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221 results on '"Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ)"'

1. Use of oxytocin after spontaneous onset of labor in France

Author: Dupont, Corinne, Riethmuller, Didier, Deneux-Tharaux, Catherine, Beranger, Rémi, Chantry, Anne, Gaucher, Laurent, Le Ray, Camille, Barasinski, Chloé, Vendittelli, Françoise, Coulm, Bénédicte, Tessier, Véronique, Rousseau, Anne, Burguet, Antoine, Fischer, Catherine, Guillou, Camille, Leroy, Fabienne, Chiesa-Dubruille, Coralie, Phan, Emmanelle, Evrard, Anne, Carayol, Marion, Health Service and Performance Research (HESPER), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Service de gynécologie, Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Hôpital Saint-Jacques, 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)-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), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), École de sages-femmes Baudelocque (ESF Baudelocque), Université Paris Descartes - Paris 5 (UPD5), Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL), DHU Risques Et Grossesse, Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Descartes - Paris 5 (UPD5)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement (PEPRADE), CHU Clermont-Ferrand-Université d'Auvergne - Clermont-Ferrand I (UdA), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Hôpital Privé NATECIA, Lyon, France, Centre Hospitalier de Montélimar, Montélimar, France, Association d'usagers, Collectif interassociatif autour de la naissance (CIANE), Paris, France, Ville de Paris, DFPE, service de PMI, Paris, France, ICM, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques, 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), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université Paris Descartes - École de sages-femmes Baudelocque (UPD ESF Baudelocque), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Health Service and Performance Research ( HESPER ), Université Claude Bernard Lyon 1 ( UCBL ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques, Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique ( CRESS - U1153 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité ( CRESS (U1153 / UMR_A 1125) ), Institut National de la Recherche Agronomique ( INRA ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut National de la Recherche Agronomique ( INRA ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Institut de recherche, santé, environnement et travail ( Irset ), Université d'Angers ( UA ) -Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -École des Hautes Études en Santé Publique [EHESP] ( EHESP ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ) -Université des Antilles ( UA ), École de sages-femmes Baudelocque ( ESF Baudelocque ), Université Paris Descartes - Paris 5 ( UPD5 ), Hôpital Femme Mère Enfant [CHU - HCL] ( HFME ), Hospices Civils de Lyon ( HCL ), Centre National de la Recherche Scientifique ( CNRS ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Assistance publique - Hôpitaux de Paris (AP-HP), Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement ( PEPRADE ), CHU Clermont-Ferrand-Université d'Auvergne - Clermont-Ferrand I ( UdA ), Risques cliniques et sécurité en santé des femmes et en santé périnatale ( RISCQ ), Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Institut National de la Santé et de la Recherche Médicale (INSERM)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Université d'Angers (UA), Centre National de la Recherche Scientifique (CNRS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: endocrine system, [ SDV ] Life Sciences [q-bio], MESH : Oxytocin, [SDV]Life Sciences [q-bio], MESH : Labor, Obstetric, MESH: Oxytocin, MESH: Practice Guideline, MESH : Practice Guideline, MESH: Labor, Obstetric, hormones, hormone substitutes, and hormone antagonists
Abstract: International audience; New guidelines have been produced by the CNSF and the CNGOF regarding the use of oxytocin after spontaneous onset of labor in France. This clinical practices were designed to redefine the normal and abnormal obstetrical labor; specify the indications, dosage, procedures, and effects of oxytocin administration; and describe the adverse maternal and perinatal effect associated with oxytocin administration.
Published: 2017

