220 results on '"G, Ducarme"'
Search Results
2. Consensus formalisé d’experts du Collège national des gynécologues et obstétriciens français : prise en charge des nausées et vomissements gravidiques et de l’hyperémèse gravidique
- Author
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P. Deruelle, L. Sentilhes, L. Ghesquière, R. Desbrière, G. Ducarme, L. Attali, A. Jarnoux, F. Artzner, A. Tranchant, T. Schmitz, and M.-V. Sénat
- Subjects
Reproductive Medicine ,Obstetrics and Gynecology - Published
- 2022
3. Recommandations pour la pratique clinique : grossesses après chirurgie bariatrique – Groupe BARIA-MAT
- Author
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G. Gascoin, C. Ciangura, C. Canale, V. Castera, M. Coupaye, R. Coutant, P. Deruelle, T. Dupré, D. Calabrese, E. Cosson, G. Ducarme, B. Gaborit, A.S. Joly, H. Johanet, B. Lelièvre, L. Mandelbrot, N. Petrucciani, M. Pigeyre, D. Quilliot, P. Ritz, G. Robin, B. Rochereau, A. Sallé, V. Taillard, J. Gugenheim, and J. Nizard
- Published
- 2019
4. Quelle alternative est à préférer en cas d’échec de maturation cervicale par dinoprostone vaginale chez les femmes à terme ?
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I. Pradeau, L. Planche, N. Winer, and G. Ducarme
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Reproductive Medicine ,Obstetrics and Gynecology - Published
- 2022
5. 275 Long-term impact of puerperal hematoma on sexuality and obstetrical prognosis: A retrospective cohort study
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G. Anfray, E. Misbert, G. Ducarme, N. Winer, and T. Thubert
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Reproductive Medicine ,Obstetrics and Gynecology - Published
- 2022
6. [Screening and management of endometriosis by primary care physicians]
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G, Ducarme, L, Planche, and A, Lebœuf
- Subjects
Adult ,Gynecology ,Surveys and Questionnaires ,Endometriosis ,Humans ,Mass Screening ,Female ,Middle Aged ,Referral and Consultation ,Physicians, Primary Care - Abstract
Analyze knowledge and practices of general practitioners concerning the screening and treatment of endometriosis in primary care.Observational study carried out with general practitioners in a healthcare area using an anonymous online questionnaire about symptoms, screening and their management of endometriosis. Responses were analyzed according to the general practitioners' sex, age and practice in gynecology.Sixty-nine general practitioners (69/458 ; 15.1%) responded. Women (18.4% vs. 9.7% : P=0.02), between 40 and 59 years old (26.5% vs. 0 ; P0.01), with additional training in gynecology (27.2% vs. 3.0%; P0.01) had significant activity in gynecology. Typical symptoms of endometriosis were experienced by 76.8% general practitioners, but only 36% "often" or "always" referred to endometriosis when faced with these symptoms. Additional training in gynecology, mostly carried out by women, between 40 and 59 years old, had a positive impact on the evocation of endometriosis in the face of these symptoms. If endometriosis was suspected, 72.5% GPs immediately ordered pelvic ultrasound and 85.5% for analgesics, but 42% referred the woman to a gynecologist.The general practitioner has a key role in the screening and initial management of endometriosis in primary care. The practice and continuing education of general practitioners in gynecology has a significant impact in improving the screening and initial management of endometriosis.
- Published
- 2020
7. Hyperémèse gravidique : vécu de l’hospitalisation
- Author
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G. Ducarme, C. Ceccaldi, A.S. Charles, and M. Auclair
- Subjects
03 medical and health sciences ,030219 obstetrics & reproductive medicine ,0302 clinical medicine ,Maternity and Midwifery ,030212 general & internal medicine - Abstract
Resume Objectifs L’objectif de cette etude etait de connaitre le vecu des femmes en cas d’hospitalisation pour hyperemese gravidique (HG) au 1 er trimestre de grossesse. Materiel et methodes Nous avons realise une etude retrospective incluant les patientes ayant ete hospitalisees pour HG entre mars 2015 et octobre 2015. Des entretiens semi-diriges ont ete realises par telephone dans les deux a cinq mois qui suivaient l’hospitalisation. Resultats Les dix patientes incluses ont ete soulagees par les perfusions de rehydratation, quatre ont constate un arret des vomissements. Huit patientes ont ete satisfaites du jeune et de la reprise alimentaire. La presence des soignants est decrite comme tres rassurante. Le repos est considere comme efficace par huit patientes. L’isolement strict est vecu comme inutile par deux patientes, comme aggravant par trois patientes les conduisant a une sortie prematuree. Conclusion Cette etude a montre que les traitements medicamenteux ont ete moyennement satisfaisants, que l’isolement, selon sa stricte application, etait soit soutenant soit deletere, et que les soignants avaient un role cle dans le soutien de ces femmes presentant une angoisse importante.
- Published
- 2017
8. [Breech Presentation: CNGOF Guidelines for Clinical Practice - Short Text]
- Author
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L, Sentilhes, T, Schmitz, E, Azria, D, Gallot, G, Ducarme, D, Korb, A, Mattuizzi, O, Parant, N, Sananès, S, Baumann, P, Rozenberg, M-V, Senat, and É, Verspyck
- Subjects
Obstetrics ,PubMed ,Cesarean Section ,Gynecology ,Pregnancy ,Risk Factors ,Humans ,Female ,Gestational Age ,France ,Breech Presentation ,Delivery, Obstetric ,Version, Fetal - Abstract
To determine the optimal management of singleton breech presentation.The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted.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 term 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).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.
- Published
- 2019
9. [Breech Presentation: CNGOF Guidelines for Clinical Practice - External Cephalic Version and other Interventions to turn Breech Babies to Cephalic Presentation]
- Author
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G, Ducarme
- Subjects
Cesarean Section ,MEDLINE ,Gestational Age ,Delivery, Obstetric ,Risk Assessment ,Obstetrics ,Meta-Analysis as Topic ,Gynecology ,Pregnancy ,Humans ,Female ,France ,Breech Presentation ,Version, Fetal - Abstract
To provide guidelines regarding efficiency and safety of external cephalic version (ECV) attempt and alternatives methods to turn breech babies to cephalic presentation.MedLine and Cochrane Library databases search in French and English and review of the main foreign guidelines between 1980 and 2019.ECV is associated with a decreasing rate of breech presentation at birth (LE2), and potentially with a lower rate of cesarean section (LE3) without an increase of severe maternal (LE3) and perinatal morbidity (LE3). It is therefore recommended to inform women with a breech presentation at term that ECV should be attempt (Professional consensus). ECV attempt should be performed with immediate access to an operating room for emergency cesarean (Professional consensus). The ECV attempt before 37 weeks, compared to ECV attempt after 37 weeks, increases the rate of cephalic presentation at birth (LE2) but with a small increase risk of moderate prematurity (LE2). ECV attempt should be performed from 36SA (Professional consensus). The main factors associated with successful ECV attempt are multiparity (LE3) and no maternal obesity (LE3). Parenteral tocolysis (β mimetic or atosiban), for ECV attempt at term is associated with a higher success rate (LE2), higher rate of achieved cephalic presentation in labor (LE2) and a lower cesarean section rate (LE2). It is recommended to use parenteral tocolysis for ECV attempt at term in order to increase its success rate (grade B). The ECV attempt is associated with an increase in transient FHR abnormalities (LE3), it is therefore recommended that cardiotocography should be performed prior and during 30minutes after the procedure (Professional consensus). There is no argument for recommending the practice of delayed cardiotocography after ECV attempt (Professional consensus). The risk of significant positivity (30mL) of the Kleihauer test after ECV attempt is low (0.1%) (LE3), it is not recommended to systematically perform a Kleihauer test after ECV attempt (professional consensus). In case of RH-1 negative women, it is recommended to ensure systematic RH-1 prophylaxis (Professional consensus). In case of breech presentation at term, acupuncture, moxibustion and postural methods are not effective in reducing breech presentation at birth (LE2), and are therefore not recommended (Grade B).According to the clear benefits and the low risks of ECV attempt, all women with a breech presentation at term should be informed that ECV should be attempted to decrease breech presentation at birth and cesarean section.
