine and Health Sciences ,Medicine ,030212 general & internal medicine ,education.field_of_study ,030219 obstetrics & reproductive medicine ,Multidisciplinary ,Age Factors ,Gestational age ,Obstetrics and Gynecology ,Hospitals ,[SDV] Life Sciences [q-bio] ,Obstetric Procedures ,Female ,France ,Research Article ,Adult ,Science ,Population ,Surgical and Invasive Medical Procedures ,03 medical and health sciences ,Humans ,education ,Socioeconomic status ,business.industry ,Cesarean Section ,Odds ratio ,Preeclampsia ,Health Care ,Pregnancy Complications ,Socioeconomic Factors ,Health Care Facilities ,Medical Risk Factors ,Birth ,Women's Health ,Observational study ,business ,Demography - Abstract
Introduction WHO has recommended using Robson’s Ten Group Classification System (TGCS) to monitor and analyze CD rates. Its failure to take some maternal and organizational factors into account, however, could limit the interpretation of CD rate comparisons, because it may contribute to variations in hospital CD rates. Objective To study the contribution of maternal socioeconomic and clinical characteristics and hospital organizational factors to the variation in CD rates when using Robson’s ten-group classification system for CD rate comparisons. Methods This prospective, observational, population-based study included all deliveries at a gestational age > 24 weeks at the 10 hospitals of the French MYPA perinatal network in the Paris area. CD rates were calculated for each TGCS group in each hospital. Interhospital variations in these rates were investigated with hierarchical logistic regression models to quantify the variation explained by differences in patient and hospital characteristics when the TGCS is considered. Variations in CD rates between hospitals were estimated with median odds ratios (MOR) to express interhospital variance on the standard odds ratio scale. The percentage of variation explained by TGCS and maternal and hospital characteristics was also calculated. Results The global CD rate was 24.0% (interhospital range: 17–32%). CD rates within each TGCS group differed significantly between hospitals (P40 years), severe preeclampsia, and two organizational factors: hospital status (private maternities) and the deliveries per staff member per 24 hours. The MOR in the empty model was 1.27 and did not change after taking the TGCS into account. Adding maternal characteristics and hospital organizational factors lowered the MOR to 1.14 and reduced the variation between hospital CD rates by 70%. Conclusion Maternal characteristics and hospital factors are needed to address variation in CD rates among the TGCS groups. Therefore, comparisons of these rates that do not consider these factors should be interpreted carefully.
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- 2021
25. Impact of the COVID-19 pandemic on preterm birth and stillbirth: a nationwide, population-based retrospective cohort study
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Jean-Bernard Gouyon, Patrick Rozenberg, Anne-Sophie Mariet, Catherine Quantin, Emmanuel Simon, Jonathan Cottenet, and Sonia Bechraoui-Quantin
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2019-20 coronavirus outbreak ,Pediatrics ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,MEDLINE ,Population based ,Cohort Studies ,Pregnancy ,Pandemic ,Research Letter ,medicine ,Humans ,Retrospective Studies ,SARS-CoV-2 ,business.industry ,COVID-19 ,Obstetrics and Gynecology ,Retrospective cohort study ,Stillbirth ,Pregnancy Complications ,Reproductive Medicine ,Premature Birth ,Female ,France ,business - Published
- 2021
26. Reply: Search for a predictive relationship between ultrasound thickness of the lower uterine segment and rupture of the uterus in women with a prior cesarean does not make biological sense
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Patrick Rozenberg
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medicine.medical_specialty ,Lower uterine segment ,business.industry ,Obstetrics ,Uterus ,Ultrasound ,Obstetrics and Gynecology ,medicine.disease ,Uterine rupture ,medicine.anatomical_structure ,Uterine Rupture ,Pregnancy ,medicine ,Humans ,Female ,Cesarean delivery ,business ,Ultrasonography - Published
- 2022
27. A snapshot of the Covid-19 pandemic among pregnant women in France
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Olivier Picone, Pierre-François Ceccaldi, Jeremy Sroussi, Christophe Vayssière, Céline Chauleur, Alexandre J. Vivanti, Raoul Desbriere, Anne-Gaël Cordier, Michel Dreyfus, Eric Verspyck, Philippe Deruelle, Franck Perrotin, Loïc Sentilhes, Cyril Huissoud, Marion Fermaut, Yasmine Chalet, Gilles Kayem, Charles Garabedian, Florence Bretelle, Elie Azria, Vivien Alessandrini, Marine Driessen, Julie Blanc, Patrick Rozenberg, Denis Gallot, Marie Bornes, Caroline Bohec, Edouard Lecarpentier, Dominique Luton, Norbert Winer, Olivier Morel, Muriel Doret, Thomas Schmitz, Service de Gynécologie-Obstétrique [CHU Trousseau], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Service de Gynécologie et Obstétrique [Marseille], Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Maternité Port-Royal [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Groupe Hospitalier Paris Saint Joseph, Assistance Publique - Hôpitaux de Marseille (APHM), Service de Gynécologie-Obstétrique (BREST - Gynéco-Obs), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service de Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Paris Diderot - Paris 7 (UPD7), INSERM U1059, SAINBIOSE - Santé, Ingénierie, Biologie, Saint-Etienne (SAINBIOSE-ENSMSE), Centre Ingénierie et Santé (CIS-ENSMSE), École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Sud - Paris 11 (UP11), Maternité Jeanne de Flandre, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de Gynécologie-Obstétrique, Pôle Parents Enfants,Hôpital Saint-Joseph, Hospices Civils de Lyon (HCL), Service de Gynécologie-Obstétrique et Médecine de la Reproduction [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants (UMR_S 953), Université Paris-Sud - Paris 11 (UP11)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris 13 (UP13), Pôle Entrepreneuriat et Innovation - Rouen Business School, Rouen Business School, Laboratoire d'Automatique, de Mécanique et d'Informatique industrielles et Humaines - UMR 8201 (LAMIH), Centre National de la Recherche Scientifique (CNRS)-Université Polytechnique Hauts-de-France (UPHF)-INSA Institut National des Sciences Appliquées Hauts-de-France (INSA Hauts-De-France), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA), Institut cellule souche et cerveau (U846 Inserm - UCBL1), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Biologie de la Reproduction, Environnement, Epigénétique & Développement (BREED), École nationale vétérinaire - Alfort (ENVA)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Saclay-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Laboratoire Electronique, Informatique et Image [UMR6306] (Le2i), Université de Bourgogne (UB)-École Nationale Supérieure d'Arts et Métiers (ENSAM), Arts et Métiers Sciences et Technologies, 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)-Arts et Métiers Sciences et Technologies, 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)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Groupe de Recherche sur les Infections pendant la Grossesse [Vélizy-Villacoublay] (Association diagnostic prévention), Service de Gynécologie-Obstétrique [Bicêtre], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, Service de gynécologie-obstétrique, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Service Obstétrique [CHU Toulouse], Pôle Femme-Mère-Couple [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Service de gynécologie et obstétrique [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Thérapie génique, Génomique et Epigénomique (U 1169), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Hôpital Mère Enfant CHU Nantes, Physiopathologie des Adaptations Nutritionnelles (PhAN), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), CCSD, Accord Elsevier, Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Descartes - Paris 5 (UPD5)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris-Sud - Paris 11 (UP11), École nationale vétérinaire d'Alfort (ENVA)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Saclay-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), HESAM Université (HESAM)-HESAM Université (HESAM)-Arts et Métiers Sciences et Technologies, HESAM Université (HESAM)-HESAM Université (HESAM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Centre National de la Recherche Scientifique (CNRS), Maternité Paule de Viguier, CHU Toulouse [Toulouse], CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Santé Ingénierie Biologie Saint-Etienne (SAINBIOSE), Institut cellule souche et cerveau (SBRI), Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Ingénierie et Santé (CIS-ENSMSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Recherche Agronomique (INRA), Université Paris-Saclay-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-École nationale vétérinaire d'Alfort (ENVA)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Université de Rouen Normandie (UNIROUEN), and Normandie Université (NU)-Normandie Université (NU)-CHU Rouen