2. Prevention of spontaneous preterm birth: Guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF)

Author: Bruno Langer, Nicolas Mottet, S Brun, Gilles Kayem, Thomas Schmitz, Héloïse Torchin, Elie Azria, Chantal Ducroux-Schouwey, Patrick Rozenberg, Loïc Sentilhes, Stéphane Marret, Pierre-Yves Ancel, Louis Marcellin, Julie Blanc, Florence Bretelle, Muriel Doret, Gilles Brabant, Anne Evrard, S. Paysant, Didier Riethmuller, Guillaume Benoist, Marie-Victoire Senat, Emeline Maisonneuve, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes ( URMITE ), Institut de Recherche pour le Développement ( IRD ) -Aix Marseille Université ( AMU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR48, INSB-INSB-Centre National de la Recherche Scientifique ( CNRS ), Gynépole, Aix Marseille Université ( AMU ) - Hôpital Nord [CHU - APHM], Université Nice Sophia Antipolis - Département d'orthophonie ( UNS Orthophonie ), Université Nice Sophia Antipolis ( UNS ), Université Côte d'Azur ( UCA ) -Université Côte d'Azur ( UCA ), Hospices Civils de Lyon ( HCL ), Association d'usagers, Collectif interassociatif autour de la naissance (CIANE), Paris, France, Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique ( CRESS - U1153 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité ( CRESS (U1153 / UMR_A 1125) ), Institut National de la Recherche Agronomique ( INRA ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut National de la Recherche Agronomique ( INRA ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service de Gynécologie-Obstétrique [CHU Trousseau], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Trousseau [APHP], Institut Cochin ( UM3 (UMR 8104 / U1016) ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Service de Gynécologie Obstétrique 2 et Médecine de la Reproduction, CHU Cochin [AP-HP], Service de pédiatrie néonatale et réanimation - neuropédiatrie [Rouen], Hôpital Charles Nicolle [Rouen]-CHU Rouen-Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Normandie Université ( NU ), Service d'urologie-andrologie, CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] ( UJM ) -Hôpital nord, Université Jean Monnet [Saint-Étienne] ( UJM ), Service de gynécologie, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques, Risques cliniques et sécurité en santé des femmes et en santé périnatale ( RISCQ ), Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ), Department of obstetrics and gynecology, CHI Poissy-Saint-Germain, Département d'obstétrique et de gynécologie [AP-HP Hôpital Robert Debré], Université Paris Diderot - Paris 7 ( UPD7 ) -AP-HP Hôpital universitaire Robert-Debré [Paris], Service de gynécologie–obstétrique, CHU Strasbourg-Hôpital de Hautepierre [Strasbourg], Service d'Obstétrique et Gynécologique [Angers], Centre hospitalier universitaire d'Angers, Service d'Obstétrique et Gynécologique [Bicêtre], AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Département d'obstétrique et de gynécologie [CH Paris Saint-Joseph] ( DHU Risks in Pregnancy ), Université Paris Descartes - Paris 5 ( UPD5 ) -Groupe hospitalier Paris Saint-Joseph - Hôpital, Education, Formation, Travail, Savoirs ( EFTS ), Université Toulouse - Jean Jaurès ( UT2J ) -École Nationale Supérieure de Formation de l'Enseignement Agricole de Toulouse-Auzeville ( ENSFEA ), 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 de Gynécologie-Obstétrique [Bicêtre], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Bicêtre, 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), 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 de Lausanne (UNIL), Unité de biostatistiques [Centre Georges-François Leclerc], Centre Régional de Lutte contre le cancer - Centre Georges-François Leclerc (CRLCC - CGFL), Aix Marseille Université (AMU)- Hôpital Nord [CHU - APHM], Hospices Civils de Lyon (HCL), Université Pierre et Marie Curie - Paris 6 (UPMC), Institut Cochin (IC UM3 (UMR 8104 / U1016)), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), 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), CHU Saint-Etienne-Université Jean Monnet [Saint-Étienne] (UJM)-Hôpital nord, Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université de Franche-Comté (UFC), La grossesse normale et pathologique: développement et fonctions du placenta et de l'utérus (UMR_S 767), Institut des sciences du Médicament -Toxicologie - Chimie - Environnement (IFR71), Institut National de la Santé et de la Recherche Médicale (INSERM)-Ecole Nationale Supérieure de Chimie de Paris- Chimie ParisTech-PSL (ENSCP)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Ecole Nationale Supérieure de Chimie de Paris- Chimie ParisTech-PSL (ENSCP)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Université Nice Sophia Antipolis - Département d'orthophonie (UNS Orthophonie), Université Nice Sophia Antipolis (... - 2019) (UNS), Université Côte d'Azur (UCA)-Université Côte d'Azur (UCA), 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), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Trousseau [APHP], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Hôpital Charles Nicolle [Rouen], Université Jean Monnet [Saint-Étienne] (UJM), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Hôpital Saint-Jacques, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris Diderot - Paris 7 (UPD7)-AP-HP Hôpital universitaire Robert-Debré [Paris], Département d'obstétrique et de gynécologie [CH Paris Saint-Joseph] (DHU Risks in Pregnancy), Université Paris Descartes - Paris 5 (UPD5)-Groupe hospitalier Paris Saint-Joseph - Hôpital, Education, Formation, Travail, Savoirs (EFTS), École Nationale Supérieure de Formation de l'Enseignement Agricole de Toulouse-Auzeville (ENSFEA)-Université Toulouse - Jean Jaurès (UT2J), Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU), Université Toulouse - Jean Jaurès (UT2J)-École Nationale Supérieure de Formation de l'Enseignement Agricole de Toulouse-Auzeville (ENSFEA), Université Paris Descartes - Paris 5 (UPD5)-Centre hospitalier Saint-Joseph [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de gynécologie-obstétrique [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA), 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), Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Cochin [AP-HP], Service de pédiatrie néonatale et réanimation - neuropédiatrie [CHU Rouen], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques, Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), Université Nice Sophia Antipolis (1965 - 2019) (UNS), CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Charles Nicolle [Rouen], Normandie Université (NU)-Normandie Université (NU)-CHU Rouen, Service d'Urologie - Andrologie [CHU Saint-Etienne], Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Université Jean Monnet - Saint-Étienne (UJM), Université Jean Monnet - Saint-Étienne (UJM), Département d'obstétrique et de gynécologie [Hôpital Robert Debré], 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), 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 Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Université de Franche-Comté (UFC), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER-UNICANCER, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Descartes - Paris 5 (UPD5)-Centre National de la Recherche Scientifique (CNRS), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon), Institut National de la Santé et de la Recherche Médicale (INSERM)-Ecole Nationale Supérieure de Chimie de Paris - Chimie ParisTech-PSL (ENSCP), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Ecole Nationale Supérieure de Chimie de Paris - Chimie ParisTech-PSL (ENSCP), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Nord [CHU - APHM]-Assistance Publique - Hôpitaux de Marseille (APHM)-Aix Marseille Université (AMU), and Normandie Université (NU)-Normandie Université (NU)-Hôpital Charles Nicolle [Rouen]-Université de Rouen Normandie (UNIROUEN)
Subjects: Cervical pessary, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Population, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, medicine, Elective Cesarean Delivery, Humans, 030212 general & internal medicine, education, ComputingMilieux_MISCELLANEOUS, education.field_of_study, 030219 obstetrics & reproductive medicine, Fetal fibronectin, Obstetrics, business.industry, Obstetrics and Gynecology, medicine.disease, 3. Good health, [ SDV.MHEP.MI ] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Reproductive Medicine, Premature birth, Premature Birth, Gestation, Female, business, Premature rupture of membranes
Abstract: International audience; In France, 60,000 neonates are born preterm every year (7.4%), half of them after the spontaneous onset of labor. Among preventable risk factors of spontaneous prematurity, only cessation of smoking is associated with decreased prematurity (level of evidence [LE]1). It is therefore recommended (Grade A). Routine screening and treatment of vaginal bacteriosis is not recommended in the general population (Grade A). The only population for which vaginal progesterone is recommended is that comprising asymptomatic women with singleton pregnancies, no history of preterm delivery, and a short cervix at 16-24 weeks of gestation (Grade B). A history-indicated cerclage is not recommended for women with only a history of conization (Grade C), uterine malformation (professional consensus), isolated history of preterm delivery (Grade B), or twin pregnancies for primary (Grade B) or secondary (Grade C) prevention of preterm birth. A history-indicated cerclage is recommended for a singleton pregnancy with a history of at least 3 late miscarriages or preterm deliveries (Grade A). Ultrasound cervical length screening is recommended between 16 and 22 weeks for women with a singleton previously delivered before 34 weeks gestation, so that cerclage can be offered if cervical length < 25 mm before 24 weeks (Grade C). A cervical pessary is not recommended for the prevention of preterm birth in a general population of asymptomatic women with twin pregnancies (Grade A) or in populations of asymptomatic women with a short cervix (professional consensus). Although the implementation of universal screening by transvaginal ultrasound for cervical length at 18-24 weeks of gestation in women with a singleton gestation and no history of preterm birth can be considered by individual practitioners, this screening cannot be universally recommended. In cases of preterm labor, (i) it is not possible to recommend any one of the several methods (ultrasound of the cervical length, vaginal examination, or fetal fibronectin assay) over any other to predict preterm birth (Grade B); (ii) routine antibiotic therapy is not recommended (Grade A); (iii) prolonged hospitalization (Grade B) and bed rest (Grade C) are not recommended. Compared with placebo, tocolytics are not associated with a reduction in neonatal mortality or morbidity (LE2) and maternal severe adverse effects may occur with all tocolytics (LE4). Atosiban and nifedipine (Grade B), unlike beta-agonists (Grade C), can be used for tocolysis in spontaneous preterm labor without preterm premature rupture of membranes. Maintenance tocolysis is not recommended (Grade B). Antenatal corticosteroid administration is recommended for all women at risk of preterm delivery before 34 weeks of gestation (Grade A). After 34 weeks, the evidence is insufficiently consistent to justify recommending systematic antenatal corticosteroid treatment (Grade B), but a course of this treatment might be indicated in clinical situations associated with high risk of severe respiratory distress syndrome, mainly in case of planned cesarean delivery (Grade C). Repeated courses of antenatal corticosteroids are not recommended (Grade A). Rescue courses are not recommended (Professional consensus). Magnesium sulfate administration is recommended for women at high risk of imminent preterm birth before 32 weeks (Grade A). Cesareans are not recommended for fetuses in vertex presentation (professional consensus). Both planned vaginal and elective cesarean delivery are possible for breech presentations (professional consensus). Delayed cord clamping may be considered if the neonatal or maternal state allows (professional consensus). (C) 2017 Elsevier Ireland Ltd. All rights reserved.
Published: 2017

3. Examen pelvien en gynécologie et obstétrique : recommandations pour la pratique clinique

Author: Deffieux, Xavier, Rousset-Jablonski, Christine, Gantois, Adrien, Brillac, Thierry, Maruani, Julia, Maitrot-Mantelet, Lorraine, Mignot, Stéphanie, Gaucher, Laurent, Athiel, Yoann, Baffet, Hortense, Bailleul, Alexandre, Bernard, Valérie, Bourdon, Mathilde, Cardaillac, Claire, Carneiro, Yaritza, Chariot, Patrick, Corroenne, Romain, Dabi, Yohann, Dahlem, Laurence, Frank, Sophie, Freyens, Anne, Grouthier, Virginie, Hernandez, Isabelle, Iraola, Elisabeth, Lambert, Marie, Lauchet, Nadege, Legendre, Guillaume, Le Lous, Maela, Louis-Vahdat, Christine, Martinat Sainte-Beuve, Anne, Masson, Marine, Matteo, Caroline, Pinton, Anne, Sabbagh, Emmanuelle, Sallee, Camille, Thubert, Thibault, Heron, Isabelle, Pizzoferrato, Anne-Cécile, Artzner, France, Tavenet, Arounie, Le Ray, Camille, Fauconnier, Arnaud, AP-HP - Hôpital Antoine Béclère [Clamart], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Research on Healthcare Performance (RESHAPE - Inserm U1290 - UCBL1), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Léon Bérard [Lyon], Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), BoRdeaux Institute in onCology (Inserm U1312 - BRIC), Université de Bordeaux (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche Interdisciplinaire sur les enjeux Sociaux - sciences sociales, politique, santé (IRIS), École des hautes études en sciences sociales (EHESS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Sorbonne Paris Nord, Institut Curie [Paris], Biologie des maladies cardiovasculaires = Biology of Cardiovascular Diseases, Université de Bordeaux (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Motricité, interactions, performance UR 4334 / Movement - Interactions - Performance (MIP), Le Mans Université (UM)-Nantes Université - UFR des Sciences et Techniques des Activités Physiques et Sportives (Nantes Univ - UFR STAPS), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy]
Subjects: Reproductive Medicine, Obstetrics and Gynecology, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics
Abstract: ObjectifÉlaborer des recommandations pour l’examen clinique pelvien en gynécologie et obstétrique.Matériel et méthodesUn groupe de travail multidisciplinaire de 45 experts a été constitué, comprenant des représentants d’associations de patients et d’usagers du système de santé. L’ensemble du processus de ces recommandations a été mené indépendamment de tout financement. Il a été conseillé aux auteurs de suivre les règles du système GRADE® (Grading of Recommendations Assessment, Development and Evaluation) pour évaluer la qualité des preuves. Les limites potentielles de faire des recommandations fortes en présence de preuves de faible qualité ont été soulignées. Le comité a étudié 40 questions dans 4 domaines pour les femmes symptomatiques ou asymptomatiques (urgence, consultation gynécologique, maladies gynécologiques, obstétrique et grossesse). Chaque question a été formulée dans un format PICO (Patients, Intervention, Comparaison, Résultat) et les éléments de preuve ont été détaillés. La revue de la littérature et les recommandations ont été réalisées selon la méthodologie GRADE®.RésultatsLe travail de synthèse des experts et l’application de la méthode GRADE ont abouti à 27 recommandations. Parmi les recommandations formalisées, 17 présentaient un accord fort, 7 un accord faible et 3 un accord professionnel. Treize questions ont donné lieu à une absence de recommandation en raison du manque de preuves (pas de réponse dans la littérature).ConclusionsLes 27 recommandations ont permis de préciser quand un examen clinique est requis pour différentes situations cliniques gynécologiques et obstétricales. Ces recommandations intéressent tout professionnel impliqué dans la santé des femmes. La nécessité de réaliser un examen clinique chez certaines patientes dans certaines situations a été fondée sur des preuves scientifiques. Des recherches supplémentaires sont nécessaires pour étudier les avantages dans d’autres situations.
Published: 2023