- Published
- 2019
10. Hepatitis y embarazo
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G. Ducarme, M. Schnee, and V. Dochez
- Published
- 2016
11. Vómitos incoercibles durante el embarazo
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V. Dochez and G. Ducarme
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03 medical and health sciences ,030219 obstetrics & reproductive medicine ,0302 clinical medicine ,030212 general & internal medicine - Abstract
Los vomitos gravidicos, sintomas fisiologicos en el primer trimestre, constituyen un motivo frecuente de consulta y de hospitalizacion en sus formas incoercibles (hiperemesis gravidica). Complican el 0,3-3,6% de los embarazos y son la primera causa de hospitalizacion durante el primer trimestre del embarazo. Los vomitos incoercibles son responsables de perdida de peso (superior al 5% del peso inicial) con deshidratacion, cetoacidosis o hipopotasemia. En caso de desequilibrios graves, resulta obligado hospitalizar a la paciente para descartar un posible origen organico y tratar de modo eficaz los vomitos, con el fin de evitar una evolucion hacia la gravedad o, incluso, la muerte materna y/o fetal.
- Published
- 2016
12. [Perineal Prevention and Protection in Obstetrics: CNGOF Guidelines for Clinical Practice - Introduction, Objectives, Methods, Definitions, Organization and Limits]
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A C, Pizzoferrato, G, Ducarme, B, Jacquetin, and X, Fritel
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Obstetrics ,Episiotomy ,Pregnancy ,Practice Guidelines as Topic ,Anal Canal ,Humans ,Female ,France ,Delivery, Obstetric ,Perineum ,Fecal Incontinence - Published
- 2018
13. Facteurs prédictifs d’échec d’entrée en travail par dinoprostone en cas de grossesse prolongée et de conditions locales défavorables
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V. Chesnoy, L. Petit, and G. Ducarme
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Reproductive Medicine ,Obstetrics and Gynecology ,General Medicine - Abstract
Resume But Identifier des facteurs predictifs d’echec d’entree en travail dans les 24 heures suivant la pose d’un dispositif intravaginal a la dinoprostone en cas de grossesse prolongee avec conditions locales defavorables a l’aide d’une etude retrospective monocentrique. Patientes et methode Trois cent vingt-cinq patientes ayant eu un dispositif intravaginal a la dinoprostone pour une grossesse unique prolongee (> 41 semaines d’amenorrhee) et des conditions locales defavorables (score de Bishop er janvier 2011 et le 31 decembre 2012 ont ete incluses et reparties en 2 groupes : les patientes entrant en travail dans les 24 heures suivant la pose, defini par une dilatation cervicale superieure a 4 cm associee a des contractions uterines (groupe R ; n = 248 ; 76,3 %) et les patientes n’entrant pas en travail dans les 24 heures (groupe E ; n = 77 ; 23,7 %). Les caracteristiques maternelles et obstetricales de ces patientes ont alors ete comparees. Resultats Les facteurs predictifs d’echec d’entree en travail apres maturation etaient la nulliparite (74,0 versus 56,0 % ; OR = 2,23 ; IC95 % : 1,27–4,00 ; p = 0,005), un âge gestationnel ≤ 41 SA + 4 (53,2 versus 33,9 % ; OR = 2,22 ; IC95 % : 1,32–3,74 ; p = 0,003) et un antecedent de dilatation cervicale et curetage (27,3 versus 10,5 % ; OR = 3,19 ; IC95 % : 1,66–6,11 ; p = 0,0005). Le score de Bishop etait significativement plus eleve dans le groupe R (3,6 versus 1,9 ; p = 0,001). Parmi les differents items du score de Bishop, un col tonique (74,0 versus 44,4 % ; OR = 3,57 ; IC95 % : 2,04–6,40 ; p −5 ) et ferme (59,7 versus 23,0 % ; OR = 4,97 ; IC95 % : 2,89–8,56 ; p −6 ) etaient des facteurs predictifs d’echecs de maturation. Conclusion La nulliparite, un âge gestationnel ≤ 41 SA + 4, un antecedent de dilatation cervicale et curetage et le score de Bishop, en particulier un col tonique et ferme, semblent etre des facteurs predictifs d’echecs de maturation en cas de grossesse prolongee.
- Published
- 2015
14. [Double-balloon catheter compared to vaginal dinoprostone for cervical ripening in obese women at term]
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J, Grange, J, Dimet, M, Vital, A, Le Thuaut, and G, Ducarme
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Adult ,Dinoprostone ,Catheterization ,Pregnancy Complications ,Uterine Cervical Diseases ,Administration, Intravaginal ,Pregnancy ,Oxytocics ,Humans ,Female ,Labor, Induced ,Obesity ,Prospective Studies ,Cervical Ripening ,Retrospective Studies - Abstract
To compare the efficacy of a double-balloon catheter versus vaginal prostaglandin E2 (dinoprostone) for cervical ripening in obese patients with unfavorable cervix at term.The study had an open-label, prospective combined with retrospective, observational design. From January 2013 until May 2016, a prospective cohort study of 46 women with pre-pregnancy BMI30kg/mAfter 24h, there was a significantly higher rate of women with favorable cervix (Bishop score ≥6) in the double-balloon group than in dinoprostone group (80.4% vs 47.8%; P=0.001). After adjustment, a double-balloon catheter was significantly associated with an efficient cervical ripening compared to vaginal dinoprostone (aOR 7.81, 95% CI 2.58-23.60). No difference was observed in cesarean section rate (39.1% in each group; P=0.96) and in mean induction time to vaginal delivery (34.5h in the balloon group vs 36.5h in the dinoprostone group; P=0.53). Maternal and neonatal outcomes were similar.For obese patients at term, cervical ripening using a double-balloon catheter is more efficient on Bishop score after 24h compared to vaginal dinoprostone.
- Published
- 2017
15. Cirrhose biliaire primitive et grossesse
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Dominique Luton, J. Bernuau, and G. Ducarme
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Pregnancy ,medicine.medical_specialty ,Cirrhosis ,Vaginal delivery ,business.industry ,Obstetrics and Gynecology ,General Medicine ,Gastric varices ,medicine.disease ,Asymptomatic ,Gastroenterology ,digestive system diseases ,Ursodeoxycholic acid ,Primary biliary cirrhosis ,Reproductive Medicine ,Internal medicine ,medicine ,medicine.symptom ,Varices ,business ,medicine.drug - Abstract
Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease, asymptomatic during a protracted time, characterized by changes in the small-sized bile ducts near portal spaces. The etiology of PBC is undefined, but immunologic and environmental disturbances may contribute to the disease. Infertility is often associated with PBC and cirrhosis, but pregnancy may well occur in women with PBC and without cirrhosis or in some others with compensated cirrhosis. A pluridisciplinary approach including gastroenterologists and obstetricians is recommended. The patient must be closely monitored throughout her pregnancy with maternal and routine antenatal care. Medical treatment requires ursodeoxycholic acid (UDCA). In non-cirrhotic UDCA-treated women with PBC, pregnancy often follows a normal course with vaginal delivery. In cirrhotic patients, UDCA must be continued during pregnancy, esophageal and gastric varices must be evaluated before pregnancy, and endoscopic ligature is recommended for treating large varices. Additionally, beta-blocker therapy may be associated, especially when variceal rupture occurred previously. Elective cesarean section is recommended in patients with large esophageal or gastric varices because of the potentially increased risk of variceal bleeding during maternal expulsive efforts in case of vaginal delivery.