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Gestational hypertension ,medicine.medical_treatment ,Severity of Illness Index ,0302 clinical medicine ,Pregnancy ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Oxygen therapy ,Obstetrics and Gynaecology ,Outcome Assessment, Health Care ,Pregnancy Complications, Infectious ,ComputingMilieux_MISCELLANEOUS ,[SDV.MP.VIR] Life Sciences [q-bio]/Microbiology and Parasitology/Virology ,[SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases ,[SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases ,Respiratory complications ,030219 obstetrics & reproductive medicine ,Respiratory distress ,Obstetrics ,Obstetrics and Gynecology ,3. Good health ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,030220 oncology & carcinogenesis ,[SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology ,[SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Female ,France ,Coronavirus Infections ,COVID 19 ,[SDV.MP.PAR] Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology ,Maternal Age ,Adult ,medicine.medical_specialty ,Pneumonia, Viral ,Article ,Preeclampsia ,Betacoronavirus ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Lockdown ,Severity of illness ,medicine ,Extracorporeal membrane oxygenation ,Humans ,[SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology ,Pandemics ,Mechanical ventilation ,Noninvasive Ventilation ,SARS-CoV-2 ,business.industry ,COVID-19 ,medicine.disease ,[SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology ,Oxygen ,Risk factors ,Reproductive Medicine ,[SDV.MP.BAC] Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology ,business - Abstract
Objective To describe the course over time of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in French women from the beginning of the pandemic until mid-April, the risk profile of women with respiratory complications, and short-term pregnancy outcomes. Methods We collected a case series of pregnant women with COVID-19 in a research network of 33 French maternity units between March 1 and April 14, 2020. All cases of SARS-CoV-2 infection confirmed by a positive result on real-time reverse transcriptase polymerase chain reaction tests of a nasal sample and/or diagnosed by a computed tomography chest scan were included and analyzed. The primary outcome measures were COVID-19 requiring oxygen (oxygen therapy or noninvasive ventilation) and critical COVID-19 (requiring invasive mechanical ventilation or extracorporeal membrane oxygenation, ECMO). Demographic data, baseline comorbidities, and pregnancy outcomes were also collected. Results Active cases of COVID-19 increased exponentially during March 1–31, 2020; the numbers fell during April 1–14, after lockdown was imposed on March 17. The shape of the curve of active critical COVID-19 mirrored that of all active cases. By April 14, among the 617 pregnant women with COVID-19, 93 women (15.1 %; 95 %CI 12.3–18.1) had required oxygen therapy and 35 others (5.7 %; 95 %CI 4.0–7.8) had had a critical form of COVID-19. The severity of the disease was associated with age older than 35 years and obesity, as well as preexisting diabetes, previous preeclampsia, and gestational hypertension or preeclampsia. One woman with critical COVID-19 died (0.2 %; 95 %CI 0−0.9). Among the women who gave birth, rates of preterm birth in women with non-severe, oxygen-requiring, and critical COVID-19 were 13/123 (10.6 %), 14/29 (48.3 %), and 23/29 (79.3 %) before 37 weeks and 3/123 (2.4 %), 4/29 (13.8 %), and 14/29 (48.3 %) before 32 weeks, respectively. One neonate (0.5 %; 95 %CI 0.01–2.9) in the critical group died from prematurity. Conclusion COVID-19 can be responsible for significant rates of severe acute, potentially deadly, respiratory distress syndromes. The most vulnerable pregnant women, those with comorbidities, may benefit particularly from prevention measures such as a lockdown.
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- 2020
28. Internal Version Compared With Pushing for Delivery of Cephalic Second Twins
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Loïc Sentilhes, Patrick Rozenberg, Victoire Pauphilet, François Goffinet, Christophe Vayssière, Gilles Kayem, Norbert Winer, Anne-Gaël Cordier, Marie-Victoire Senat, Thomas Schmitz, Philippe Deruelle, Elie Azria, Diane Korb, Aurélien Seco, Nicolas Sananès, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), 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), Service d'obstétrique-gynécologie [Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Physiopathologie des Adaptations Nutritionnelles (PhAN), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), and Université de Nantes (UN)-Université de Nantes (UN)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)
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Adult ,medicine.medical_specialty ,[SDV]Life Sciences [q-bio] ,Population ,Twins ,Gestational Age ,1ST ,03 medical and health sciences ,MORBIDITY ,0302 clinical medicine ,Breech presentation ,Pregnancy ,Infant Mortality ,medicine ,MANAGEMENT ,Humans ,030212 general & internal medicine ,MODE ,Prospective Studies ,education ,Prospective cohort study ,Breech Presentation ,education.field_of_study ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics ,NEONATAL-MORTALITY ,Cesarean Section ,Cephalic presentation ,VAGINAL DELIVERY ,CESAREAN DELIVERY ,Infant, Newborn ,Obstetrics and Gynecology ,Gestational age ,Infant ,medicine.disease ,Delivery, Obstetric ,3. Good health ,Quartile ,Relative risk ,Multivariate Analysis ,Pregnancy, Twin ,Regression Analysis ,Female ,France ,business - Abstract
International audience; OBJECTIVE: To assess neonatal morbidity and mortality according to whether cephalic second twins were born after internal version followed by total breech extraction or after instructions to push. We hypothesized that interval version would result in shorter intertwin delivery intervals and lower cesarean delivery rates for the second twin and therefore better neonatal outcomes. METHODS: These planned analyses of the JUMODA (JUmeaux MODe d'Accouchement) cohort, a national prospective population-based study of twin deliveries, examined births of cephalic second twins after vaginal birth of the first twin at or after 32 weeks of gestation. The internal version group of second twins born in breech presentation after obstetric maneuvers was compared with the pushing group, comprising those born in cephalic presentation. The primary outcome was a composite of neonatal morbidity and mortality. Multivariate modified Poisson regression models were used to control for potential confounders. RESULTS: Of 2,256 cephalic second twins, 487 (21.6%) were born in breech presentation after internal version and total breech extraction and 1,769 (78.4%) in cephalic presentation after pushing. Composite neonatal morbidity and mortality was not lower in the internal version (17/487 [3.5%]) compared with the pushing group (38/1,769 [2.1%]; adjusted relative risk [aRR] 1.73 [95% CI 0.98-3.05]), although median [quartile 1-quartile 3] intertwin delivery intervals were shorter (5 [4-8] vs 8 [5-12] minutes, P
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- 2020
29. Évolution du taux de césariennes à partir de 37 semaines d’aménorrhée parmi les nullipares ou comment évaluer la validité externe d’un essai randomisé nord-américain sur le déclenchement artificiel du travail
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P. Raynal, Patrick Rozenberg, T. Quibel, C. Bouyer, Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Centre Hospitalier de Versailles André Mignot (CHV), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), and Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)
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03 medical and health sciences ,030219 obstetrics & reproductive medicine ,0302 clinical medicine ,Reproductive Medicine ,[SDV]Life Sciences [q-bio] ,Obstetrics and Gynecology ,Cesarean delivery ,030212 general & internal medicine ,Nullipara Network ,[SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,Induction of labor ,Expectative management - Abstract
Resume Objectif Determiner le risque de cesarienne d’une nullipare a partir de 37 semaines d’amenorrhee (SA) lorsqu’une attitude expectative est envisagee. Materiel et methodes Etude prospective incluant toutes les nullipares ayant accouche d’une grossesse unique en presentation cephalique a un terme ≥ 37 SA au sein d’un reseau de perinatalite (MYPA), entre le 1er janvier 2017 et le 31 decembre 2017. Pour chaque semaine d’amenorrhee de 37 SA a 41 SA, le taux de cesarienne etait calcule en fonction du mode d’entree en travail (spontane ou declenchement artificiel). Le taux de cesarienne lie a une attitude expectative a un âge gestationnel donne etait calcule en prenant la population totale arrivant a cet âge, diminue du nombre des patientes ayant eu un declenchement artificiel du travail ou une cesarienne programmee avant travail a ce meme âge gestationnel. Resultats Parmi les 16 085 patientes ayant accouche dans le reseau a ≥ 24 SA, 5498 (34,1 %) etaient des nullipares avec grossesse unique accouchant ≥ 37SA en presentation cephalique. Le risque de cesarienne augmentait a partir de 40 SA, quel que soit le mode d’entree en travail : en cas de travail spontane, le taux de cesarienne etait stable autour de 11 % jusqu’a 39 SA, puis augmentait a 14,1 % a 40 SA et 20 % a partir de 41 SA ; en cas de declenchement artificiel du travail, le taux de cesarienne passait de 28 % a 39 SA a 40 % a 40 SA et a 38 % a partir de 41 SA. Le risque global de cesarienne lorsqu’une attitude expectative etait envisagee des 37 SA restait stable autour de 21 %. Conclusion Le risque de cesarienne a partir de 37 SA d’une nullipare a bas risque geree par une attitude expectative au sein de ce reseau est proche de celui d’une patiente nullipare accouchant aux Etat-Unis.