4. Management of Mother's Own Milk for Very Preterm Infants in Tertiary-Level Neonatal Units in the Ile-de-France Region in France

Author: Bonet, Mercedes, Durox, Mélanie, Blondel, Béatrice, Boileau, Pascal, Pierrat, Véronique, Zeitlin, Jennifer, Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants (UMR_S 953), 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), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Service de Médecine Néonatale, Hôpital Jeanne de Flandre [Lille], This study was funded by INSERM ., 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 ), Risques cliniques et sécurité en santé des femmes et en santé périnatale ( RISCQ ), Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ), and 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)
Subjects: Europe, neonatal unit, breast milk, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, ComputingMilieux_MISCELLANEOUS
Abstract: International audience;
Published: 2014

5. Isthmocèle : définition, diagnostic, facteurs de risque, prévention, symptômes, complications, et traitements

Author: Antoine Torre, E. Verspyck, Jim G Thornton, Samir Hamamah, P Crochet, Arnaud Fauconnier, I. Thomassin, Service de gynécologie et obstétrique [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Développement embryonnaire précoce humain et pluripotence EmbryoPluripotency (UMR 1203), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-CHU Montpellier, Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service d'Imageries Radiologiques et Interventionnelles [CHU Tenon] (IRIS), CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), 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, Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), and Les auteurs remercient Andrea Kaelin et Olivier Limot pour leur soutien dans la r?daction de cet article.
Subjects: Gynecology, medicine.medical_specialty, 030219 obstetrics & reproductive medicine, business.industry, Prevention, [SDV]Life Sciences [q-bio], Obstetrics and Gynecology, Definition, Caesarean scar niche, female genital diseases and pregnancy complications, 3. Good health, Treatment, 03 medical and health sciences, 0302 clinical medicine, Reproductive Medicine, Diagnosis, Medicine, 030212 general & internal medicine, business, reproductive and urinary physiology
Abstract: Resume Objectifs Etablir un etat des lieux sur la definition, le diagnostic, les facteurs de risque, les symptomes, et les traitements de l’isthmocele. Methodes Revue de la litterature, reflexions critiques, et conseils pragmatiques. Resultats La definition de l’isthmocele n’est pas consensuelle. Certains proposent une indentation ≥ 2 mm du myometre de la cicatrice de cesarienne, mais cet aspect present chez plus de la moitie des uterus cicatriciels ne prend pas en compte les symptomes de la femme. La methode de diagnostic la plus performante semble etre l’echographie ± hysterosonographie. Les situations a risque d’isthmocele sont l’uterus multicicatriciel, la cesarienne pendant le travail avec une incision trop basse, et l’uterus retroverse. Les symptomes de l’isthmocele sont des saignements gynecologiques anormaux et des douleurs pelviennes, et leur presence signe le « syndrome de la cicatrice de cesarienne ». Les risques d’une grossesse en cas d’isthmocele ont ete peu etudies, mais elle ne semble pas contre-indiquee, meme si l’isthmocele n’est pas traite. Le traitement de l’isthmocele est avant tout chirurgical, conservateur, et semble reserve aux patientes symptomatiques, et aux infertilites secondaires en echec de traitement. Les patientes avec myometre residuel ≥ 2,5 mm peuvent beneficier d’un traitement hysteroscopique de premiere intention, tandis qu’on proposera un abord cœlioscopique ou vaginal dans les autres cas. Conclusions Une definition pragmatique de l’isthmocele maladie en incluant la presence de symptomes est le pre-requis necessaire a la prise en charge des femmes. Le traitement est avant tout chirurgical, conservateur ou non suivant le desir de grossesse ulterieur.
Published: 2021

6. Presentation and Prognosis of Primary Expansile and Infiltrative Mucinous Carcinomas of the Ovary

Author: Marine Huin, Jerome Lorenzini, Flavie Arbion, Xavier Carcopino, Cyril Touboul, Yohann Dabi, Yohan Kerbage, Hélène Costaz, Lise Lecointre, Vincent Lavoué, Pierre-Adrien Bolze, Cyrille Huchon, Alexandre Bricou, Geoffroy Canlorbe, Camille Mimoun, Sofiane Bendifallah, Tristan Gauthier, Gilles Body, Lobna Ouldamer, CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Nutrition, croissance et cancer (U 1069) (N2C), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Nord [CHU - APHM], Aix Marseille Université (AMU), Centre Hospitalier Intercommunal de Créteil (CHIC), CHU Lille, Hôpital Jeanne de Flandre [Lille], Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, CHU Strasbourg, CHU Pontchaillou [Rennes], Oncogenesis, Stress, Signaling (OSS), Université de Rennes (UR)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), CHI Poissy-Saint-Germain, Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], CHU Tenon [AP-HP], CHU Limoges, None, and Jonchère, Laurent
Subjects: expansile mucinous carcinomas, [SDV.CAN] Life Sciences [q-bio]/Cancer, lymphadenectomy, mucinous ovarian carcinoma, [SDV.CAN]Life Sciences [q-bio]/Cancer, General Medicine, prognosis
Abstract: International audience; Objective: The aim of the present study was to evaluate evolution and prognosis of mucinous ovarian carcinomas (mOC), with respect to the two invasive patterns: expansile and infiltrative invasion. Methods: This was a descriptive, retrospective, multicenter study conducted in 13 French centres from 1 January 2001 to 31 December 2019. All patients operated on for epithelial ovarian neoplasia of the mucinous type (infiltrative/ expansile) were included, whether the surgery was performed immediately or after neoadjuvant chemotherapy. Results: A total of 94 women with mucinous carcinomas were included in the present study. Mucinous tumours were divided into 35 expansile (37%) and 59 infiltrative (63%) mOC. There was a statistically significant difference in early and late stages at initial diagnosis between expansile and infiltrative mOC. None of the expansile mOC showed metastatic lymph nodes, whereas almost a quarter of the infiltrative mOC were metastatic to the pelvic /para-aortic region. There was a clear difference in RFS, in favour of expansile mOC, with 90% survival at 5 years, compared with 60% for infiltrative mOC. Conclusions: Although infiltrative and expansile mOC belong to the same histological family, they present many distinctions in clinical presentation, histological invasion, and disease course.
Published: 2022

7. Routine ultrasound examination by OB/GYN residents increase the accuracy of diagnosis for emergency surgery in gynecology