- Published
- 2014
16. Hépatites et grossesse
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G Ducarme, P F Ceccaldi, J. Bernuau, C. Thuillier, and Dominique Luton
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business.industry ,Medicine ,business - Published
- 2009
17. Prise en charge de l'endométriose: les bonnes pratiques de la cœlioscopie diagnostique
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G Ducarme and C Poncelet
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Gynecology ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Pelvic pain ,Female infertility ,Endometriosis ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,Palpation ,Endoscopy ,Reproductive Medicine ,medicine ,Operative report ,Differential diagnosis ,medicine.symptom ,Laparoscopy ,business - Abstract
The interest for diagnostic laparoscopy for the diagnosis of endometriosis is not longer discussed. Indications could be pelvic pain, infertility, menorragia, and/or organic ovarian tumour. Several lesions, typical and non typical, have been described and should be recognized. Histological confirmation seems suitable even though the correlation with visual inspection is not perfect. New laparoscopic techniques seem interesting to increase diagnostic relevance. Visual inspection should be associated with palpation. For deep infiltrating endometriotic lesions diagnostic laparoscopy has shown its limits. Precisions concerning peri-operative methods and operative reports are described. The place of the different classifications has been discussed.
- Published
- 2007
18. [Expansion dilatation balloons for cervical ripening in obstetric practice]
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G, Ducarme, J, Grange, and M, Vital
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Uterine Rupture ,Pregnancy ,Contraindications ,Humans ,Female ,Labor, Induced ,Delivery, Obstetric ,Labor Stage, First ,Dilatation ,Vaginal Birth after Cesarean ,Catheterization ,Cervical Ripening - Abstract
During recent decades, mechanical devices have been substituted by pharmacological methods. Their place in the therapeutic arsenal remains important with a renewed obstetrical interest for these devices. Due to a lack of data they are still not recommended as first-line. This review thus attempted to examine the use of expansion dilatation balloons (Foley catheter and double-balloons) to analyze their effectiveness in case of native uterus and previous cesarean section. Twenty-seven clinical trials had compared balloons catheter and prostaglandins in patients without a history of uterine scar. The risk of cesarean section did not differ. Mechanical methods seemed to be more effective in achieving delivery within 24hours, with fewer episodes of excessive uterine contractions, but they necessitated more oxytocin during labor. Ten clinical trials analyzed dilatation balloons in patients with previous cesarean section. More than 70% women had favorable cervical ripening (Bishop score6), and vaginal delivery was reported between 35 and 70% of patients. The risk of uterine rupture was low between 0.64 and 0.72%, with neither increased risk of severe neonatal and maternal morbidity nor increased risk of infectious morbidity. Mechanical methods are effective and safe for third trimester cervical ripening, mainly in women with previous cesarean section. Potential advantages may include wide availability and reduction of some of the side effects.
- Published
- 2015
19. Miomectomía: prevención de la hemorragia
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Michèle Uzan, A. Tigaizin, M. Benchimol, C. Poncelet, N. Seince, A.-B. Rodrigues, C. Davitian, H. Dauphin, and G. Ducarme
- Abstract
La miomectomia es una intervencion quirurgica que, en los casos de miomatosis, permite a la paciente conservar su utero. Para realizar esta intervencion pueden utilizarse diversas vias de acceso. Sin embargo, una hemorragia peroperatoria abundante puede originar determinadas complicaciones como, por ejemplo, una cirugia incompleta, una modificacion de la via de acceso, un shock hipovolemico, una transfusion sanguinea o una anemia postoperatoria grave que obligue a una transfusion o a la administracion de hierro y un retraso de la reanudacion de las actividades normales. Teniendo en cuenta estas posibilidades, parece justificado adoptar las medidas oportunas para prevenir la hemorragia peroperatoria. Se han valorado con detenimiento varios metodos medicos preoperatorios. Asi, la administracion de agonistas de la GnRH (hormona liberadora de gonadotropinas) antes de la intervencion parece reducir la hemorragia peroperatoria mediante una disminucion del volumen uterino por modificaciones de la vascularizacion del miometrio, pero estos resultados son aun objeto de debate. La administracion de antagonistas de la GnRH, de misoprostol o de antiprogesterona parece prometedora, pero antes de llegar a una conclusion definitiva deben hacerse estudios complementarios. La embolizacion preoperatoria de los miomas podria reducir las perdidas de sangre peroperatorias. Sin embargo, su uso en las mujeres que desean un embarazo posterior todavia se esta evaluando. Tambien pueden utilizarse metodos peroperatorios de tipo quimico, como el empleo de productos vasoconstrictores o de oxitocicos, y mecanicos que interrumpen de forma transitoria el flujo sanguineo del miometrio. Algunos de ellos poseen una eficacia demostrada. Las alternativas a la cirugia, como la tecnica de la miolisis, que implica la destruccion in situ de los miomas, requiere informacion adicional, sobre todo para las mujeres jovenes que desean tener hijos.
- Published
- 2006
20. Myomectomies : prévention de l'hémorragie
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N. Seince, Michèle Uzan, A.-B. Rodrigues, C. Davitian, A. Tigaizin, C. Poncelet, M. Benchimol, H. Dauphin, and G. Ducarme
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Gynecology ,medicine.medical_specialty ,business.industry ,Gonadotrophin releasing hormone ,Obstetrics and Gynecology ,Medicine ,Oxytocic Agents ,business - Abstract
Resume La myomectomie est un acte chirurgical permettant aux patientes de conserver leur uterus dans le cadre d'une maladie myomateuse. Differentes voies d'abord peuvent etre envisagees pour realiser cette intervention. Cependant, une hemorragie peroperatoire importante peut etre a l'origine de complications comme, par exemple, une chirurgie incomplete, une modification de voie d'abord, un choc hypovolemique, une transfusion sanguine et une anemie severe postoperatoire, imposant une transfusion ou un traitement martial et ralentissant la reprise d'activite. Devant ces constatations, il semble legitime de s'interesser aux differents moyens permettant de prevenir l'hemorragie peroperatoire. Plusieurs moyens medicaux preoperatoires ont beneficie d'une evaluation serieuse. L'utilisation d'agonistes de la Gn-RH (gonadotrophin releasing hormone) en preoperatoire semble permettre, via une reduction du volume uterin par remaniements vasculaires du myometre, une diminution de l'hemorragie peroperatoire, mais ces resultats sont encore controverses. Les administrations d'antagonistes de la GnRH, de misoprostol ou d'antiprogesterone semblent prometteuses, mais des etudes complementaires doivent etre realisees avant de pouvoir conclure. L'embolisation preoperatoire des myomes pourrait reduire les pertes sanguines peroperatoires. Cependant, son utilisation chez les femmes desireuses de grossesse est en cours d'evaluation. Des moyens peroperatoires sont egalement utilisables : chimiques avec l'utilisation de produits vasoconstricteurs ou d'ocytociques, et mecaniques interrompant temporairement le flux sanguin myometrial. Certains d'entre eux ont fait la preuve de leur efficacite. Les alternatives a la chirurgie, comme les techniques de myolyse, qui impliquent une destruction in situ des myomes, necessitent, notamment chez les femmes jeunes desireuses de grossesse, des donnees complementaires.