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- 2020
30. Out-of-maternity deliveries in France: A nationwide population-based study
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Evelyne Combier, Jean-Louis Chabernaud, Patrick Rozenberg, Adrien Roussot, Catherine Quantin, Jonathan Cottenet, Service Biostatistiques et Informatique Médicale (CHU de Dijon) (DIM), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), AP-HP - Hôpital Antoine Béclère [Clamart], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Biostatistique, Biomathématique, Pharmacoépidémiologie et Maladies Infectieuses (B2PHI), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM), This study has received aid from the 'Direction Gérérale de la Santé' (DGS), the 'Caisse Nationale de l’Assurance Maladie des Travailleurs Salariés' (CNAMTS), and from the Inserm and the INSERM Plan Cancer, within the framework of the call for projects launched by the IRESP in 2014., Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), and Bodescot, Myriam
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Male ,Maternal Health ,Hypothermia ,Pathology and Laboratory Medicine ,Geographical locations ,Hematologic Cancers and Related Disorders ,Labor and Delivery ,0302 clinical medicine ,Pregnancy ,Risk Factors ,Infant Mortality ,Medicine and Health Sciences ,030212 general & internal medicine ,Generalized estimating equation ,Geographic Areas ,education.field_of_study ,030219 obstetrics & reproductive medicine ,Multidisciplinary ,Geography ,Obstetrics and Gynecology ,Hematology ,3. Good health ,Europe ,Maternal Mortality ,Oncology ,Medicine ,Female ,Maternal death ,France ,Stillbirths ,Research Article ,Urban Areas ,Adult ,medicine.medical_specialty ,Science ,Population ,Polycythemia ,Hospitals, Maternity ,[SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,03 medical and health sciences ,Signs and Symptoms ,Diagnostic Medicine ,medicine ,Humans ,European Union ,Management of High-Risk Pregnancies ,education ,Myeloproliferative Disorders ,business.industry ,Biology and Life Sciences ,Neonates ,Cancers and Neoplasms ,Infant ,Retrospective cohort study ,Delivery, Obstetric ,medicine.disease ,Health Surveys ,Infant mortality ,Population based study ,[SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,Emergency medicine ,Birth ,Earth Sciences ,Women's Health ,Observational study ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,People and places ,business ,Developmental Biology - Abstract
International audience; INTRODUCTION:In France, many maternity hospitals have been closed as a result of hospital restructuring in an effort to reduce costs through economies of scale. These closures have naturally increased the distance between home and the closest maternity ward for women throughout the country. However, studies have shown a positive correlation between this increase in distance and the incidence of unplanned out-of-maternity deliveries (OMD). This study was conducted to estimate the frequency of OMD in France, to identify the main risk factors and to assess their impact on maternal mortality and neonatal morbidity and mortality.MATERIALS AND METHODS:We conducted a population-based observational retrospective study using data from 2012 to 2014 obtained from the French hospital discharge database. We included 2,256,797 deliveries and 1,999,453 singleton newborns in mainland France, among which, 6,733 (3.0‰) were OMD. The adverse outcomes were maternal mortality in hospital or during transport, stillbirth, neonatal mortality, neonatal hospitalizations, and newborn hypothermia and polycythemia. The socio-residential environment was also included in the regression analysis. Maternal and newborn adverse outcomes associated with OMD were analyzed with Generalized Estimating Equations regressions.RESULTS:The distance to the nearest maternity unit was the main factor for OMD. OMD were associated with maternal death (aRR 6.5 [1.6-26.3]) and all of the neonatal adverse outcomes: stillbirth (3.3 [2.8-3.8]), neonatal death (1.9 [1.2-3.1]), neonatal hospitalization (1.2 [1.1-1.3]), newborn hypothermia (5.9 [5.2-6.6]) and newborn polycythemia (4.8 [3.5-6.4]).DISCUSSION:In France, OMD increased over the study period. OMD were associated with all the adverse outcomes studied for mothers and newborns. Caregivers, including emergency teams, need to be better prepared for the management these at-risk cases. Furthermore, the increase in adverse outcomes, and the additional generated costs, should be considered carefully by the relevant authorities before any decisions are made to close or merge existing maternity units.
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- 2020
31. Présentation du siège. Recommandations pour la pratique clinique du CNGOF — Introduction
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M.-V. Senat, Eric Verspyck, Thomas Schmitz, Loïc Sentilhes, Patrick Rozenberg, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Centre de recherche en épidémiologie et santé des populations (CESP), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)
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medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,business.industry ,General surgery ,[SDV]Life Sciences [q-bio] ,MEDLINE ,Obstetrics and Gynecology ,Clinical Practice ,03 medical and health sciences ,0302 clinical medicine ,Reproductive Medicine ,Breech presentation ,medicine ,030212 general & internal medicine ,business ,ComputingMilieux_MISCELLANEOUS - Abstract
International audience
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- 2020
32. Breech presentation: Clinical practice guidelines from the French College of Gynaecologists and Obstetricians (CNGOF)
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Patrick Rozenberg, Loïc Sentilhes, Diane Korb, Nicolas Sananès, Olivier Parant, Eric Verspyck, Marie-Victoire Senat, Sophie Baumann, Guillaume Ducarme, Aurélien Mattuizzi, Dennis Gallot, Elie Azria, Thomas Schmitz, CHU Bordeaux [Bordeaux], Hôpital Robert Debré, Hôpital Robert Debré-Centre Hospitalier Universitaire de Reims (CHU Reims), 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), 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), DHU Risques Et Grossesse, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, Retinoids, Development and Developmental Diseases (R2D2), Université d'Auvergne - Clermont-Ferrand I (UdA), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps (LEASP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Les Hôpitaux Universitaires de Strasbourg (HUS), Biomatériaux et Bioingénierie (BB), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Collège National des Sages-femmes de France, Partenaires INRAE, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), CHI Poissy-Saint-Germain, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Département de génétique [CHU Rouen] (Centre Normandie de Génomique et de Médecine Personnalisée), CHU Rouen, Normandie Université (NU)-Normandie Université (NU), The authors thank Ms. Joann Cahn for editorial assistance., CCSD, Accord Elsevier, 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), Centre National de la Recherche Scientifique (CNRS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, Hôpital Paule de Viguier, CHU Toulouse [Toulouse], Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Matériaux et nanosciences d'Alsace (FMNGE), Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Poissy-saint Germain, and Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)
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Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Breech presentation ,[SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,Trial of labor ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,medicine ,Rupture of membranes ,Humans ,030212 general & internal medicine ,Child ,Version, Fetal ,reproductive and urinary physiology ,Planned cesarean delivery ,030219 obstetrics & reproductive medicine ,Hysterectomy ,business.industry ,Vaginal delivery ,Obstetrics ,Infant, Newborn ,Obstetrics and Gynecology ,medicine.disease ,Delivery, Obstetric ,female genital diseases and pregnancy complications ,3. Good health ,Uterine rupture ,Planned vaginal delivery ,[SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,Reproductive Medicine ,Pelvimetry ,Gynecology ,Labor induction ,External cephalic version ,Female ,France ,business ,Maternal and neonatal morbidity - Abstract
International audience; Objective: To determine the optimal management of singleton fetuses in breech presentation. Materials and methods: Consultation of the PubMed database, the Cochrane Library and guidelines issued by the French and foreign obstetrical societies or colleges. Results: In France, 5% of women have breech deliveries (level of evidence [LE] 3). One third of them have a planned vaginal delivery (LE3), and 70% of these give birth vaginally (LE3). External cephalic version (ECV) is associated with lower rates of both breech presentation at birth (LE2) and of cesarean deliveries (LE3) without any increase in severe maternal (LE3) or perinatal morbidity (LE3). Women with a fetus in breech presentation at term should be informed that ECV can be attempted starting at 36 weeks of gestation (professional consensus). Planned vaginal delivery of breech presentation may be associated with a higher risk of composite perinatal mortality or serious neonatal morbidity than planned cesarean birth (LE2). These two modes do not differ for neurodevelopmental outcomes at two years (LE2), cognitive and psychomotor outcomes between 5 and 8 years (LE3), or adult intellectual performance (LE4). Short- and long-term maternal complications appear similar in the two groups, unless subsequent pregnancies are under consideration. Pregnancies after a cesarean delivery are at higher risk of uterine rupture, placenta accreta spectrum disorders, and hysterectomy (LE2). Women who want a planned vaginal delivery should be offered a pelvimetry at term (Grade C) and should have ultrasonography to verify that the fetal head is not hyperextended (professional consensus) to plan their mode of delivery. Complete breech presentation, a previous cesarean, nulliparity, and term prelabor rupture of membranes are not, each one by itself, per se contraindications to planned vaginal delivery (professional consensus). Term breech presentation is not a contraindication to labor induction when the criteria for planned vaginal delivery are met (Grade C). Conclusion: In cases of breech presentation at term, the child and the mother are at low risk of severe morbidity after either planned vaginal or planned cesarean delivery. The French College of Obstetricians and Gynecologists (CNGOF) considers that planned vaginal delivery is a reasonable option in most cases (professional consensus). The decision about the planned route of delivery should be shared by the woman and her healthcare provider, who must respect her right to autonomy.