Author: Flavie Toret-Labeeuw, Anne A. Chantry, Alexandre Dumont, Cyrille Huchon, Arnaud Fauconnier, Thomas Popowski, Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants (UMR_S 953), 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), Mère et enfant en milieu tropical : pathogènes, système de santé et transition épidémiologique (MERIT - UMR_D 216), Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5), BMC, Ed., 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), Service de gynécologie et obstétrique, Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ) -CHI Poissy-Saint-Germain, Risques cliniques et sécurité en santé des femmes et en santé périnatale ( RISCQ ), Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ), 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 ), Mère et enfant face aux infections tropicales ( MERIT - UMR_D 216 ), and Institut de Recherche pour le Développement ( IRD ) -Université Paris Descartes - Paris 5 ( UPD5 )
Subjects: medicine.medical_specialty, Routine ultrasound, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, Physical examination, Acute pelvic pain, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, 03 medical and health sciences, 0302 clinical medicine, Sensitivity, Emergency surgery, medicine, 030212 general & internal medicine, [ SDV.MHEP.CHI ] Life Sciences [q-bio]/Human health and pathology/Surgery, Laparoscopy, [ SDV.MHEP.GEO ] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Gynecologic emergency, Ultrasonography, Gynecology, 030219 obstetrics & reproductive medicine, medicine.diagnostic_test, business.industry, Retrospective cohort study, 3. Good health, [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Emergency medicine, Emergency Medicine, Specificity, Severe morbidity, Surgery, business, Research Article
Abstract: Introduction Diagnostic accuracy of first-line sonographic evaluation by obstetrics/gynecology residents in determining the need for emergency surgery in women with acute pelvic pain is unknown. Aim of this study was to evaluate the diagnostic accuracy of routine ultrasound evaluation by obstetrics/gynecology residents, available 24 hours a day, in patients with acute pelvic pain. Methods A cross-sectional retrospective study included consecutive patients who underwent emergency laparoscopy for acute pelvic pain at a teaching hospital gynecologic emergency unit, between January 1, 2004, and December 31, 2006. The laparoscopic diagnosis was the reference standard. Gynecologic and nongynecologic conditions requiring immediate surgery to avoid severe morbidity or death were defined as surgical emergencies. In all patients, obstetrics/gynecology residents routinely performed clinical examination and standardized ultrasonography was routinely recorded. Sonograms were re-interpreted for the study, blinded to physical examination and laparoscopic findings, according to evidence-based predetermined criteria. Sensitivity, specificity, and likelihood ratios were computed for clinical data alone, sonographic data alone, and the combination of both. Results Emergency laparoscopy was performed in 234 patients, diagnosing 139 (59%) surgical emergencies. Clinical and sonographic examinations performed by the residents each independently predicted a need for emergency surgery. Combining both examinations was superior over each examination alone and had an acceptable false-negative rate of 1%. Conclusions First-line combined clinical and sonographic examination by obstetrics/gynecology residents is effective in ruling out surgical emergencies in patients with acute pelvic pain.
Published: 2013

8. Menopause, hormone treatment and urinary incontinence at midlife

Author: Virginie Ringa, Guillaume Legendre, Xavier Fritel, Arnaud Fauconnier, Centre de recherche en épidémiologie et santé des populations ( CESP ), Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ) -Université Paris-Sud - Paris 11 ( UP11 ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service de gynécologie obstétrique, CHI Poissy-Saint-Germain, Risques cliniques et sécurité en santé des femmes et en santé périnatale ( RISCQ ), Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers ( CHU Poitiers ) -Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Faculté de Médecine et de Pharmacie - Université de Poitiers, Université de Poitiers, Service de gynécologie et obstétrique [Poitiers], Université de Poitiers-Centre hospitalier universitaire de Poitiers ( CHU Poitiers ), 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 ), INSERM CIC802 ( CIC802 ), Institut National de la Santé et de la Recherche Médicale ( INSERM ), 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), Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Poitiers - Faculté de Médecine et de Pharmacie, Centre hospitalier universitaire de Poitiers (CHU Poitiers), Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants (UMR_S 953), 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), INSERM CIC802 (CIC802), Institut National de la Santé et de la Recherche Médicale (INSERM), Fritel, Xavier, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-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-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), INSERM CIC 0802 (INSERM - CHU de Poitiers), Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Adult, Stress incontinence, medicine.medical_specialty, Urinary system, medicine.medical_treatment, Urinary incontinence, Urine, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, General Biochemistry, Genetics and Molecular Biology, 03 medical and health sciences, 0302 clinical medicine, Epidemiology, medicine, Humans, 030212 general & internal medicine, [ SDV.MHEP.GEO ] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Gynecology, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics, Estrogen Replacement Therapy, Obstetrics and Gynecology, Estrogens, Middle Aged, medicine.disease, 3. Good health, Menopause, [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Urinary Incontinence, Overactive bladder, Female, Hormone therapy, medicine.symptom, business
Abstract: International audience; Whether there is any association between urinary incontinence and menopause is the subject of debate, partly due to the fact it is difficult to tell the difference between the effects of menopause and those of ageing. For some time it was hoped that hormonal treatment for menopause would be beneficial for urinary incontinence because there are hormonal receptors in the urinary tract. The goal of this survey of current knowledge on the subject is to explore thoroughly the relationship between menopause and urinary incontinence. Our study is based on a review of the literature dealing with the epidemiology of urinary incontinence in women aged between 45 and 60, and the effects of hormonal treatment with respect to the symptoms of involuntary loss of urine. Analysis of the epidemiological data drawn from large cohorts shows that on the one hand, the menopause has little if any impact on the risk of urinary incontinence, and on the other hand that the effects of oestrogen medication on urinary incontinence vary according to how it is administered and the type of incontinence. The effect of oral hormone treatments for menopause is rather negative with respect to stress incontinence. Vaginal treatment appears to be beneficial for overactive bladder symptoms.
Published: 2013

9. Systematic Nerve Sparing during Surgery for Deep-infiltrating Posterior Endometriosis Improves Immediate Postoperative Urinary Outcomes

Author: Arnaud Fauconnier, Michelle Soares, Joseph Du Cheyron, Myriam Mimouni, Anne Oppenheimer, Krystel Nyangoh Timoh, Département de biologie de la reproduction et de gynécologie [CHIPS, Poissy], 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), CHU Pontchaillou [Rennes], and The authors thank Mira Hryniuk, BA, for reviewing the English language of the manuscript, as well as the Direction ? la Recherche Clinique et ? l'Innovation of Versailles (France) and the Centre Hospitalier Intercommunal de Poissy (France) for sponsoring the study and for their help in data collection.
Subjects: Laparoscopic surgery, medicine.medical_specialty, Urinary system, medicine.medical_treatment, Uterosacral ligament, Endometriosis, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, medicine, Humans, Nerve sparing, Urinary outcomes, Deep-infiltrating endometriosis, 2. Zero hunger, 030219 obstetrics & reproductive medicine, business.industry, Urinary Bladder Diseases, Obstetrics and Gynecology, Postoperative complication, Splanchnic Nerves, medicine.disease, 3. Good health, Surgery, Dissection, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Female, Laparoscopy, Peritoneum, Bladder dysfunction, business, Complication, Abdominal surgery
Abstract: International audience; Study Objective: Evaluate the feasibility and risk–benefit ratio of systematic nerve sparing by complete dissection of the inferior hypogastric nerves and afferent pelvic splanchnic nerves during surgery for deep-infiltrating endometriosis (DIE) on the basis of complication rates and postoperative bladder morbidity. Design: Observational before (2012–2014)–and–after (2015–2017) study based on a prospectively completed database of all patients treated medically or surgically for endometriosis. Setting: Unicentric study at the Centre Hospitalier Intercommunal de Poissy-St-Germain-en-Laye. Patients: This study included patients undergoing laparoscopic surgery for DIE (pouch of Douglas resection with or without colpectomy or bilateral uterosacral ligament resection), with complete excision of all identifiable endometriotic lesions, with or without an associated digestive procedure, between 2012 and 2017. The exclusion criteria included prior history of surgery for DIE or colorectal DIE excision, unilateral uterosacral ligament resection, and bladder endometriotic lesions. Interventions: For the patients in group 1 (2012–2014, n = 56), partial dissection of the pelvic nerves was carried out only if they were macroscopically caught in endometriotic lesions, without dissection of the pelvic splanchnic nerves. The patients in group 2 (2015–2017, n = 65) systematically underwent nerve sparing during DIE surgery, with dissection of the inferior hypogastric nerves and pelvic splanchnic nerves. Measurements and Main Results: Both groups were comparable in terms of patient age, parity, body mass index, and previous abdominal surgery. The operating times were similar in both groups (228 ± 105 minutes in group 2 vs 219 ± 71 minutes in group 1), as were intra- and postoperative complication rates. Time to voiding was significantly longer in the patients in group 1 (p
Published: 2021

10. Evaluation of the Effects of Pasireotide LAR Administration on Lymphocele Prevention after Axillary Node Dissection for Breast Cancer: Results of a Randomized Non-Comparative Phase 2 Study