- Published
- 2005
21. Choriocarcinome primitif de l'ovaire : à propos d'un cas
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Denis Vinatier, J.-L. Leroy, G. Ducarme, S. Vautier-Rit, and L. Devisme
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Gynecology ,medicine.medical_specialty ,Pregnancy ,business.industry ,Choriocarcinoma ,Obstetrics and Gynecology ,Ovary ,General Medicine ,medicine.disease ,female genital diseases and pregnancy complications ,medicine.anatomical_structure ,Reproductive Medicine ,embryonic structures ,medicine ,Gestation ,business ,reproductive and urinary physiology - Abstract
A case of primary choriocarcinoma of the ovary in a 32-year-old woman, 1 month after a voluntary interruption of pregnancy, is reported. A review of the literature shows that this tumour is rare and the distinction between a gestational and a non-gestational choriocarcinoma is difficult. The distinction between these two diagnoses and specific treatment are discussed.
- Published
- 2004
22. Échographie endovaginale et troubles mictionnels après TVT® (Tension-free Vaginal Tape)
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F. Staerman, G. Ducarme, D. Rey, and Y. Ménard
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Gynecology ,medicine.medical_specialty ,Tvt procedure ,Reproductive Medicine ,Transvaginal ultrasonography ,business.industry ,medicine ,Obstetrics and Gynecology ,General Medicine ,business - Abstract
Resume Objectif. – Evaluer l’echographie endovaginale pour expliquer les troubles mictionnels observes dans les suites du TVT® (Tension-free Vaginal Tape). Patientes et methodes. – Cinquante-quatre patientes ont beneficie d’une echographie endovaginale trois mois apres TVT avec mesure de la taille de la bandelette et de sa distance par rapport au col vesical. Parallelement, la guerison (groupe 1), l’existence de troubles mictionnels a type de dysurie (groupe 2), l’existence d’imperiosites (groupe 3) ou la persistance de fuites urinaires sont evaluees par un autoquestionnaire et un examen clinique. Les analyses statistiques utilisent le test de comparaison de variance (Anova). Resultats. – L’analyse des mesures de la distance bandelette–col vesical montre une difference significative entre les groupes 1 et 2 : 13,2 vs 7,6 mm et entre les groupes 1 et 3 : 13,2 vs 17,7 mm. De meme, il apparait une difference significative dans l’analyse des tailles de bandelettes entre les groupe 1 et 2 : 8,8 vs 6,6 mm et entre les groupes 1 et 3 : 8,8 vs 6,5 mm. L’analyse des distances bandelette–col vesical dans les groupes 2 et 3 montre une difference significative : 7,6 vs 17,7 mm. En revanche, la taille de la bandelette n’est pas significativement differente entre ces deux groupes (6,6 vs 6,5 mm). Discussion et conclusion. – Ces resultats montrent une correlation entre les differents troubles mictionnels observes a distance du TVT et la mesure echographique par voie endovaginale de la distance entre la bandelette et le col vesical.
- Published
- 2004
23. Maladies digestives
- Author
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G. Ducarme, D. Luton, P. Amate, and Y. Bouhnik
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business.industry ,Medicine ,business - Published
- 2014
24. Endometriosis mimicking hernia recurrence
- Author
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C. Poncelet, G. Ducarme, and M. Uzan
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Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Endometriosis ,Hernia, Inguinal ,Diagnosis, Differential ,Cicatrix ,Postoperative Complications ,Recurrence ,medicine ,Humans ,Hernia ,Pelvis ,business.industry ,General surgery ,Nodule (medicine) ,medicine.disease ,Hernia repair ,Surgery ,Inguinal hernia ,surgical procedures, operative ,medicine.anatomical_structure ,Female ,Differential diagnosis ,medicine.symptom ,business ,Abdominal surgery - Abstract
Endometriosis is a common gynecologic condition and has been described in several locations, mostly in the pelvis. Extragenital endometriosis may appear as a painful nodule evoking an inguinal hernia. Scar endometriosis after inguinal hernia repair seems to be a rare occurrence. We report an unusual case of a 28-year-old woman who developed a scar endometriosis 2 years after an inguinal hernia repair. This case highlights that the presence of a painless inguinal mass similar to a recurrent hernia, with possible swelling related to the menstrual cycle, may evoke endometriosis, especially after a previous hernia repair and should lead to prompt diagnosis, wide excision, and gynecological advice.
- Published
- 2006
25. Pour le forceps
- Author
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G. Ducarme and D. Luton
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Neonatal morbidity ,medicine.medical_specialty ,Reproductive Medicine ,business.industry ,Obstetrics ,Forceps ,Obstetrics and Gynecology ,Medicine ,Forceps delivery ,Maternal morbidity ,General Medicine ,business - Published
- 2006
26. [Factors predicting unsuccessful labor induction with dinoprostone in post-term pregnancy with unfavorable cervix]
- Author
-
G, Ducarme, V, Chesnoy, and L, Petit
- Subjects
Adult ,Gestational Age ,Cervix Uteri ,Middle Aged ,Prognosis ,Dinoprostone ,Parity ,Young Adult ,Pregnancy ,Risk Factors ,Oxytocics ,Humans ,Female ,Pregnancy, Prolonged ,Labor, Induced ,Treatment Failure ,Cervical Ripening ,Retrospective Studies - Abstract
To identify predictive factors for unsuccessful induction of labor within 24hours after dinoprostone insertion in post-term pregnancy with unfavorable cervix.We retrospectively reviewed 325 singleton pregnancies with a diagnosis of post-term pregnancy and unfavorable cervix (Bishop score6) during the period January 2012-Decembre 2012. Patients were classified into 2 groups: successful labor, defined as cervical ripening, within 24hours after dinoprostone insertion (Group R; n=248; 76.3 %) or failure group (Group E; n=77; 23.7 %). Antepartum and perpartum characteristics of women were compared.Nulliparity (74.0 versus 56.0 %; OR=2.23; 95 % CI: 1.27-4.00; P=0.005), gestational age ≤41 SA+4 (53.2 versus 33.9 %; OR=2.22; 95 % CI: 1.32-3.74; P=0.003) and history of dilatation and curettage (27.3 versus 10.5 %; OR=3.19; 95 % CI: 1.66-6.11; P=0.0005) were significantly associated with unsuccessful induction of labor. Bishop score was significantly higher in Group R (3.6 versus 1.9; P=0.001). Also, consistency (74.0 versus 44.4 %; OR=3.57; 95 % CI: 2.04-6.40; P10(-5)) and absence of dilatation of the cervix (59.7 versus 23.0 %; OR=4.97; 95 % CI: 2.89-8.56; P10(-6)) were identified as significant predictive factors for unsuccessful induction of labor.Nulliparity, gestational age ≤41 SA+4, history of dilatation and curettage and Bishop score, in particular consistency and dilatation, are correlated with failure of cervical ripening in post-term pregnancy with unfavorable cervix.