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- 2020
33. Présentation du siège. Recommandations pour la pratique clinique du CNGOF – Texte court
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Thomas Schmitz, Loïc Sentilhes, Elie Azria, M.-V. Senat, Olivier Parant, Eric Verspyck, Guillaume Ducarme, Nicolas Sananès, Aurélien Mattuizzi, S. Baumann, Patrick Rozenberg, Diane Korb, Denis Gallot, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université de Bordeaux (UB), CHU Bordeaux [Bordeaux], AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de recherche et d'études en sciences sociales (CRESS) (EA 1334 - UMB), Centre hospitalier Saint-Joseph [Paris], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, Retinoids, Development and Developmental Diseases (R2D2), Université d'Auvergne - Clermont-Ferrand I (UdA), Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée), Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps (LEASP), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Les Hôpitaux Universitaires de Strasbourg (HUS), Biomatériaux et Bioingénierie (BB), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Collège National des Sages-femmes de France, Partenaires INRAE, Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy], Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Hôpital Bicêtre, Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), and CHU Rouen
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[SHS.SOCIO]Humanities and Social Sciences/Sociology ,030219 obstetrics & reproductive medicine ,[SDV]Life Sciences [q-bio] ,Obstetrics and Gynecology ,Breech presentation ,female genital diseases and pregnancy complications ,3. Good health ,Planned vaginal delivery ,03 medical and health sciences ,siège ,0302 clinical medicine ,tentative de voie basse ,Reproductive Medicine ,version par manœuvre externe ,External cephalic version ,morbidité maternelle et néonatale ,césarienne programmée ,030212 general & internal medicine ,Maternal and neonatal morbidity ,reproductive and urinary physiology ,Planned cesarean delivery - Abstract
International audience; Objectives. – To determine the optimal management of singleton breech presentation. Materials and methods. – The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. Results. – In France, 5% of women have breech deliveries (Level of Evidence [LE3]). One third of them have a planned vaginal delivery (LE3) of whom 70% deliver vaginally (LE3). External cephalic version (ECV) is associated with a reduced rate of breech presentation at birth (LE2), and with a lower rate of cesarean section (LE3) without increases in severe maternal (LE3) and perinatal morbidity (LE3). It is therefore recommended to inform women with a breech presentation at term that ECV could be attempted from 36 weeks of gestation (Professional consensus). In case of breech presentation, planned vaginal compared with planned cesarean delivery might be associated with an increased risk of composite perinatal mortality or serious neonatal morbidity (LE2). No difference has been found between planned vaginal and planned cesarean delivery for neurodevelopmental outcomes at two years (LE2), cognitive and psychomotor outcomes between 5 and 8 years (LE3), and adult intellectual performances (LE4). Short and long terms maternal complications appear similar in case of planned vaginal compared with planned cesarean delivery in the absence of subsequent pregnancies. A previous cesarean delivery results for subsequent pregnancies in higher risks of uterine rupture, placenta accreta spectrum and hysterectomy (LE2). It is recommended to offer women who wish a planned vaginal delivery a pelvimetry at term (Grade C) and to check the absence of hyperextension of the fetal head by ultrasonography (Professional consensus) to plan their mode of delivery. Complete breech presentation, previous cesarean, nulliparity, term prelabor rupture of membranes do not contraindicate planned vaginal delivery (Professionnal consensus). Term breech presentation is not a contraindication to labor induction when the criteria for acceptance of vaginal delivery are met (Grade C). Conclusion. – In case of breech presentation at term, the risks of severe morbidity for the child and the mother are low after both planned vaginal and planned cesarean delivery. For the French College of Obstetricians and Gynecologists (CNGOF), planned vaginal delivery is a reasonable option in most cases (Professional consensus). The choice of the planned route of delivery should be shared by the woman and her caregiver, respecting the right to woman's autonomy.; ObjectifDéterminer les modalités de prise en charge en cas de présentation du siège.Matériel et méthodesConsultation de la base de données MedLine, de la Cochrane Library et des recommandations des sociétés savantes françaises et étrangères.RésultatsEn France, 5 % des femmes accouchent d’un enfant en présentation du siège (NP3). Un tiers d’entre elles ont une tentative de voie basse (TVB) (NP3), et 70 % de ces dernières accouchent par voie basse (NP3). La tentative de version par manoeuvre externe (VME) est associée à une diminution du taux des présentations du siège à l’accouchement (NP2) et à une diminution du taux de césarienne (NP3) sans augmentation de la morbidité maternelle (NP3) et périnatale sévère (NP3). Il est recommandé d’informer les femmes ayant une présentation du siège de la possibilité de réaliser une tentative de VME à partir de 36 SA (Accord professionnel). En cas de présentation du siège à terme, la TVB pourrait être associée à une augmentation du risque composite de mortalité périnatale ou de survenue d’une morbidité néonatale sévère comparativement à la césarienne programmée (CP) (NP2). Il n’a pas été retrouvé de différence entre la TVB et la CP concernant le développement neurologique de l’enfant à 2 ans (NP2), le développement psychomoteur et cognitif entre 5 et 8 ans (NP3), et le niveau intellectuel à l’âge adulte (NP4). Les risques de complications maternelles sévères à court et à long terme semblent comparables après une TVB et une CP en l’absence de grossesse ultérieure. En cas de grossesse ultérieure, l’antécédent de césarienne expose la femme à des complications sévères (placenta accreta, rupture utérine notamment). Il est recommandé de proposer aux femmes qui souhaitent une TVB à terme une pelvimétrie (Grade C) et de vérifier l’absence d’hyperextension de la tête fœtale (Accord professionnel) pour décider avec elles de leur voie d’accouchement. La présentation du siège complet, l’antécédent de césarienne, la nulliparité, la rupture des membranes à terme avant travail ne contre-indiquent pas la TVB (Accord professionnel). La présentation du siège à terme n’est pas une contre-indication à un déclenchement du travail lorsque les critères d’acceptation de la voie basse sont réunis (Grade C).ConclusionEn cas de présentation du siège à terme, les risques de complications sévères pour l’enfant et la mère sont faibles en cas de TVB ou de CP. Pour le Collège national des gynécologues et obstétriciens français, la TVB est une option raisonnable dans la majorité des cas (Accord professionnel). Le choix de la voie d’accouchement doit être partagé par la patiente et le médecin, en respectant le droit à l’autonomie de la patiente (Accord professionnel).