Author: Catherine Uzan, Jean-Rémi Garbay, C. Bezu, Emile Daraï, Emmanuelle Boutmy-Deslandes, Sarah Zohar, Chafika Mazouni, Roman Rouzier, Elisabeth Chereau, Service de Gynécologie-Obstétrique [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Tenon [APHP], Physiologie, physiopathologie et thérapeutique ( ED 394 ), Université Pierre et Marie Curie - Paris 6 ( UPMC ), 'Transporteurs ABC et épithéliums normaux et tumoraux' EA 3499, Département de chirurgie générale [Gustave Roussy], Institut Gustave Roussy ( IGR ), Service de biostatistiques et information médicale [Saint-Louis], Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Diderot - Paris 7 ( UPD7 ) -Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Centre de Recherche des Cordeliers ( CRC ), Université Paris Diderot - Paris 7 ( UPD7 ) -École pratique des hautes études ( EPHE ) -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 ), Institut Curie/ Departement de chirurgie/ 26 rue d'Ulm/ 75005 Paris, Risques cliniques et sécurité en santé des femmes et en santé périnatale ( RISCQ ), Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ), 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), Physiologie, physiopathologie et thérapeutique (ED 394), Université Pierre et Marie Curie - Paris 6 (UPMC), Institut Gustave Roussy (IGR), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de Recherche des Cordeliers (CRC), Université Pierre et Marie Curie - Paris 6 (UPMC)-École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), HAL UPMC, Gestionnaire, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Pierre et Marie Curie - Paris 6 (UPMC)-École Pratique des Hautes Études (EPHE), 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), Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Diderot - Paris 7 (UPD7)-École pratique des hautes études (EPHE), and Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-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)
Subjects: Lymphocele, Peptide Hormones, medicine.medical_treatment, Cancer Treatment, lcsh:Medicine, Drug research and development, Biochemistry, chemistry.chemical_compound, Postoperative Complications, Endocrinology, Clinical trials, 0302 clinical medicine, Breast Tumors, Medicine and Health Sciences, Prospective Studies, Reproductive System Procedures, lcsh:Science, Prospective cohort study, Total Mastectomy, Mastectomy, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Multidisciplinary, Middle Aged, Prognosis, 3. Good health, Oncology, Research Design, Lymphatic Metastasis, 030220 oncology & carcinogenesis, Female, Somatostatin, 0305 other medical science, Phase II clinical investigation, Research Article, Adult, medicine.medical_specialty, Clinical Research Design, Endocrine Disorders, Breast Neoplasms, Surgical and Invasive Medical Procedures, Research and Analysis Methods, Placebo, 03 medical and health sciences, Double-Blind Method, [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, Breast Cancer, Cardiac conduction, Diabetes Mellitus, medicine, Humans, Aged, Neoplasm Staging, Pharmacology, 030505 public health, Surgical Excision, business.industry, lcsh:R, Axillary Lymph Node Dissection, Biology and Life Sciences, Cancers and Neoplasms, medicine.disease, Hormones, Pasireotide, Surgery, chemistry, Metabolic Disorders, Clinical medicine, Axilla, Lymph Node Excision, lcsh:Q, Adverse Events, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Follow-Up Studies
Abstract: Objective The aim of this study was to assess the efficacy (response rate centered on 80%) of a somatostatin analog with high affinity for 4 somatostatin receptors in reducing the postoperative incidence of symptomatic lymphocele formation following total mastectomy with axillary lymph node dissection. Setting This prospective, double-blind, randomised, placebo-controlled, phase 2 trial was conducted in two secondary care centres. Participants All female patients for whom mastectomy and axillary lymph node dissection were indicated were eligible for the study, including patients who had received neo-adjuvant chemotherapy. Main exclusion criteria were related to diabetes, cardiac insufficiency, disorder of cardiac conduction or hepatic failure. Interventions Patients were randomised to receive one injection of either prolonged-release pasireotide 60 mg or placebo (physiological serum), which were administered intramuscularly 7 to 10 days before the scheduled surgery. The study was conducted in a double-blind manner. Primary and Secondary Outcome Measures The primary outcome measure was the percentage of patients who did not develop post-operative axillary symptomatic lymphoceles during the 2 postoperative months. Secondary endpoints were the total quantity of lymph drained, duration and daily volume of drainage and aspirated volumes of lymph. Results Ninety-one patients were randomised. Ninety patients were evaluable: 42 patients received pasireotide, and 48 patients received placebo. The mean estimated response rate were 62.4% (95% Credibility Interval [CrI]: 48.6%-75.3%) in the treatment group and 50.2% (95% CrI: 37.6%-62.8%) in the placebo group. Overall safety was comparable across groups, and one serious adverse event occurred. In the treatment group, one patient with known insulin-depe*ndent diabetes required hospitalization for hyperglycaemia. Conclusions With this phase 2 preliminary study, even if our results indicate a trend towards a reduction in symptomatic lymphocele, pre-operative injection of pasireotide failed to achieve a response rate centered on 80%. Pharmacokinetics analysis suggests that effect of pasireotide could be optimised. Trial Registration ClinicalTrials.gov NCT01356862
Published: 2016

11. Risk Factors for Recurrence of Borderline Ovarian Tumours after Conservative Surgery and Impact on Fertility: A Multicentre Study by the Francogyn Group

Author: Adele Ozenne, Marion De Berti, Gilles Body, Xavier Carcopino, Olivier Graesslin, Yohan Kerbage, Cherif Akladios, Cyrille Huchon, Alexandre Bricou, Camille Mimoun, Emilie Raimond, Lobna Ouldamer, Service de Gynécologie-Obstétrique [CHRU Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Nutrition, croissance et cancer (U 1069) (N2C), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Avignon Université (AU)-Aix Marseille Université (AMU)-Institut de recherche pour le développement [IRD] : UMR237-Centre National de la Recherche Scientifique (CNRS), Service de gynécologie-obstétrique [Hôpital Nord - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Université de Reims Champagne-Ardenne (URCA), Hôpital Jeanne de Flandres, Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Strasbourg, 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-obstétrique [Hôpital Jean Verdier, Bondy], Université Paris 13 (UP13)-Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de gynécologie et obstétrique [Hopital Lariboisière - Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), and HAL UVSQ, Équipe
Subjects: fertility, recurrence, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, ovarian tumours, conservative treatment, [SDV.CAN]Life Sciences [q-bio]/Cancer, General Medicine, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, peritoneal staging, [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, [SDV.CAN] Life Sciences [q-bio]/Cancer, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Abstract: Introduction: Borderline ovarian tumours (BOT) represent 10–20% of epithelial tumours of the ovary. Although their prognosis is excellent, the recurrence rate can be as high as 30%, and recurrence in the infiltrative form accounts for 3% to 5% of recurrences. Affecting, in one third of cases, women of childbearing age, the surgical strategy with ovarian conservation is now recommended despite a significant risk of recurrence. Few studies have focused exclusively on patients who have received ovarian conservative treatment in an attempt to identify factors predictive of recurrence and the impact on fertility. The objective of this study was to identify the risk factors for recurrence of BOT after conservative treatment and the impact on fertility. Material and methods: This was a retrospective, multicentre study of women who received conservative surgery for BOT between February 1997 and September 2020. We divided the patients into two groups, the “R group” with recurrence and the “NR group” without recurrence. Results: Of 175 patients included, 35 had a recurrence (R group, 20%) and 140 had no recurrence (NR group, 80%). With a mean follow-up of 30 months (IQ 8–62.5), the overall recurrence rate was 20%. Recurrence was BOT in 17.7% (31/175) and invasive in 2.3% (4/175). The mean time to recurrence was 29.5 months (IQ 16.5–52.5). Initial complete peritoneal staging (ICPS) was performed in 42.5% of patients (n = 75). In multivariate analysis, age at diagnosis, nulliparity, advanced FIGO stage, the presence of peritoneal implants, and the presence of a micropapillary component for serous tumours were factors influencing the occurrence of recurrence. The post-surgery fertility rate was 67%. Conclusion: This multicentre study is to date one of the largest studies analysing the risk factors for recurrence of BOT after conservative surgery. Five risk factors were found: age at diagnosis, nulliparity, advanced FIGO stage, the presence of implants, and a micropapillary component. Only 25% of the patients with recurrence underwent ICPS. These results reinforce the interest of initial peritoneal staging to avoid ignoring an advanced tumour stage.
Published: 2022