- Published
- 2013
27. Acute pancreatitis during pregnancy: a review
- Author
-
Dominique Luton, Pascal Hammel, G. Ducarme, Frédérique Maire, and P. Chatel
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Pregnancy ,Intensive care ,medicine ,Humans ,Neonatology ,Cholangiopancreatography, Endoscopic Retrograde ,Hypertriglyceridemia ,Endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,Gestational age ,Gallstones ,medicine.disease ,Pregnancy Complications ,Cholecystectomy, Laparoscopic ,Pancreatitis ,Pediatrics, Perinatology and Child Health ,Acute pancreatitis ,Cholecystectomy ,Female ,business ,Algorithms - Abstract
This article aims to draw together recent thinking on pregnancy and acute pancreatitis (AP), with a particular emphasis on pregnancy complications, birth outcomes and management of AP during pregnancy contingent on the etiology. AP during pregnancy is a rare but severe disease with a high maternal-fetal mortality, which has recently decreased thanks to earlier diagnosis and some maternal and neonatal intensive care improvement. AP usually occurs during the third trimester or the early postpartum period. The most common causes of AP are gallstones (65 to 100%), alcohol abuse and hypertriglyceridemia. Although the diagnostic criteria for AP are not specific for pregnant patients, Ranson and Balthazar criteria are used to evaluate the severity and treat AP during pregnancy. The fetal risks from AP during pregnancy are threatened preterm labor, prematurity and in utero fetal death. In cases of acute biliary pancreatitis during pregnancy, a consensual strategy could be adopted according to the gestational age, and taking in consideration the high risk of recurrence of AP (70%) with conservative treatment and the specific risks of each treatment. This could include: conservative treatment in first trimester and laparoscopic cholecystectomy in second trimester. During the third trimester, conservative treatment or endoscopic retrograde cholangiopancreatography with biliary endoscopic sphincterotomy, and laparoscopic cholecystectomy in early postpartum period are recommended. A multidisciplinary approach, including gastroenterologists and obstetricians, seems to be the key in making the best choice for the management of AP during pregnancy.
- Published
- 2013
28. Rupture utérine après hystéroscopie opératoire. À propos d’un cas
- Author
-
R Gabriel, G. Robinet, G Ducarme, and F. Maitrot
- Subjects
animal structures ,Reproductive Medicine ,Obstetrics and Gynecology ,General Medicine - Abstract
Resume Nous rapportons un cas de rupture uterine a 32 semaines d’amenorrhee survenant un an apres resection hysteroscopique d’une cloison uterine. Une revue de la litterature montre seulement 16 autres observations de rupture uterine apres hysteroscopie operatoire. La physiopathologie et la prevention de ces complications sont discutees.
- Published
- 2004
29. [Primary biliary cirrhosis and pregnancy]
- Author
-
G, Ducarme, J, Bernuau, and D, Luton
- Subjects
Diagnosis, Differential ,Pregnancy Complications ,Fertility ,Liver Cirrhosis, Biliary ,Pregnancy ,Humans ,Female - Abstract
Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease, asymptomatic during a protracted time, characterized by changes in the small-sized bile ducts near portal spaces. The etiology of PBC is undefined, but immunologic and environmental disturbances may contribute to the disease. Infertility is often associated with PBC and cirrhosis, but pregnancy may well occur in women with PBC and without cirrhosis or in some others with compensated cirrhosis. A pluridisciplinary approach including gastroenterologists and obstetricians is recommended. The patient must be closely monitored throughout her pregnancy with maternal and routine antenatal care. Medical treatment requires ursodeoxycholic acid (UDCA). In non-cirrhotic UDCA-treated women with PBC, pregnancy often follows a normal course with vaginal delivery. In cirrhotic patients, UDCA must be continued during pregnancy, esophageal and gastric varices must be evaluated before pregnancy, and endoscopic ligature is recommended for treating large varices. Additionally, beta-blocker therapy may be associated, especially when variceal rupture occurred previously. Elective cesarean section is recommended in patients with large esophageal or gastric varices because of the potentially increased risk of variceal bleeding during maternal expulsive efforts in case of vaginal delivery.
- Published
- 2012
30. [Estimation of fetal weight by external abdominal measurements and fundal height measurement near term for the detection of intra-uterine growth retardation]
- Author
-
G, Ducarme, E, Seguro, V, Chesnoy, C, Davitian, and D, Luton
- Subjects
Adult ,Fetal Growth Retardation ,Adolescent ,Anthropometry ,Pregnancy Trimester, Third ,Gestational Age ,Ultrasonography, Prenatal ,Cohort Studies ,Young Adult ,Fetal Weight ,Pregnancy ,Abdomen ,Humans ,Female ,Retrospective Studies - Abstract
To evaluate the estimation of fetal weight by external abdominal measurements, alone or associated with fundal height measurement and/or ultrasonographic exams near 32 weeks, to detect intra-uterine growth retardation (IUGR) near term.A retrospective cohort study included all women who delivered a small-for-gestational-age infant less than 37 weeks gestation during 2008-2009. We analyzed the sensitivity of estimation of fetal weight by external abdominal measurements and the others different routine exams during third trimester, and compared them to detect IUGR near term.The estimation of fetal weight by external abdominal measurements was used in 263 pregnant patients. External abdominal measurements and fundal height measurement were not statistically different and were better tests than ultrasonographic exams at 32 weeks to detect IUGR near term (sensitivity: 41.4%, 42.2% and 22.8%, respectively; P0.05). External abdominal measurements associated with regular ultrasonographic examination at 32 weeks of gestation significantly increased the sensitivity to detect IUGR near term (42.9% vs. 22.8%; P0.05). But, the association of external abdominal measurements and fundal height measurement did not increase the rate of detection (47.9% vs. 42.2%; P=0.22).The present findings confirm that the use of the estimation of fetal weight by external abdominal measurements to detect intra-uterine growth retardation is effective. Measures to improve the learning of this technique and its reproducibility are recommended.
- Published
- 2011
31. Six-year follow-up without recurrence after a carcinosarcoma of the breast: case report
- Author
-
R, Wernert, G, Yazbek, C, Voisin-Rigaud, and G, Ducarme
- Subjects
Aged, 80 and over ,Mastectomy, Modified Radical ,Treatment Outcome ,Carcinosarcoma ,Humans ,Breast Neoplasms ,Female ,Disease-Free Survival - Abstract
Carcinosarcoma (CS) of the breast is a rare entity (less than 0.2% of breast malignancies), characterized by the presence of a biphasic pattern of malignant epithelial and mesenchymal elements, and with a high risk of loco-regional recurrence. The diagnosis of CS of the breast is difficult and needs detailed histological investigations to differentiate it from other malignant breast tumors. Expertise and evidence-based information on optimal treatment is very limited due to the low incidence and inconsistent classification. The principles of treatment modalities seem to be similar to others breast malignancies. CS has a different biologic behavior from others breast cancers, being very aggressive in keeping with its high-grade mesenchymal stroma. Still many questions remain about its origin and optimal treatment modalities for better outcome. We report the case of CS of the breast without local or regional recurrence after six years of follow-up in an 82-year-old woman.