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- 2020
34. Risk of preterm birth in a twin pregnancy after an early-term birth in the preceding singleton pregnancy: a retrospective cohort study
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Patrick Rozenberg, Anne Rousseau, Iris Bitumba, Paul Berveiller, François Goffinet, Manon Rousseau, Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Service de Gynécologie et Obstétrique [Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
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Adult ,medicine.medical_specialty ,Term Birth ,[SDV]Life Sciences [q-bio] ,Population ,Gestational Age ,[SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics ,Logistic regression ,Body Mass Index ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Risk Factors ,medicine ,Humans ,030212 general & internal medicine ,Risk factor ,education ,Twin Pregnancy ,Retrospective Studies ,education.field_of_study ,030219 obstetrics & reproductive medicine ,subsequent twin pregnancy ,Obstetrics ,Singleton ,business.industry ,Obstetrics and Gynecology ,preterm birth ,Retrospective cohort study ,Odds ratio ,3. Good health ,previous singleton delivery ,late‐term ,Pregnancy, Twin ,Gestation ,Premature Birth ,Female ,France ,business ,Early‐term - Abstract
Objective To evaluate whether a history of spontaneous early-term birth (37+0 -38+6 weeks of gestation) in the previous singleton pregnancy is a risk factor for preterm birth (PTB) in a subsequent twin pregnancy. Design Retrospective cohort study. Settings Two French university hospitals (2006-2016). Population All women who delivered twins from 24+0 weeks after a preceding singleton pregnancy birth at 37+0 to 41+6 weeks. Methods Multivariate logistic regression analysis of association between twin PTB and a previous spontaneous singleton early-term birth. Main outcome measures Twin PTB rate before 37, 34 and 32 weeks of gestation. Results Among 618 twin pregnancies, 270 were born preterm, 92 of them with a preceding spontaneous singleton early-term birth. The univariate analysis showed a significantly higher risk of twin PTB before 37, 34 and 32 weeks among those 92 women compared with those with a full- or late-term birth in their previous singleton pregnancy. This association remained significant after logistic regression (odds ratio [OR] between 2.42 and 3.88). The secondary analysis, restricted to the twin pregnancies with spontaneous PTB found similar results, with a risk of PTB before 37, 34 and 32 weeks significantly higher among women with a previous spontaneous singleton early-term birth, including after logistic regression analysis (OR between 3.51 and 3.56). Conclusion A preceding spontaneous singleton early-term birth is a strong and easily identified risk factor for PTB in twin pregnancies. Tweetable abstract Spontaneous 'early-term' birth of a singleton is a significant risk factor for future preterm births in twin pregnancies.
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- 2019
35. Prédiction échographique du risque de rupture utérine après césarienne : LUSTrial, un essai randomisé pragmatique
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Emmanuel Simon, M. V. Senat, Yves Ville, Raoul Desbriere, Norbert Winer, Philippe Deruelle, Gilles Kayem, Groupe de recherche en obstétrique et gynécologie, Isabelle Boutron, and Patrick Rozenberg
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Gynecology ,medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,Lower uterine segment ,business.industry ,Obstetrics and Gynecology ,03 medical and health sciences ,0302 clinical medicine ,Reproductive Medicine ,medicine ,030212 general & internal medicine ,Cesarean delivery ,Ultrasonography ,business ,Uterine Dehiscence - Abstract
Resume Contexte En cas d’antecedent de cesarienne, la pauvrete des donnees de haut niveau scientifique empeche la quantification precise des risques et des benefices qui pourraient aider cliniciens et patientes a prendre une decision eclairee sur la tentative de voie basse ou la cesarienne elective iterative. Une voie de recherche interessante consiste a evaluer les benefices potentiels d’une regle de decision integrant les donnees de l’echographie du segment inferieur cicatriciel. En effet, l’echographie peut etre utile pour determiner le risque specifique d’une patiente en mesurant l’epaisseur du segment inferieur de l’uterus, c’est-a-dire, l’epaisseur de la zone sur laquelle siege la cicatrice de cesarienne. Bien que les etudes publiees soient le plus souvent de petite taille, elles sont encourageantes car leurs resultats sont tous concordants : les mesures echographiques de l’epaisseur du segment inferieur sont fortement correlees aux constatations peroperatoires lors de la realisation de la cesarienne. En outre, plus le segment inferieur est mince en echographie, plus la probabilite d’un defect du segment inferieur est elevee. Finalement, l’evaluation echographique du segment inferieur a une excellente valeur predictive negative sur le risque de defect de la cicatrice uterine. C’est pourquoi, cet examen associe a une regle de decision pourrait aider a diminuer le taux de cesariennes electives iteratives et surtout diminuer la mortalite et la morbidite fœtale et maternelle liee a tentative de voie basse parmi les patientes ayant un antecedent de cesarienne. Methodes/conception de l’etude Il s’agit d’un essai pragmatique randomise, controle, multicentrique, ouvert, en deux bras paralleles. La randomisation sera centralisee et informatisee. L’aveugle etant impossible, un comite d’adjudication evaluera les elements constitutifs du critere de jugement principal afin d’eviter les biais d’evaluation. Une analyse intermediaire sera planifiee a mi-effectifs de l’essai. Les echographies seront realisees par des echographistes experts apres certification par l’investigateur principal. Seront incluses dans le protocole les patientes âgees de 18 ans et plus presentant une grossesse unique, une presentation cephalique, un âge gestationnel compris entre 36+0 et 38+6 SA, un antecedent de cesarienne segmentaire, et ayant signe le consentement eclaire. Entre 36+0 et 38+6 SA, les patientes seront invitees a participer a l’etude et seront randomises dans deux groupes : dans le bras experimental, la mesure echographique de l’epaisseur du segment inferieur sera realisee et la patiente sera informee qu’en cas de mesure superieure au seuil de 3,5 mm, elle sera consideree « a bas risque » de complications et sera encouragee a tenter une epreuve du travail alors qu’en cas de mesure inferieure ou egale au seuil de 3,5 mm, elle sera consideree « a risque » de complications et sera encouragee a accoucher par cesarienne elective iterative ; dans le bras controle, la mesure echographique du segment inferieur ne sera pas realisee. Le mode d’accouchement sera decide selon la pratique habituelle. Le critere de jugement principal sera composite incluant rupture uterine, dehiscence uterine, hysterectomie, complications thromboemboliques, transfusion, endometrite, mortalite maternelle, mortalite fœtale antepartum et intrapartum, encephalopathie hypoxique ischemique, et mortalite neonatale. Discussion Cet essai evalue l’utilite clinique de l’echographie du segment inferieur parmi les patientes ayant un antecedent de cesarienne pour reduire la morbidite et la mortalite fœtale et maternelle et fournira des preuves afin d’etablir des recommandations cliniques. Enregistrement de l’essai Identifiant ClinicalTrials.gov : NCT01916044 (date d’inscription : 5 aout 2013).
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- 2018
36. Quels sont l’objectif réel et la portée du dépistage des aneuploïdies ?
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Thibault Quibel and Patrick Rozenberg
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Down syndrome ,medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics ,Genetic counseling ,Cytogenetics ,Obstetrics and Gynecology ,Aneuploidy ,Prenatal diagnosis ,medicine.disease ,3. Good health ,03 medical and health sciences ,0302 clinical medicine ,Reproductive Medicine ,medicine ,030212 general & internal medicine ,False positive rate ,Trisomy ,Risk assessment ,business - Abstract
In France, the recommended method for Down syndrome screening is the first trimester combined test, the risk assessment, based on maternal age, ultrasound measurement of fetal nuchal translucency and maternal serum markers (free β-hCG and PAPP-A). The Down syndrome detection rate is 78.7% at a screen positive rate of 5%. However, the best screening test is the integrated test using a combination of first trimester combined test and second trimester quadruple test (serum α-fetoprotein, human chorionic gonadotropin, unconjugated E3, and dimeric inhibin-A) and being able to achieve a detection rate for Down syndrome of approximately 96% at a screen-positive rate of 5%. In recent years, the isolation of small fragments of "fetal" cell-free DNA in the maternal blood dramatically changed the screening strategy paradigm allowing a Down syndrome detection rate and false positive rate of 99.2 and 0.09%, respectively. However, aneuploidy screening based on cell-free DNA presents two major limitations which must be taken into account because they considerably limit its benefit: (i) not every woman will receive an interpretable result and that those who fail to receive a result are at increased risk for fetal aneuploidy: whether an inconclusive result is treated as screen positive or screen negative affects the overall detection rate (sensitivity) and false-positive rate (specificity) of the test; (ii) the limited number of targeted aneuploidies (trisomies 21, 18, 13 and common sex chromosome aneuploidies) in contrast to conventional noninvasive screening which is also able to detect rare aneuploidies, duplications, deletions, and other structural rearrangements. Of course, genetic counseling has to include a discussion about benefits and limitations of aneuploidy screening based on cell-free DNA. However, it should not be considered as a new screening test to substitute for conventional noninvasive screening. Moreover, if the ultimate goal is to deliver the most information about potential risk of various chromosomal abnormalities associated with adverse perinatal outcomes, then current cell-free DNA screening strategies may not be the best approach. These data highlight the limitations of cell-free DNA screening and the importance of a clear and fair information during pretest genetic counseling about benefits and limitations of any prenatal noninvasive screening (whether conventional or by cell-free DNA), but also about risks and benefits of invasive diagnostic procedures (in first- or second-line), especially since the cytogenetic analysis with chromosomal microarray analysis has improved the detection of genome microdeletions and microduplications (variants of the copy number) that can not be detected by standard cytogenetic analysis.