12. A Framework Proposal for Quality and Safety Measurement in Gynecologic Emergency Care

Author: Françoise Vendittelli, Jeremy Sroussi, Muriel Doret-Dion, Antoine Bourret, Arnaud Fauconnier, Alexandre Dumont, Solenn Carvalho, Michelle Nisolle, Géraldine Giraudet, Cyrille Huchon, Rym Boulkedid, Christophe Lejeune, Claire Tourette, Estelle Bauville, Isabelle Le Creff, Marie-Hélène Bouvier-Colle, Corinne Alberti, Romain Jacobs, Johan Provot, Martin Koskas, Cherif Akladios, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Institut Pascal (IP), and SIGMA Clermont (SIGMA Clermont)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS)
Subjects: Adult, medicine.medical_specialty, Delphi Technique, Quality Assurance, Health Care, MEDLINE, Near Miss, Healthcare, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Pelvic Pain, Miscarriage, 03 medical and health sciences, 0302 clinical medicine, Belgium, Health care, Pelvic inflammatory disease, medicine, Humans, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Clinical Practice and Quality, Quality Indicators, Health Care, [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, 030219 obstetrics & reproductive medicine, business.industry, Case-control study, Obstetrics and Gynecology, Odds ratio, medicine.disease, Quality Improvement, Appendicitis, 3. Good health, Gynecology, Case-Control Studies, Emergency medicine, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Contents, Female, France, Emergencies, business, Emergency Service, Hospital
Abstract: Potentially life-threatening gynecologic emergencies are high-risk conditions that may serve as a useful framework to improve quality and safety in emergency care., OBJECTIVE: To define and assess the prevalence of potentially life-threatening gynecologic emergencies among women presenting for acute pelvic pain for the purpose of developing measures to audit quality of care in emergency departments. METHODS: We conducted a mixed-methods multicenter study at gynecologic emergency departments in France and Belgium. A modified Delphi procedure was first conducted in 2014 among health care professionals to define relevant combinations of potentially life-threatening conditions and near misses in the field of gynecologic emergency care. A prospective case–cohort study in the spring of 2015 then assessed the prevalence of these potentially life-threatening emergencies and near misses among women of reproductive age presenting for acute pelvic pain. Women in the case group were identified at 21 participating centers. The control group consisted of a sample of women hospitalized for acute pelvic pain not caused by a potentially life-threatening condition and a 10% random sample of outpatients. RESULTS: Eight gynecologic emergencies and 17 criteria for near misses were identified using the Delphi procedure. Among the 3,825 women who presented for acute pelvic pain, 130 (3%) were considered to have a potentially life-threatening condition. The most common diagnoses were ectopic pregnancies with severe bleeding (n=54; 42%), complex pelvic inflammatory disease (n=30; 23%), adnexal torsion (n=20; 15%), hemorrhagic miscarriage (n=15; 12%), and severe appendicitis (n=6; 5%). The control group comprised 225 hospitalized women and 381 outpatients. Diagnostic errors occurred more frequently among women with potentially life-threatening emergencies than among either hospitalized (odds ratio [OR] 1.7, 95% CI 1.1–2.7) or outpatient (OR 14.7, 95% CI 8.1–26.8) women in the control group. Of the women with potentially life-threatening conditions, 26 met near-miss criteria compared with six with not potentially life-threatening conditions (OR 25.6, 95% CI 10.9–70.7). CONCLUSIONS: Potentially life-threatening gynecologic emergencies are high-risk conditions that may serve as a useful framework to improve quality and safety in emergency care.
Published: 2020

13. A subset of activated fibroblasts is associated with distant relapse in early luminal breast cancer

Author: Yann Kieffer, Fatima Mechta-Grigoriou, Jean Marc Guinebretière, Roman Rouzier, Delphine Hequet, Floriane Pelon, Sylvain Ladoire, Christophe Blanchet, Anne Vincent-Salomon, Antoine Elies, Claire Bonneau, Brigitte Bourachot, Unité de génétique et biologie des cancers (U830), Institut Curie [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, Institut Curie [Paris], Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Institut National de la SantÃ© et de la Recherche MÃ©dicale, Inserm ANR-10-EQPX-03, INCa-DGOS-Inserm-12554, STROMAE INCa-DGOS-9963 Institut National Du Cancer, INCa: INCa-11692, INCa-DGOS-4654, INCa-DGOS-9963 Fondation pour la Recherche MÃ©dicale, FRM Institut Curie: PIC3i CAFi Ligue Contre le Cancer: PC201317 Fondation Simone et Cino Del Duca, C.B. was supported by the Institut National de la Santé et de la Recherche Médicale (Inserm, Plan Cancer - Formation à la recherche translationnelle), A.E. by the association d’aide en Cancérologie de Saint-Cloud (ARCS), and Y.K. by the Institut National du Cancer, INCa (INCa-DGOS-9963, INCa-11692), SIRIC (INCa-DGOS-4654), and the Fondation pour la Recherche Medicale (FRM). The experimental work was supported by grants from the Ligue Nationale Contre le Cancer (Labelisation), Inserm (PC201317), Institut Curie (Incentive and Cooperative Program Tumor Micro-environment PIC TME/T-MEGA, PIC3i CAFi), ICGex (ANR-10-EQPX-03), SIRIC (INCa-DGOS-4654), and INCa (STROMAE INCa-DGOS-9963, CaLYS INCa-11692, INCa-DGOS-Inserm-12554). F.M-G acknowledges both the Association 'Le cancer du sein, Parlons-en' and the Simone and Cino del Duca Foundation for attribution of their 'Grand Prix'. F.M-G is very grateful to all her funders for providing support throughout the years., and F.M-G. received research support from Innate-Pharma, Roche and Bristol-Myers-Squibb (BMS). R. R received financial support for research (travel reimbursement) and speaker honoraria from Nanostring Technologies. Other authors declare no potential conflict of interest.
Subjects: Oncology, CDH11, Receptor, ErbB-2, Stroma, Metastases, 0302 clinical medicine, Luminal breast cancer, Surgical oncology, Tumor Microenvironment, Aged, 80 and over, 0303 health sciences, Carcinoma, Ductal, Breast, Middle Aged, Prognosis, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Combined Modality Therapy, 3. Good health, Tumor infiltrating lymphocytes, Survival Rate, Cadherin 11, Receptors, Estrogen, 030220 oncology & carcinogenesis, Immunohistochemistry, Female, Receptors, Progesterone, Research Article, Adult, medicine.medical_specialty, Breast Neoplasms, [SDV.CAN]Life Sciences [q-bio]/Cancer, lcsh:RC254-282, 03 medical and health sciences, Breast cancer, Lymphocytes, Tumor-Infiltrating, Internal medicine, medicine, Biomarkers, Tumor, Humans, Clinical significance, TILs, Cancer-associated fibroblasts, 030304 developmental biology, Aged, business.industry, Tumor-infiltrating lymphocytes, medicine.disease, Carcinoma, Lobular, Tumor micro-environment, Case-Control Studies, Cancer cell, Cancer-Associated Fibroblasts, Neoplasm Recurrence, Local, business, Follow-Up Studies
Abstract: BackgroundEarly luminal breast cancer (BC) represents 70% of newly diagnosed BC cases. Among them, small (under 2 cm) BC without lymph node metastasis (classified as T1N0) have been rarely studied, as their prognosis is generally favorable. Nevertheless, up to 5% of luminal T1N0 BC patients relapse with distant metastases that ultimately prove fatal. The aim of our work was to identify the mechanisms involved in metastatic recurrence in these patients.MethodsOur study addresses the role that autonomous and non-autonomous tumor cell features play with regard to distant recurrence in early luminal BC patients. We created a cohort of T1N0 luminal BC patients (tumors between 0.5–2 cm without lymph node metastasis) with metastatic recurrence (“cases”) and corresponding “controls” (without relapse) matched 1:1 on main prognostic factors: age, grade, and proliferation. We deciphered different characteristics of cancer cells and their tumor micro-environment (TME) by deep analyses using immunohistochemistry. We performed in vitro functional assays and highlighted a new mechanism of cooperation between cancer cells and one particular subset of cancer-associated fibroblasts (CAF).ResultsWe found that specific TME features are indicative of relapse in early luminal BC. Indeed, quantitative histological analyses reveal that “cases” are characterized by significant accumulation of a particular CAF subset (CAF-S1) and decrease in CD4+T lymphocytes, without any other association with immune cells. In multivariate analysis, TME features, in particular CAF-S1 enrichment, remain significantly associated with recurrence, thereby demonstrating their clinical relevance. Finally, by performing functional analyses, we demonstrated that CAF-S1 pro-metastatic activity is mediated by the CDH11/osteoblast cadherin, consistent with bones being a major site of metastases in luminal BC patients.ConclusionsThis study shows that distant recurrence in T1N0 BC is strongly associated with the presence of CAF-S1 fibroblasts. Moreover, we identify CDH11 as a key player in CAF-S1-mediated pro-metastatic activity. This is independent of tumor cells and represents a new prognostic factor. These results could assist clinicians in identifying luminal BC patients with high risk of relapse. Targeted therapies against CAF-S1 using anti-FAP antibody or CDH11-targeting compounds might help in preventing relapse for such patients with activated stroma.
Published: 2020