- Published
- 2011
32. Risk of synechiae following uterine compression sutures in the management of major postpartum haemorrhage
- Author
-
O, Poujade, A, Grossetti, L, Mougel, P F, Ceccaldi, G, Ducarme, and D, Luton
- Subjects
Adult ,Sutures ,Postpartum Hemorrhage ,Suture Techniques ,Gynatresia ,Middle Aged ,Young Adult ,Pregnancy ,Risk Factors ,Pressure ,Humans ,Female ,Uterine Inertia ,Physical Examination ,Retrospective Studies - Abstract
To determine with hysteroscopy or hysterosalpingogram the risk of uterine synechiae following uterine compression sutures for major postpartum haemorrhage (PPH) caused by uterine atony.A retrospective observational study.Department of Obstetrics and Gynaecology, Beaujon Hospital, Clichy, France.One hundred and ninety-seven women with PPH between 2007 and 2010. One hundred and thirteen women (57.4%) were transferred as an emergency to our institution from other centres.Of the 197 women, 94 with PPH had uterine arterial embolisation and 33 with major PPH were managed with surgical uterine compression sutures (Hackethal technique). The women were invited to undergo a control hysteroscopy or hysterosalpingogram, after postpartum consultation, to assess the uterine cavity.The prevalence of subsequent uterine synechiae.Uterine compression sutures succeeded in controlling PPH in 26 of 33 women (78.8%). Seven needed a hysterectomy. Among women with a preserved uterus, 15 underwent an exploration of the uterine cavity, including hysteroscopy (12) or hysterosalpingogram (8). Four women (26.7%) developed uterine synechiae and one had a subsequent pregnancy 18 months after uterine compression sutures. The median time between delivery and hysteroscopy or hysterosalpingogram was 9.3 months (2.4-34.8 months).This study suggests a significant risk of uterine synechiae after placement of compression sutures for PPH that transverse the uterine cavity. Postoperative uterine synechiae might be underestimated, and their prevalence and clinical significance should be assessed in long-term follow-up studies.
- Published
- 2011
33. Anomalies de la thyroïde fœtale. Prise en charge d'un goitre fœtal
- Author
-
E. Vuillard, D. Luton, P. Chatel, and G. Ducarme
- Subjects
business.industry ,Medicine ,business - Published
- 2011
34. [Anti-TNFα therapy and its implication in gynecology and obstetrics]
- Author
-
G, Ducarme, P, Amate, M, Seirafi, P-F, Ceccaldi, Y, Bouhnik, and D, Luton
- Subjects
Obstetrics ,Pregnancy Complications ,Gynecology ,Pregnancy ,Tumor Necrosis Factor-alpha ,Rheumatic Diseases ,Anti-Inflammatory Agents ,Antibodies, Monoclonal ,Humans ,Female ,Inflammatory Bowel Diseases ,Infliximab - Abstract
Anti-TNFα treatments have modified the medical care, the course and the quality of life of the patients with autoimmune rheumatic, cutaneous or bowel inflammatory diseases. On the other hand, these treatments may have potential severe side effects during pregnancy (congenital malformations, fetal infections). Actually, many pregnancies have been reported during anti-TNFα exposures, with good maternal and neonatal outcomes. The introduction or the discontinuation of these treatments will always have to be discussed with the specialist of the chronic disease and, ideally, during a preconceptional counselling. In gynecology, anti-TNFα drugs may offer a new safe and effective approach to treating patients with recurrent miscarriages or unexplained or failed in vitro fertilization cycles. On the other hand, these treatments significantly increase the risk for serious infections or viral reactivations and may promote gynaecological malignancies. An adapted gynaecological survey is necessary.
- Published
- 2010
35. [Inflammatory bowel diseases: gynecological and obstetrical considerations]
- Author
-
P, Amate, M, Seirafi, Y, Bouhnik, D, Luton, and G, Ducarme
- Subjects
Adult ,Risk ,Cesarean Section ,Incidence ,Infant, Newborn ,Infant, Low Birth Weight ,Inflammatory Bowel Diseases ,Congenital Abnormalities ,Pregnancy Complications ,Sexual Dysfunction, Physiological ,Young Adult ,Gastrointestinal Agents ,Pregnancy ,Recurrence ,Humans ,Premature Birth ,Female ,Infertility, Female - Abstract
Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, are invalidating inflammatory affections, which evolve by relapse interrupted with clinical remission. Crohn's disease commonly affects young women in their reproductive years with a peak of incidence between 20 and 30. Infertility and sexual dysfunction are equivalent to that of the general population while they are increasing in patients with active IBD or after colorectal surgery. IBD are well controlled by medical treatments and the frequency of relapse during the pregnancy is similar to that of the non-pregnant IBD patients. The data concerning the risk of congenital malformations in IBD are contradictory. The risk of preterm delivery and low birth weight is significantly increased and correlated to the disease activity. When a medical treatment insures a quiescent disease before the pregnancy, it is advisable to continue it during the pregnancy because the benefits of controlled disease outweigh the risks of medication. IBD, possible perianal lesions and colorectal surgical interventions influence the mode of delivery, but the indication of caesarean section should primarily be governed by obstetric necessity. Preconceptional counseling seems desirable because of the risks during pregnancy, according to the disease activity, the surgical histories and the therapeutic agents.
- Published
- 2010
36. [Single-shot ropivacaine wound infiltration during cesarean section for postoperative pain relief]
- Author
-
G, Ducarme, S, Sillou, A, Wernet, C, Davitian, O, Poujade, P-F, Ceccaldi, B, Bougeois, and D, Luton
- Subjects
Adult ,Pain, Postoperative ,Cesarean Section ,Injections, Intralesional ,Amides ,Treatment Outcome ,Double-Blind Method ,Pregnancy ,Humans ,Female ,Ropivacaine ,Prospective Studies ,Anesthetics, Local ,Pain Measurement - Abstract
To assess the efficiency of single-shot ropivacaine wound infiltration during cesarean section for postoperative pain relief, using a prospective, randomized, double-blinded study.One hundred consecutive patients with planned cesarean section were enrolled between September 2007 and May 2008 and randomized into two groups: single-shot wound infiltration of 20mL of ropivacaine 7.5mg/mL (Group R; n=56) or single-shot wound infiltration of 20mL of saline solution (group T; n=44). The primary goal of this study was the double-blinded evaluation of the postoperative pain after coughing and leg raise using the 100-mm visual analog scales (VAS) during the first 48 postoperative hours after cesarean delivery. The secondary goals were the occurrence of nausea and vomiting and the morphine consumption.Numerical pain rating scale for pain evaluation was significantly lower (P0.05) in the ropivacaine group than in the control group at M0, M20, M40, M60, H2 and H4. But, at H8, H12 and H24, no significant difference for VAS was noted between the two groups. The occurrence of nausea and vomiting and the total morphine consumption were not significantly different between the two groups during the first 48 postoperative hours.Single-shot ropivacaine wound infiltration during planned cesarean section is a simple and safe procedure that provides effective reduction of post-partum pain within the first 4hours.
- Published
- 2010
37. [Liver and preeclampsia]
- Author
-
G, Ducarme, J, Bernuau, and D, Luton
- Subjects
Adult ,Fatty Liver ,HELLP Syndrome ,Maternal Mortality ,Liver ,Pre-Eclampsia ,Pregnancy ,Liver Diseases ,Postpartum Period ,Humans ,Female ,Liver Circulation - Abstract
HELLP syndrome complicates PE in 5 to 20 % of cases. The clinical manifestations (i.e. epigastric pain, elevated liver enzymes, thrombocytopenia and hemolysis) are secondary to the fibrin deposit within the peri-portal sinusoids. The clinical presentation of HELLP syndrome can be misleading. It is therefore necessary to suspect this complication whenever a PE patient develops gastro-intestinal pain. The interruption of pregnancy is the only effective treatment against HELLP syndrome. If it can be safely performed passed the 34(th) week of amenorrhea, a protective attitude should be adopted prior to reaching this date. This consists of the administration of corticosteroid therapy for fetal pulmonary maturation, intensive clinical, biological and sonographic monitoring of the mother's parameters. The administration of corticosteroids or performing a plasmapharesis is not recommended for the treatment of established HELLP syndrome because neither improves the maternal or neonatal outcome. The differential diagnosis may also include acute fatty liver of pregnancy. An early liver impairment, polyuria-polydipsia syndrome and a rise in INR support this diagnosis.