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- 2018
37. Recommandations pour la pratique clinique : prévention de la prématurité spontanée et de ses conséquences (hors rupture des membranes) — Texte des recommandations (texte court)
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Nicolas Mottet, Stéphane Marret, Thomas Schmitz, Chantal Ducroux-Schouwey, Florence Bretelle, S Brun, Muriel Doret, Julie Blanc, Bruno Langer, M. V. Senat, Anne Evrard, Pierre-Yves Ancel, S. Paysant, Didier Riethmuller, Gilles Kayem, Guillaume Benoist, Patrick Rozenberg, Elie Azria, Louis Marcellin, Emeline Maisonneuve, Héloïse Torchin, Loïc Sentilhes, G. Brabant, Service de gynécologie-obstétrique, CHU d'Angers, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Service de gynécologie-obstétrique, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 (UPD7), Hôpital Ambroise Paré, Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL), Association d'usagers, Collectif interassociatif autour de la naissance (CIANE), Paris, France, Service de Gynécologie-Obstétrique, Hôpital Louis-Mourier, AP-HP, 92701 Colombes, France., Hopital Louis Mourier - AP-HP [Colombes], Team 4 'NeoVasc' - INSERM U1245, Génomique et Médecine Personnalisée du Cancer et des Maladies Neuropsychiatriques (GPMCND), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département d'urologie, Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Université de Franche-Comté (UFC), Unité de pathologie cellulaire et génétique (UPCG), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Hôpital Ambroise Paré [AP-HP], Assistance Publique - Hôpitaux de Marseille (APHM), Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Team 4 NeoVasc - Region Team ERI 28 INSERM (Neovasc), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (UR 3181) (CEF2P / CARCINO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU), Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)
- Subjects
03 medical and health sciences ,030219 obstetrics & reproductive medicine ,0302 clinical medicine ,Reproductive Medicine ,[SDV]Life Sciences [q-bio] ,Maternity and Midwifery ,Obstetrics and Gynecology ,030212 general & internal medicine ,General Medicine ,ComputingMilieux_MISCELLANEOUS ,030217 neurology & neurosurgery ,3. Good health - Abstract
Resume Objectif Determiner les mesures permettant de prevenir la prematurite spontanee et ses consequences (hors rupture des membranes). Materiel et methodes Consultation de la base de donnees MedLine, de la Cochrane Library et des recommandations des societes savantes francaises et etrangeres. Resultats En France, 60 000 enfants (7,4 %) par an naissent avant 37 SA, dont la moitie survient apres un travail spontane. Parmi les facteurs de risque modifiables de prematurite spontanee, seul le sevrage tabagique est associe a une diminution de la prematurite (NP1). Ce sevrage est recommande (grade A). Le depistage systematique et le traitement de la vaginose bacterienne en population generale n’est pas recommande (grade A). Le traitement par progestatif est recommande uniquement pour les grossesses monofœtales asymptomatiques et sans antecedent d’accouchement premature presentant un col mesure a moins de 20 mm entre 16 et 24 SA (grade B). Un cerclage sur antecedent n’est pas recommande du fait du seul antecedent de conisation (grade C), de malformation uterine (accord professionnel), d’antecedent isole d’accouchement premature (grade B). Le cerclage n’est pas non plus recommande pour les grossesses gemellaires, en prevention primaire (grade B) ou secondaire (grade C). Il est recommande pour les femmes presentant une grossesse unique avec un antecedent d’au moins 3 FCT ou d’accouchement premature (grade A). En cas d’antecedent de FCT ou d’accouchement premature spontane avant 34 SA d’une grossesse monofœtale, il est recommande de realiser une surveillance echographique de la longueur cervicale entre 16 et 22 SA afin de proposer un cerclage en cas de col inferieur a 25 mm avant 24 SA (grade C). Il n’est pas recommande d’utiliser un pessaire pour la prevention de l’accouchement premature dans une population generale asymptomatique de grossesse gemellaire (grade A) et dans les populations asymptomatiques a col court (accord professionnel). Bien que la mise en œuvre d’un depistage echographique universel de la longueur du col parmi les grossesses monofœtales sans antecedent d’accouchement premature entre 18 et 24 SA puisse etre consideree par les praticiens individuellement, ce depistage ne peut pas etre recommande universellement (accord professionnel). En cas de menace d’accouchement premature, (i) il n’est pas recommande d’utiliser un outil plus qu’un autre (echographie du col, toucher vaginal ou fibronectine fœtale) pour predire l’accouchement premature (grade B) ; (ii) il est recommande de ne pas administrer systematiquement d’antibiotiques (grade A) ; (iii) l’hospitalisation prolongee (grade B) et le repos au lit strict (grade C) ne sont pas recommandes. Aucun tocolytique n’est associe a une diminution de la mortalite et de la morbidite neonatale par rapport au placebo (NP2) et tous les tocolytiques peuvent engendrer des effets indesirables graves (NP4). L’atosiban et la nifedipine (grade B) peuvent etre utilises a visee tocolytique mais plus les betamimetiques (grade C). Il est recommande de ne pas prescrire un traitement d’entretien a l’issue des 48 heures de la tocolyse initiale (grade A). L’administration antenatale d’une cure de corticoides est recommandee a toutes les patientes a risque d’accouchement premature avant 34 SA (grade A). Apres 34 SA, il n’existe pas d’arguments suffisants pour recommander l’administration systematique de corticoides antenatals (grade B), mais une cure pourra toutefois etre discutee dans les situations a haut risque de detresse respiratoire severe, en particulier en cas de cesarienne programmee (grade C). La strategie de repetition des cures de corticoides n’est pas recommandee (grade A). La cure de sauvetage ne peut pas etre recommandee (accord professionnel). L’administration antenatale de sulfate de magnesium intraveineux est recommandee en cas d’accouchement imminent avant 32 SA (grade A). La cesarienne systematique n’est pas recommandee en cas de presentation cephalique (accord professionnel). Il n’est pas recommande une voie d’accouchement plutot qu’une autre en cas de presentation du siege (accord professionnel). Si l’etat neonatal ou maternel le permet, un clampage du cordon retarde peut etre envisage (accord professionnel). Conclusion En dehors de l’administration antenatale des corticoides et du sulfate de magnesium, les outils diagnostiques ou traitements prenatals mis en œuvre depuis 30 ans afin de prevenir la prematurite et ses consequences n’ont pas ete a la hauteur des attentes des professionnels et des familles.
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- 2017
38. 769: Morbidity associated with planned cesarean sections performed prior to the scheduled date
- Author
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Laure Haller, Floriane Jochum, Patrick Rozenberg, Philippe Deruelle, Nicolas Sananès, and Bruno Langer
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medicine.medical_specialty ,business.industry ,General surgery ,Obstetrics and Gynecology ,Medicine ,business - Published
- 2020
39. Présentation du siège. Recommandations pour la pratique clinique du CNGOF – Méthode et organisation
- Author
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Patrick Rozenberg, Eric Verspyck, M.-V. Senat, Thomas Schmitz, and Loïc Sentilhes
- Subjects
Reproductive Medicine ,Obstetrics and Gynecology - Published
- 2020
40. Severe Acute Maternal Morbidity in Twin Compared With Singleton Pregnancies
- Author
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Aurélien Seco, Hugo Madar, Patrick Rozenberg, Catherine Deneux-Tharaux, Corinne Dupont, and François Goffinet
- Subjects
Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,macromolecular substances ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Risk Factors ,medicine ,Childbirth ,Humans ,Caesarean section ,030212 general & internal medicine ,education ,Twin Pregnancy ,education.field_of_study ,030219 obstetrics & reproductive medicine ,Obstetrics ,business.industry ,Cesarean Section ,Postpartum Hemorrhage ,Postpartum Period ,Obstetrics and Gynecology ,Odds ratio ,medicine.disease ,Pregnancy Complications ,Logistic Models ,Case-Control Studies ,Multivariate Analysis ,Pregnancy, Twin ,Gestation ,Female ,France ,Morbidity ,business ,Postpartum period ,Maternal Age - Abstract
Objective To investigate the association between twin pregnancy and severe acute maternal morbidity, overall and by timing (before, during or after delivery) and underlying causal condition. Methods We conducted a cohort-nested case-control analysis from the EPIMOMS prospective study conducted in six French regions from 2012-2013 (N=182,309 deliveries). The case group comprised 2,500 women with severe acute maternal morbidity (defined by a national expert consensus process) occurring from 22 weeks of gestation and up to 42 days postpartum. A random sample of 3,650 women who gave birth without severe acute maternal morbidity made up the control group. The association between twin pregnancy and severe acute maternal morbidity was analyzed with multilevel multivariable logistic regression. The role of cesarean delivery as an intermediate factor between twin pregnancy and severe acute maternal morbidity was assessed by path analysis. Results The population-based incidence of severe acute maternal morbidity was 6.2% (n=197/3,202, 95% CI 5.3-7.1) in twin pregnancies, and 1.3% (n=2,303/179,107, 95% CI 1.2-1.3) in singleton pregnancies. After controlling for confounders, the risk of severe acute maternal morbidity was higher in twin than in singleton pregnancies (adjusted odds ratio [OR] 4.2, 95% CI 3.1-5.8), both antepartum and intrapartum or postpartum, and regardless of the category of causal condition (severe hemorrhage, severe hypertensive complications, or other conditions). The association was also found for the most severe near-miss cases (adjusted OR 5.1, 95% CI 3.5-7.3). In path analysis, cesarean delivery mediated 20.6% (95% CI 12.9-28.2) of the total risk of intrapartum or postpartum severe acute maternal morbidity associated with twin pregnancy. Conclusion Compared with women with singleton pregnancies, women with twin pregnancies have a fourfold increased risk for severe maternal complications both before and after delivery. About one fifth of the association between twin pregnancy and intrapartum or postpartum severe acute maternal morbidity may be mediated by cesarean delivery.