14. Impact of Extent of Lymphadenectomy on Survival in Patients With Endometrial Cancer: A Matched Cohort Study

Author: Lea Pauly, Louise Benoit, Martin Koskas, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), and Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)
Subjects: Cancer Research, medicine.medical_specialty, Multivariate analysis, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Urology, survival, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Matched cohort, Endometrial cancer, Epidemiology, medicine, Clinical endpoint, Humans, In patient, Pelvic lymphadenectomy, pelviclymphadenectomy, para aortic lymphadenectomy, business.industry, General Medicine, Middle Aged, medicine.disease, Endometrial Neoplasms, 3. Good health, Survival Rate, Oncology, 030220 oncology & carcinogenesis, Lymph Node Excision, Female, Lymphadenectomy, business
Abstract: International audience; Background/Aim: This study aimed to determine whether a pelvic and para-aortic lymphadenectomy (PPAL) improves survival compared with a pelvic lymphadenectomy (PL) in patients with endometrial cancer. Patients and Methods: Data from all women operated for endometrial cancer between 1998 and 2013 were extracted from the Surveillance, Epidemiology and End Results database. Women treated with PL were matched with those treated with PPAL according to age and risk of recurrence. The primary endpoint was disease-specific survival (DSS). Results: A total of 1015 patients who underwent PL were matched with 1015 patients who underwent PPAL. The 3-year DSS probabilities for patients at intermediate- and high-risk (IHR) of recurrence were similar in the PPAL group and the PL group. Multivariate analysis of prognostic factors indicated that in patients with an IHR of recurrence, PPAL did not reduce the risk of death compared with PL. Conclusion: For patients with an IHR of recurrence, the extent of lymphadenectomy does not impact DSS.
Published: 2020

15. A Pre-operative Score to Discriminate Fibroepithelial Lesions of the Breast: Phyllode Tumor or Fibroadenoma?

Author: J.-L. Benifla, Julien Seror, Vinciane Placé, Amelie Zeller, Françoise Cornelis, Laurene Majoulet, Pascal Cherel, Eva Marchand, Matthieu Mezzadri, Roman Rouzier, Camille Mimoun, 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 [Hopital Lariboisière - Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université de Paris (UP), and Hôpital René HUGUENIN (Saint-Cloud)
Subjects: Adult, Cancer Research, medicine.medical_specialty, Fibroepithelial lesions, [SDV]Life Sciences [q-bio], Clinical Decision-Making, Breast Neoplasms, Logistic regression, Phyllodes tumors, Diagnosis, Differential, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Neoplasms, Fibroepithelial, Phyllodes Tumor, Biopsy, medicine, Humans, Mammography, Breast, Retrospective Studies, medicine.diagnostic_test, Tumor size, business.industry, Score, Disease Management, Phyllodes tumor, General Medicine, Decision rule, Middle Aged, medicine.disease, Fibroadenoma, Pre operative, 3. Good health, ROC Curve, Oncology, 030220 oncology & carcinogenesis, Female, Biopsy, Large-Core Needle, Radiology, business
Abstract: International audience; Background/Aim: Fibroepithelial lesions (FEL) of the breast include fibroadenomas and phyllodes tumors (PT). Their histologic characteristics on core needle biopsy can overlap, while their clinical management is different. The aim of this study was to develop and to validate a pre-operative score for the diagnosis of PT with surgical decision rules. Patients and Methods: We developed a pre-operative score for the diagnosis of PT by performing logistic regression on 217 FEL of the Rene Huguenin Hospital. This score and the surgical decision rules were validated on 87 FEL of the Lariboisiere Hospital. Results: Three variables were independently and significantly associated with PT: Age ≤40 years, mammography's tumor size ≤3 cm and PT diagnosed by CNB. The pre-operative score was based on these three criteria with values ranging from 0 to 10. Surgical decision rules were created: The low-risk group of PT (score≥2) had a sensitivity of 92.6% and a LR-of 0.2, the high-risk group (score>7) had a specificity of 93.5% and a LR+ of 4.4. In the validation sample, surgical decision rules were applied. Conclusion: These surgical decision rules may prove useful in deciding which FEL needs surgical resection.
Published: 2020

16. Evaluation of the usefulness of ultrasound measurement of the lower uterine segment before delivery of women with a prior cesarean delivery: a randomized trial

Author: 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.
Subjects: 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.
Published: 2022

17. Do obstetricians apply the national guidelines? A vignette‐based study assessing practices for the prevention of preterm birth

Author: Anne Rousseau, M. V. Senat, S. Baumann, E Azria, C Deneux-Tharaux, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), 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), Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), and AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre)
Subjects: medicine.medical_specialty, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Population, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Bed rest, Adherence to guidelines, 03 medical and health sciences, Obstetric Labor, Premature, 0302 clinical medicine, Qualitative analysis, 030202 anesthesiology, Pregnancy, quality of care, Physicians, Surveys and Questionnaires, prevention of preterm birth, Humans, Medicine, 030212 general & internal medicine, education, Aged, education.field_of_study, 030219 obstetrics & reproductive medicine, business.industry, Preterm labour, Infant, Newborn, Obstetrics and Gynecology, Survey research, Guideline, 3. Good health, Short cervix, Cross-Sectional Studies, Vignette, Family medicine, case vignette, Premature Birth, Female, business
Abstract: Objective To describe spontaneous preterm birth prevention practices self-reported before and after the dissemination of relevant guidelines, and to identify personal and organisational factors associated with adherence. Design A repeated cross-sectional vignette-based survey study. Setting French obstetricians. Population French obstetricians practicing in public or private maternity units. Methods Before and after the dissemination of the 2017 French guidelines on the prevention of spontaneous preterm birth, participants were asked to complete a web-based self-administered questionnaire based on two clinical vignettes. Vignette 1 focused on respondents' attitudes towards strict bed rest, cerclage, and progesterone treatment for women with a short cervix in mid-trimester; vignette 2 focused on attitudes towards strict bed rest and maintenance tocolysis after successful tocolysis for preterm labour. A mixed quantitative and qualitative analysis was conducted. Main outcome measures Non-adherence to guidelines for the prevention of spontaneous preterm birth in responses to each vignette. Results We obtained complete responses from 286 obstetricians before and 282 obstetricians after guideline dissemination, including 145 obstetricians participating in both. After dissemination, 51.4% of obstetricians self-reported non-adherent practices for vignette 1 and 22.3% of obstetricians self-reported non-adherent practices for vignette 2. No improvement was observed after dissemination. The quantitative analysis identified factors associated with non-adherence, including older age and practice in non-university or small hospitals, whereas the qualitative analysis highlighted barriers to implementation, including fear of change, habits, work overload, and lack of time. Conclusions Adherence to guidelines was generally low, with practices unmodified by their dissemination. Improvement is required, especially regarding applicability. Tweetable abstract Adherence to guidelines to prevent spontaneous preterm birth was generally low and remained unmodified after guideline dissemination.
Published: 2019

18. Lymphovascular invasion as a criterion for adjuvant chemotherapy for FIGO stage I-IIa clear cell carcinoma, mucinous,low grade serous and low grade endometrioid ovarian cancer

Author: Geoffroy Canlorbe, Julie Delvallée, Lobna Ouldamer, Charles Coutant, Alexandre Bricou, Pierre Collinet, Emile Daraï, Cyril Touboul, Sofiane Bendifallah, Gilles Body, Cherif Akladios, Mathilde Cancel, Camille Mimoun, Pierre-Adrien Bolze, Xavier Carcopino, Cyrille Huchon, Marcos Ballester, Yohann Dabi, Vincent Lavoué, Nutrition, croissance et cancer (U 1069) (N2C), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHI Créteil, CHU Lille, Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, CHU Strasbourg, Chemistry, Oncogenesis, Stress and Signaling (COSS), Université de Rennes (UR)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Gynécologie et Obstétrique [Rennes] = Gynaecology [Rennes], CHU Pontchaillou [Rennes], Hospices Civils de Lyon (HCL), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Pitié-Salpêtrière [AP-HP], Groupe Hospitalier Diaconesses Croix Saint-Simon, Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Avignon Université (AU)-Aix Marseille Université (AMU)-Institut de recherche pour le développement [IRD] : UMR237-Centre National de la Recherche Scientifique (CNRS), Hôpital Lariboisière-Fernand-Widal [APHP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS)-Institut de recherche pour le développement [IRD] : UMR237-Aix Marseille Université (AMU)-Avignon Université (AU), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-CRLCC Eugène Marquis (CRLCC)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), and Jonchère, Laurent
Subjects: Oncology, endocrine system diseases, Lymphovascular invasion, Adjuvant chemotherapy, 0302 clinical medicine, Overall survival, Stage (cooking), Neoplasm Metastasis, Aged, 80 and over, Ovarian Neoplasms, education.field_of_study, 030219 obstetrics & reproductive medicine, Obstetrics and Gynecology, Middle Aged, Prognosis, Adenocarcinoma, Mucinous, Lymphovascular, female genital diseases and pregnancy complications, 3. Good health, Serous fluid, Chemotherapy, Adjuvant, 030220 oncology & carcinogenesis, Clear cell carcinoma, Female, France, Adult, medicine.medical_specialty, Adolescent, Lymphovascular space invasion, Population, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Decision Support Techniques, 03 medical and health sciences, [SDV.CAN] Life Sciences [q-bio]/Cancer, Ovarian cancer, Internal medicine, medicine, Humans, education, [SDV.BDLR] Life Sciences [q-bio]/Reproductive Biology, Aged, Neoplasm Staging, Retrospective Studies, business.industry, [SDV.BDLR]Life Sciences [q-bio]/Reproductive Biology, medicine.disease, Recurrence-free survival, Endometrial Neoplasms, [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Reproductive Medicine, business, Adenocarcinoma, Clear Cell
Abstract: International audience; BACKGROUND: The aim of this study was to evaluate the impact of lymphovascular space invasion (LVSI) on overall survival (OS) and recurrence-free survival (RFS) in patients managed for stage I-IIa clear cell carcinoma, mucinous, low-grade serous and low-grade endometrioid ovarian cancer MATERIAL AND METHODS: Retrospective multicentre study of the research group FRANCOGYN between January 2001 and December 2018. All patients managed for stage I-IIa clear cell carcinoma, mucinous /low grade serous and endometrioid ovarian cancer and for whom the presence of histological slides for the review of LVSI was available, were included. Patient’s characteristics with LVSI (LVSI group) were compared to those without LVSI (No LVSI group). A cox analysis for OS and RFS analysis were performed in all population. RESULTS: Over the study period, 133 patients were included in the thirteen institutions. Among them, 12 patients had LVSI (9%). LVSI was an independent predictive factor for poorer Overall and recurrence free survivals. LVSI affected OS (p
Published: 2021