- Published
- 2010
38. [Amniocentesis and viral risk (hepatitis B, C virus and HIV)]
- Author
-
G, Ducarme, P-F, Ceccaldi, J, Bernuau, and D, Luton
- Subjects
Risk ,Pregnancy ,Amniocentesis ,Humans ,Female ,HIV Infections ,Pregnancy Complications, Infectious ,Hepatitis B ,Hepatitis C ,Infectious Disease Transmission, Vertical - Abstract
Very few studies have properly addressed to the risk of fetal hepatitis B (HBV), hepatitis C (HCV) or human immunodeficiency virus (HIV) infection through amniocentesis. For HBV, this risk is low. However, knowledge of the maternal hepatitis B e antigen status is valuable in the counselling of risks associated with amniocentesis. For HCV, the risk is not well known but cannot be excluded. For HIV, it seems rational to propose a viral test before amniocentesis for patients with contamination's risk and to postpone the sampling in cases with positive results in order to obtain an undetectable HIV-1 RNA viral load. For these reasons, it can be useful to analyse for each virus the benefit of amniocentesis and the risk of mother-to-infant transmission, and to inform the patient.
- Published
- 2009
39. Foie et prééclampsie
- Author
-
Dominique Luton, G. Ducarme, and J. Bernuau
- Subjects
business.industry ,Medicine ,business - Published
- 2009
40. [Eclampsia: retrospective study about 16 cases]
- Author
-
G, Ducarme, S, Herrnberger, I, Pharisien, L, Carbillon, and M, Uzan
- Subjects
Adult ,Male ,HELLP Syndrome ,Incidence ,Infant, Newborn ,Pregnancy Outcome ,Young Adult ,Maternal Mortality ,Pregnancy ,Risk Factors ,Infant Mortality ,Humans ,Eclampsia ,Female ,Antihypertensive Agents ,Retrospective Studies - Abstract
To determine the etiologic factors, circumstances of diagnosis, obstetrical management and complications of eclampsia and to value the maternal and perinatal outcomes.We conducted a retrospective descriptive study, from January 1996 to December 2006 in a maternity type IIB.Sixteen cases of eclampsia were studied. The prevalence of eclampsia over the study period was 8.1 per 10,000 births, without annual change in the incidence. The mean age of the patients was 27.8+/-6.7 years. The major risk factor was the primipaternity (87.5%). The eclampsia occurred in ante-, peri- and post-partum in 56, 6 and 38% of the cases, respectively. In cases of eclampsia, 75% of the patients had elevated blood pressure, 93% presented headache, but 62% presented with an atypical form with less than three functional symptoms (headache, visual trouble, hyperreflexia). Various treatments had been started: antihypertensive treatment (75%), antiepileptic treatment (69%) and magnesium sulphate (94%). Eleven patients had developed complications, mainly HELLP syndrome (10 patients). No maternal death was noted. The mean birth weight was 2366+/-818 g, 43.8% of children had birth weight less than the 10th percentile, and 87.5% of children were girls. One fetal and one perinatal death at day 19 had been noted.Nowadays, the physiopathology of eclampsia remains misunderstood. It is difficult to establish risk factors, the primipaternity being certainly one of these. Eclampsia may occur in an atypical and unforeseeable form in well followed patients, without risk factor. The diagnosis should be done quickly for an adapted treatment and obstetrical management.
- Published
- 2008
41. [Evolution of surgical operations for female for stress urinary incontinence in gynaecology departments of Parisian public hospitals between 2002 and 2006]
- Author
-
A, Frati, C, Poncelet, P, Madelenat, D, Luton, and G, Ducarme
- Subjects
Paris ,Suburethral Slings ,Gynecology ,Hospitals, Public ,Surveys and Questionnaires ,Urinary Incontinence, Stress ,Humans ,Urologic Surgical Procedures ,Female ,Prostheses and Implants ,Practice Patterns, Physicians' - Abstract
To appreciate the evolution of the current surgical practice for female for stress urinary incontinence (SUI) in the gynaecologic surgery departments of Parisian public hospitals in three different periods of 12 months (2002-2003, 2003-2004, and 2006).The 16 departments were surveyed by postal questionnaire about their surgical practice for the treatment of female SUI. The number, the type of operation, the type of suburethral tapes and their surgical routes were detailed.The participation rate in the survey was 87.5% (14/16) for the first two studied periods and 75% (12/16) for the last one. The number of SUI procedure decreases between the three periods (586, 505, and 263 procedures, respectively; p0.001). Suburethral slings represent the technique of choice for SUI (86.2% in 2002-2003; 92.7% in 2003-2004, and 98.1% in 2006). Other practices are exceptional. The transobturator approach has widely progressed and became the preferred one in 2006 (31.1%; 64.5%; 95.4% in 2006; p0.001). No transobturator route was privileged. TVT procedures have decreased between the three studied periods (48.3%, 36.5%, and 4.6% in 2006; p0.001). TVT-O is the preferred sling in 2006 (120/258, 46.5% of suburethral tapes).Suburethral tape placement is nowadays the main surgical treatment for female SUI amongst members in gynaecology departments in Parisian public hospitals. The transobturator approach is preferred.
- Published
- 2008
42. [Bariatric surgery and obstetrics]
- Author
-
G, Ducarme, A, Revaux, and D, Luton
- Subjects
Pregnancy Complications ,Pregnancy ,Pregnancy Outcome ,Bariatric Surgery ,Humans ,Female ,Infertility, Female ,Obesity, Morbid - Abstract
Obesity poses a significant risk to reproductive-aged women. Weight reduction before conception is the best way to increasing fertility and reduces obesity associated morbidity. When medical interventions fail, bariatric surgery is the most successful method of weight loss, effective increasing fertility and reducing obstetrical complications and maternal and neonatal morbidity comparing obese women. Gastric banding and gastric bypass are the most increasingly utilized treatment option in France and should be offered to morbidly obese women of childbearing age. This literature review provides information about different techniques of bariatric surgery and about the multidisciplinary management of these pregnancies (monitoring, micronutrient supplementation) to promote maternal and fetal wellbeing in concert with continuing postoperative weight control.
- Published
- 2008
43. [Continuous medical evaluation in a gynaecological and obstetrical unit: Our experience about scheduled caesarean]
- Author
-
C, Davitian, G, Ducarme, A, Grossetti, P, Desfeux, C, Yver, H, Pejoan, M-C, Andre, M, Levardon, B, Bougeois, and D, Luton
- Subjects
Quality Control ,Quality Assurance, Health Care ,Cesarean Section ,Infant, Newborn ,Accreditation ,Appointments and Schedules ,Professional Competence ,Pregnancy ,Humans ,Women's Health ,Education, Medical, Continuing ,Female ,Maternal Health Services ,France ,Obstetrics and Gynecology Department, Hospital ,Anesthetics ,Program Evaluation ,Retrospective Studies - Abstract
Continuous medical evaluation (CME) is compulsory which aims to ameliorate and guarantee quality of care. This paper describes the experience of our unit during the different stages of evaluation that permit us to obtain our accreditation. Our evaluation dealt with the "amelioration of women's and newborn's care after scheduled caesarean section". A first retrospective study of files of scheduled caesareans allowed to update possible points of improvement, after application of adapted corrective actions, both at the medical and paramedical level. The second study, made after application of these actions, allowed to appreciate the results of our initiative of CME, to update new possible points of improvement, but also to notice certain limits in the achievement of the objectives.