- Published
- 2019
41. Cesarean delivery rate and staffing levels of the maternity unit
- Author
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Saad Zbiri, Carine Milcent, Patrick Rozenberg, François Goffinet, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Service de Gynécologie et Obstétrique [Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), 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 / UMR_S_1153)), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Cochin [AP-HP], Université Paris Descartes - Paris 5 (UPD5), Paris-Jourdan Sciences Economiques (PJSE), École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École des hautes études en sciences sociales (EHESS)-École des Ponts ParisTech (ENPC)-Centre National de la Recherche Scientifique (CNRS), Paris School of Economics (PSE), École des Ponts ParisTech (ENPC)-École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Paris 1 Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)-École des hautes études en sciences sociales (EHESS)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Service de Gynécologie-Obstétrique [Poissy], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP], CHU Cochin [AP-HP], Centre National de la Recherche Scientifique (CNRS)-École des Ponts ParisTech (ENPC)-École des hautes études en sciences sociales (EHESS)-École normale supérieure - Paris (ENS Paris), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC), and École normale supérieure - Paris (ENS Paris)-École des hautes études en sciences sociales (EHESS)-École des Ponts ParisTech (ENPC)-Centre National de la Recherche Scientifique (CNRS)
- Subjects
Medical Doctors ,Maternal Health ,Health Care Providers ,Pediatrics ,Midwives ,Labor and Delivery ,0302 clinical medicine ,Mathematical and Statistical Techniques ,Pregnancy ,Obstetric Nursing ,Elective Cesarean Delivery ,Medicine and Health Sciences ,030212 general & internal medicine ,Medical Personnel ,Obstetric nursing ,reproductive and urinary physiology ,education.field_of_study ,030219 obstetrics & reproductive medicine ,Multidisciplinary ,Obstetrics ,Statistics ,Obstetrics and Gynecology ,[SHS.ECO]Humanities and Social Sciences/Economics and Finance ,female genital diseases and pregnancy complications ,3. Good health ,Professions ,Obstetric Procedures ,Physical Sciences ,Medicine ,Female ,Bivariate Analysis ,Research Article ,Adult ,medicine.medical_specialty ,Science ,Population ,Staffing ,Personnel Staffing and Scheduling ,Surgical and Invasive Medical Procedures ,Midwifery ,Research and Analysis Methods ,03 medical and health sciences ,Physicians ,medicine ,Humans ,Maternal Health Services ,Statistical Methods ,education ,Retrospective Studies ,business.industry ,Cesarean Section ,Retrospective cohort study ,Odds ratio ,Models, Theoretical ,medicine.disease ,Confidence interval ,Health Care ,People and Places ,Multivariate Analysis ,Birth ,Women's Health ,Population Groupings ,Neonatology ,business ,Mathematics - Abstract
ObjectiveTo investigate whether staffing levels of maternity units affect prelabor urgent, elective, and intrapartum cesarean delivery rates.MethodsThis population-based retrospective cohort study covers the deliveries of the 11 hospitals of a French perinatal network in 2008-2014 (N = 102 236). The independent variables were women's demographic and medical characteristics as well as the type, organization, and staffing levels for obstetricians, anesthesiologists, and midwives of each maternity unit. Bivariate and multivariate analyses were conducted with multilevel logistic models.ResultsOverall, 23.9% of the women had cesarean deliveries (2.4% urgent before labor, 10% elective, and 11.5% intrapartum). Independently of individual- and hospital-level factors, the level of obstetricians, measured by the number of full-time equivalent persons (i.e., 35 working hours per week) per 100 deliveries, was negatively associated with intrapartum cesarean delivery (adjusted odds ratio, aOR 0.55, 95% confidence interval, CI 0.36-0.83, P-value = 0.005), and the level of midwives negatively associated with elective cesarean delivery (aOR 0.79, 95% CI 0.69-0.90, P-value < 0.001). Accordingly, a 10% increase in obstetrician and midwife staff levels, respectively, would have been associated with a decrease in the likelihood of intrapartum cesarean delivery by 2.5 percentage points and that of elective cesarean delivery by 3.4 percentage points. These changes represent decreases in intrapartum and elective cesarean delivery rates of 19% (from 13.1% to 10.6%) and 33% (from 10.3% to 6.9%), respectively.ConclusionStaffing levels of maternity units affect the use of cesarean deliveries. High staffing levels for obstetricians and midwives are associated with lower cesarean rates.
- Published
- 2018
42. 1 Tranexamic acid for the prevention of postpartum hemorrhage after cesarean delivery: the TRAAP2 trial
- Author
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Loïc Sentilhes, null Marie-Victoire senat, Maëla Le Lous, Norbert Winer, Patrick Rozenberg, Gilles Kayem, Eric Verspyck, Florent Fuchs, Elie AZRIA, Denis Gallot, Diane Korb, Raoul Desbriere, Camille Le Ray, Céline Chauleur, Fanny De Marcillac, Franck Perrotin, Olivier Parant, Laurent Salomon, Emilie Gauchotte, Florence Bretelle, Antoine Benard, Aurore Georget, Astrid Darsonval, and Catherine Deneux-Tharaux
- Subjects
Obstetrics and Gynecology - Published
- 2021
43. 485 Efficacy of early versus late intrauterine balloon tamponade in the management of severe postpartum hemorrhage
- Author
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Alexandre J. Vivanti, Nicolas Sananès, Aurélien Seco, Bassam Haddad, Franck Perrotin, Pierre Raynal, Catherine Deneux-Tharaux, Marie-Victoire Senat, Christophe Vayssière, Raoul Desbriere, Gilles Kayem, Olivier Morel, Eric Verspyck, Patrick Rozenberg, Charles Garabedian, Denis Gallot, Loïc Sentilhes, Norbert Winer, Julie Blanc, and François Goffinet
- Subjects
medicine.medical_specialty ,business.industry ,Intrauterine balloon ,Obstetrics and Gynecology ,Medicine ,Tamponade ,business ,Surgery - Published
- 2021
44. Angle of fetal head progression measured using transperineal ultrasound as a predictive factor of vacuum extraction failure
- Author
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Mathieu Resche‐Rigon, Philippe Bouhanna, Thierry Bultez, Patrick Rozenberg, Thibaud Quibel, and Thomas Popowski
- Subjects
medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,business.industry ,Vacuum extraction ,Cephalic presentation ,Ultrasound ,Forceps ,technology, industry, and agriculture ,Obstetrics and Gynecology ,General Medicine ,Surgery ,body regions ,03 medical and health sciences ,surgical procedures, operative ,0302 clinical medicine ,Reproductive Medicine ,Interquartile range ,Medicine ,Gestation ,Radiology, Nuclear Medicine and imaging ,Fetal head ,030212 general & internal medicine ,Transperineal ultrasound ,business - Abstract
Objective To evaluate the predictive value of angle of progression (AoP) of the fetal head for a failed vacuum delivery. Methods This was a prospective observational study that included women with a singleton pregnancy of ≥ 37 weeks' gestation, in cephalic presentation requiring vacuum extraction. Transperineal ultrasound was performed immediately before vacuum extraction, although AoP was measured on stored images after delivery. Vacuum extraction was defined as failed when the duration of extraction exceeded 20 min or the vacuum cup detached more than three times. We compared the demographic and ultrasound data of failed vacuum deliveries with those that were successful. The predictive value of AoP for failure of vacuum delivery was calculated. Results AoP was measured in 235 women. Vacuum extractions failed in 30 (12.8%) women (29/184 nulliparous and 1/51 parous) and resulted in 28 vaginal deliveries by forceps and two Cesarean deliveries. Median AoP was significantly lower in the vacuum failure group compared with those with successful vacuum delivery (136.6° (interquartile range (IQR), 129.8–144.1°) vs 145.9° (IQR, 135.0–158.4°); P