- Published
- 2008
44. [Third trimester ultrasonographic scan: early at 32 weeks or later?]
- Author
-
G, Ducarme and D, Luton
- Subjects
Time Factors ,Pregnancy ,Pregnancy Trimester, Third ,Humans ,Female ,Ultrasonography, Prenatal - Published
- 2008
45. [Against universal screening for gestational diabetes mellitus]
- Author
-
G, Ducarme, C, Muratorio, and D, Luton
- Subjects
Adult ,Diabetes, Gestational ,Evidence-Based Medicine ,Pregnancy ,Humans ,Mass Screening ,False Positive Reactions ,Female - Published
- 2008
46. [Postpartum endocrine syndrome]
- Author
-
G, Ducarme, P, Châtel, and D, Luton
- Subjects
Pregnancy ,Endocrine Glands ,Humans ,Female ,Puerperal Disorders ,Syndrome ,Endocrine System Diseases - Abstract
Postpartum endocrine syndromes occur in the year after delivery. They are due to immunologic and vascular modifications during pregnancy. The Sheehan syndrome is the first described postpartum endocrine syndrome and consists on a hypophyse necrosis in relation with a hypovolemic shock during delivery. The immunologic consequences of the pregnancy are the most frequent, sometimes discrete and transitory. The physiological evolution of the endocrine glands during pregnancy and the most frequent post-partum endocrine syndromes are discussed: postpartum lymphocytic hypophysitis, thyroiditis and Sheehan' syndrome.
- Published
- 2007
47. [Delayed presentation of eclampsia: lessons from a case diagnosed at Day 11]
- Author
-
M, Valentin, G, Ducarme, A, Wernet, J, Mantz, and D, Luton
- Subjects
Adult ,Diagnosis, Differential ,Time Factors ,Pregnancy ,Seizures ,Postpartum Period ,Humans ,Eclampsia ,Female ,Puerperal Disorders - Abstract
We report a case of late postpartum eclampsia at Day 11 in a 40-year-old woman after normal pregnancy and delivery. The delayed eclamptic episode is defined by seizures between two days and four weeks after delivery. About 40% of late eclampsia has no premonitory symptoms. This case highlights the possible diagnosis of late eclampsia even after normal pregnancy and delivery. Active and prompt management, brain imaging are mandating in cases of persistent headaches in postpartum.
- Published
- 2007
48. [Prevention of intrauterine adhesions after hysteroscopic surgery]
- Author
-
A, Revaux, G, Ducarme, and D, Luton
- Subjects
Postoperative Complications ,Treatment Outcome ,Humans ,Cellulose, Oxidized ,Female ,Membranes, Artificial ,Tissue Adhesions ,Cervix Uteri ,Hysteroscopy ,Hyaluronic Acid ,Safety ,Polytetrafluoroethylene ,Randomized Controlled Trials as Topic - Abstract
Intrauterine adhesions are the most frequent complications after hysteroscopic surgery in women of reproductive age. The prevalence of intrauterine adhesions after hysteroscopic surgery is correlated to intrauterine pathology (myoma, polyp, or adhesions). Few clinical trials have demonstrated the efficiency of barrier agents developed in order to prevent adhesions after operative hysteroscopy. Adhesion barriers are mechanic agent (intrauterine device), fluid agents (Seprafilm, Hyalobarrier) and postoperative systemic treatment (estroprogestative treatment). In this article, we evaluate the efficiency of these barrier agents for adhesion prevention in hysteroscopic surgery, undertaking a review of clinical trials published. The most frequent published studies evaluate the anatomic efficiency of antiadhesion agents after hysteroscopic surgery in order to evaluate the fertility. Data are still insufficient to evaluate them for clinical use. There is a need for other randomised controlled trials.
- Published
- 2007
49. [Surgical management of peripartum hemorrhage: a retrospective study]
- Author
-
G, Ducarme, S, Bargy, A, Grossetti, B, Bougeois, M, Levardon, and D, Luton
- Subjects
Adult ,Treatment Outcome ,Pregnancy ,Postpartum Hemorrhage ,Humans ,Female ,Hysterectomy ,Emergency Treatment ,Vascular Surgical Procedures ,Retrospective Studies - Abstract
Peripartum haemorrhage is an obstetrical emergency and requests a life saving procedure. The purpose of this study is to describe our experience with the surgical management of peripartum haemorrhage.We performed a retrospective study including 16 patients who necessitated a surgical management of peripartum haemorrhage (artery ligations, uterine compression and/or emergency peripartum hysterectomy) between 1985 and 2007.The incidence of surgical management of peripartum haemorrhage was 0.047%. Conservative surgical management consisted in uterine compression sutures in three cases. Artery ligations were performed without success in seven patients; only one case of isolated utero-ovarian artery ligations was effective. An emergency peripartum hysterectomy was necessary in 12 cases. Uterine atony was the principal etiologic factor (43.8% of cases). There were no significant perioperative complications. No maternal death was reported.In cases of non life-saving procedure, medical treatment and uterine arteries embolisation are often sufficient. Uterine compression suturing techniques are interesting alternatives and uterine arteries ligations can always be performed before hysterectomy. In cases of failure of conservative treatment, the emergency peripartum hysterectomy must be performed. Then, the choice concerning the surgical technique for the management of peripartum haemorrhage may be adapted to the patient, the centre and the obstetrical team.
- Published
- 2007
50. [Surgical management of stress urinary incontinence: a questionnaire-based survey amongst members of the Société de Chirurgie Gynécologique et Pelvienne (SCGP)]
- Author
-
G, Ducarme, C, Poncelet, A, Grossetti, M, Uzan, and D, Luton
- Subjects
Suburethral Slings ,Urodynamics ,Treatment Outcome ,Surveys and Questionnaires ,Urinary Incontinence, Stress ,Humans ,Urologic Surgical Procedures ,Female ,France ,Length of Stay ,Practice Patterns, Physicians' - Abstract
To evaluate by voluntary and anonymous declaration the current surgical practice for female stress urinary incontinence (SUI) in France.A postal survey, anonymous, sealed, and validated by the Scientific Committee of the Société de chirurgie gynécologie et pelvienne (SCGP), was conducted among all members. The questionnaire was also available online, on the SCGP website.One hundred and three (18%) members responded. The respondents (87%; n=90) were performing less than 10 incontinence procedures in a month. Suburethral slings represent the choice technique for SUI, prior by transobturator approach (87%; n=90). Other practices are exceptional. Urodynamics study was routinely performed prior to surgery in 69% of cases. Surgical treatment was performed using prior regional anaesthesia in retropubic approach (58%; n=40 in 68 respondents); either loco-regional (47%; n=48 in 102 respondents) or general anaesthesia (50%; n=51 in 102 respondents) were used in transobturator approach. No transobturator route was privileged. The postoperative urethral catheter was being left for 24h or less in case of retropubic or transobturator approach (70%; n=37 in 53 respondents and 68%; n=52 in 76 respondents, respectively). The patient's hospital stay was one night (83%; n=54 in 65 respondents and 85%; n=87 in 102 respondents, respectively). A postoperative audit was not done by 19% of respondents.Suburethral tape placement is nowadays the main surgical treatment for female stress urinary incontinence amongst members of SCGP. The transobturator approach is preferred.
- Published
- 2007
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