- Published
- 2016
45. The performance of an intermediate 16th-week ultrasound scan for the follow-up of euploid fetuses with increased nuchal translucency
- Author
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Claire Colmant, P. Bouhanna, Thibaud Quibel, Patrick Rozenberg, and Maela Le Lous
- Subjects
Gynecology ,Pregnancy ,Fetus ,medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,business.industry ,Genitourinary system ,Obstetrics ,Genetic counseling ,Ultrasound ,Obstetrics and Gynecology ,Diaphragmatic breathing ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Gestation ,030212 general & internal medicine ,business ,Increased nuchal translucency ,Genetics (clinical) - Abstract
OBJECTIVE The objective of the study is to assess the utility of an intermediate ultrasound scan at 16(+0) to 18(+6) weeks of gestation in euploid fetuses with increased nuchal translucency ≥ 3.5 mm. METHODS Three hundred eighty-nine fetuses with nuchal translucency (NT) ≥ 3.5 mm were identified in two prenatal centers between January 2008 and December 2012. Pregnancy work-up included karyotyping, monthly detailed ultrasound scan starting with a 16th-week scan, a cardioechography, and a genetic counseling. Abnormal findings and pregnancy outcomes were analyzed retrospectively. RESULTS Of the 389 fetuses included, 52% had normal karyotype. Among euploid fetuses, 51 (30.7%) structural defects were identified overall. First-trimester scan was useful to identify 16 of the major defects (31.3%), and the 16th-week scan was useful to identify an additional 21 of them (41.2%), whereas the 22nd-week pregnancy scan discovered an additional 14 (27.4%). Structural defects discovered with the 16th-week scan were cardiac defects (n = 7), polymalformative syndromes (n = 3), left diaphragmatic hernias (n = 3), limbs abnormalities (n = 2), genitourinary (n = 2), microretrognathism (n = 2), hydrops (n = 1), and exomphalos (n = 1). If the intermediate scan was normal, the chances of a favorable outcome were as high as 85% and were close to 100% after 20 weeks, irrespective of initial NT. CONCLUSION The intermediate ultrasound was useful in fetuses with increased NT pregnancy work-up.
- Published
- 2015
46. 1: Lower uterine segment ultrasound measurement for deciding about TOLAC: a randomized clinical trial
- Author
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Gilles Kayem, Marie-Victoire Senat, Emmanuel Simon, Isabelle Boutron, Yves Ville, Patrick Rozenberg, Philippe Deruelle, Raoul Desbriere, and Norbert Winer
- Subjects
medicine.medical_specialty ,Lower uterine segment ,Randomized controlled trial ,law ,business.industry ,Ultrasound ,medicine ,Obstetrics and Gynecology ,business ,Surgery ,law.invention - Published
- 2020
47. Predictors of preterm birth
- Author
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Yves Ville and Patrick Rozenberg
- Subjects
medicine.medical_specialty ,Fetal Membranes, Premature Rupture ,Gestational Age ,Cervix Uteri ,Asymptomatic ,03 medical and health sciences ,0302 clinical medicine ,CLs upper limits ,Pregnancy ,Risk Factors ,Medicine ,Humans ,Mass Screening ,030212 general & internal medicine ,Prospective Studies ,Cervical length ,Randomized Controlled Trials as Topic ,030219 obstetrics & reproductive medicine ,Fetal fibronectin ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,Transvaginal ultrasound ,In utero ,Cervical Length Measurement ,Premature Birth ,Infectious risk ,Female ,medicine.symptom ,business ,Premature rupture of membranes ,Biomarkers - Abstract
Cervical length (CL) measured by transvaginal ultrasound examination (TVUE) best identifies the risk for preterm birth (PTB). It identifies women at risk who can benefit from corticosteroids or in utero transfer. Early screening improves effectiveness of tocolysis. It reduces iatrogenicity and cost. In preterm premature rupture of membranes (PPROM), CL is devoid of infectious risk and predicts duration of the latency phase but not the risk of perinatal sepsis. Asymptomatic women at risk should be screened at a 2-week interval starting from 16 to 18 weeks, up to 24 weeks. CLs10th centile are at risk of PTB, especially with decrease in CL after 16 weeks. Repeat ultrasound improves predictive values. Stable CL calls for term delivery. Funneling does not improve predictivity of CL. In twin pregnancies, CL reduces unnecessary interventions. In symptomatic women, fetal fibronectin performs less than CL. Its combination with inconclusive CL has not emerged productive through randomized controlled trials (RCTs), and studies with homogeneous management for preterm labor (PTL) suggest that up to 15% of unjustified hospitalizations and treatment could be avoided.
- Published
- 2018
48. Intrauterine balloon tamponade for severe postpartum hemorrhage
- Author
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Mathilde Revert, Patrick Rozenberg, Catherine Quantin, Jonathan Cottenet, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Service Biostatistiques et Informatique Médicale (CHU de Dijon) (DIM), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), and Supported by a research grant from the Département de la Recherche Clinique et du Développement, Assistance Publique–Hôpitaux de Paris.
- Subjects
Adult ,medicine.medical_specialty ,Balloon tamponade ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,Population ,Gestational Age ,Pilot Projects ,Risk Assessment ,Severity of Illness Index ,Cohort Studies ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Humans ,Medicine ,030212 general & internal medicine ,education ,Retrospective Studies ,Uterine Balloon Tamponade ,education.field_of_study ,030219 obstetrics & reproductive medicine ,Hysterectomy ,business.industry ,Obstetrics ,Vaginal delivery ,Postpartum Hemorrhage ,Obstetrics and Gynecology ,Gestational age ,Retrospective cohort study ,Odds ratio ,Uterine Artery Embolization ,Delivery, Obstetric ,3. Good health ,Survival Rate ,Treatment Outcome ,Female ,France ,Tamponade ,business ,Follow-Up Studies ,Maternal Age - Abstract
International audience; OBJECTIVE:To compare the rates of invasive procedures (surgical or vascular) for hemorrhage control between a perinatal network that routinely used intrauterine balloon tamponade and another perinatal network that did not in postpartum hemorrhage management.METHODS:This population-based retrospective cohort study included all women (72,529) delivering between 2011 and 2012 in the 19 maternity units in two French perinatal networks: a pilot (in which balloon tamponade was used) and a control network. Outcomes were assessed based on discharge abstract data from the national French medical information system. General and obstetric characteristics were included in two separate multivariate logistic models according to the mode of delivery (vaginal and cesarean) to estimate the independent association of the network with invasive procedures.RESULTS:Invasive procedures (pelvic vessel ligation, arterial embolization, hysterectomy) were used in 298 women and in 4.1 per 1,000 deliveries (95% CI 3.7-4.6). The proportion of women with at least one invasive procedure was significantly lower in the pilot network (3.0/1,000 vs 5.1/1,000, P
- Published
- 2018
49. Reply
- Author
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Claire Thuillier and Patrick Rozenberg
- Subjects
medicine.medical_specialty ,Labor, Obstetric ,Pregnancy ,business.industry ,Family medicine ,medicine ,Obstetrics and Gynecology ,Female ,business - Published
- 2019
50. 358: Management of monoamniotic twin pregnancies: Retrospective multicenter study of 221 cases
- Author
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Didier Riethmuller, Vincent Dochez, Anne Sophie Riteau, Fleur Lorton, Thibault Thubert, Chloé Arthuis, Cyril Flamant, Louise Cariou de Vergie, Patrick Rozenberg, François Goffinet, Laure Maillet Dumas, and Norbert Winer
- Subjects
Pediatrics ,medicine.medical_specialty ,Multicenter study ,business.industry ,Obstetrics and Gynecology ,Medicine ,business - Published
- 2019
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