19. Access-to-care: evidence from home-based postnatal coordinated care after hospital discharge

Author: Carine Milcent, Saad Zbiri, Patrick Rozenberg, 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), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), The authors would like to thank the public health insurance agency of the Yvelines district for the access to the data and helpful support., Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Centre National de la Recherche Scientifique (CNRS), Université Paris 1 Panthéon-Sorbonne (UP1)-École normale supérieure - Paris (ENS-PSL), and 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)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)
Subjects: Postnatal Care, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Context (language use), Midwifery, Health professional accessibility, Health informatics, Inequity, Health administration, [SHS]Humanities and Social Sciences, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Health care, Humans, Medicine, 030212 general & internal medicine, Child, Socioeconomic status, business.industry, Research, 4. Education, 030503 health policy & services, Health Policy, Public health, Nursing research, Home Care Services, Hospitals, Patient Discharge, 3. Good health, Patient information, Postnatal care, Family medicine, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Public aspects of medicine, RA1-1270, 0305 other medical science, business, Home-based coordinated care
Abstract: Background Home-based postnatal care after hospital discharge has become an integral part of postnatal care. This study aimed to determine the factors relating either to individuals or the healthcare system that affect enrollment and full participation (adherence) in the French home-based postnatal coordinated care program (PRADO). Methods All admitted women for delivery in a French district over one year and eligible for this home-based midwifery support after hospital discharge were included (N = 4189). Both a simple probit model and a probit Heckman selection model were used. The control variables were the characteristics of the women, the municipalities, and the hospitals. Results Approximately 68% of the eligible women chose to enroll in the PRADO program, of who nearly 60% fully participated in this program. Enrollment in the program was influenced mostly by the family context, such as the woman’s age at the time of her pregnancy and the number of children in the household, the woman’s level of prenatal education and information about postnatal care, as well as some hospital variables such as the characteristics and organization of the maternity units. Full participation in the program was influenced by the accessibility to health professionals, particularly midwives. Furthermore, the women’s level of prenatal education and information about postnatal care, as well as their accessibility to health professionals, correlated with the socioeconomic environment. Conclusion While individual factors impacted enrollment in the PRADO program, only healthcare system-related factors influenced full participation in the program. A public health policy promoting home-based postnatal care could increase the women’s participation by improving their level of prenatal education and information about postnatal care. In addition, reducing regional inequality is likely to have a positive impact, as the availability of health professionals is a key factor for participation in home-based postnatal coordinated care.
Published: 2021

20. Supplementary private health insurance: The impact of physician financial incentives on medical practice

Author: Carine Milcent, Saad Zbiri, 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), Paris Jourdan Sciences Economiques (PJSE), Université Paris 1 Panthéon-Sorbonne (UP1)-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)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), and This work has been funded by a French government subsidy managed by the Agence Nationale de la Recherche under the framework of the Investissements d'avenir programme reference ANR-17-EURE-001.
Subjects: [SDV]Life Sciences [q-bio], Payment system, Social Welfare, [SHS]Humanities and Social Sciences, Hospitals, Private, 03 medical and health sciences, 0302 clinical medicine, Financial incentives, Pregnancy, Universal Health Insurance, Physicians, Health insurance, Physician financial incentives, Public healthcare system, Humans, [INFO]Computer Science [cs], 030212 general & internal medicine, Reimbursement, health care economics and organizations, DGR-based payment, Motivation, Actuarial science, Supplementary private health insurance, Insurance, Health, business.industry, 030503 health policy & services, Health Policy, Medical practice, Cesarean delivery, [SHS.ECO]Humanities and Social Sciences/Economics and Finance, Preference, 3. Good health, Incentive, Female, Business, 0305 other medical science
Abstract: International audience; In the French diagnosis-related group (DRG)-based payment system, both private and public hospitals are financed by a public single payer. Public hospitals are overcrowded and have no direct financial incentives to choose one procedure over another. If a patient has a strong preference, they can switch to a private hospital. In private hospitals, the preference does come into play, but the patient has to pay for the additional cost, for which they are reimbursed if they have supplementary private health insurance. Do financial incentives from the fees received by physicians for different procedures drive their behavior? Using French exhaustive data on delivery, we find that private hospitals perform significantly more cesarean deliveries than public hospitals. However, for patients without private health insurance, the two sectors differ much less in terms of cesareans rate. We determine the impact of the financial incentive for patients who can afford the additional cost. Affordability is mainly ensured by the reimbursement of costs by private health insurance. These findings can be interpreted as evidence that, in healthcare systems where a public single payer offers universal coverage, the presence of supplementary private insurance can contribute to creating incentives on the supply side and lead to practices and an allocation of resources that are not optimal from a social welfare perspective.
Published: 2021

21. Ulipristal Acetate Modifies miRNA Expression in Both Superficial and Basal Layers of the Human Endometrium

Author: J. Varinot, Martin Koskas, Selim Aractingi, Geoffroy Canlorbe, Kamila Kolanska, Maria Sbeih, Arsène Mekinian, Emile Daraï, Nathalie Chabbert-Buffet, Perrine Capmas, Gestionnaire, HAL Sorbonne Université 5, 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), Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Service de Gynécologie-Obstétrique, Maternité, Chirurgie Gynécologique [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Service de médecine interne [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Service de Pathologie [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), 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, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), 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), Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: Microarray, basal and functional layer, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Endometrium, medicine.disease_cause, Article, Andrology, 03 medical and health sciences, chemistry.chemical_compound, Basal (phylogenetics), 0302 clinical medicine, Ulipristal acetate, microRNA, Selective progesterone receptor modulator, ulipristal acetate, medicine, endometrium, 030304 developmental biology, miRNA, 0303 health sciences, 030219 obstetrics & reproductive medicine, business.industry, General Medicine, Cell cycle, 3. Good health, [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, medicine.anatomical_structure, chemistry, Medicine, Carcinogenesis, business
Abstract: (1) Background: Ulipristal acetate (UPA) is a selective progesterone receptor modulator (SPRM) widely used for emergency contraception and mid- to long-term leiomyoma treatment. The aim of this study was to identify modifications of miRNA expression in superficial and basal layers of the human endometrium at the end of the UPA treatment for at least 3 months. (2) Methods: Microarray miRNA analysis of formalin-fixed, paraffin-embedded hysterectomy tissue samples was conducted, followed by an Ingenuity Pathway Analysis. Samples were divided into three groups: women having had 3 months of UPA treatment (n = 7), and two control groups of UPA-naïve women in the proliferative (n = 8) or secretory (n = 6) phase. (3) Results: The UPA modified the expression of 59 miRNAs involved in the processes of cell cycle, carcinogenesis, and inflammation. Their expression profiles were different in the basal and superficial layers. Most of the processes influenced by the UPA in the basal layer were connected to the cell cycle and immune regulation. (4) Conclusion: Specific changes were observed in both layers of the endometrium in the UPA group. However, the miRNA expression in the basal layer was not consistent with that in the superficial layer. Other large studies analysing the long-term impact of SPRM on endometrial miRNA expression are necessary.
Published: 2021

22. Impact of the information for HPV vaccination given to parents with girls in the age of 11-14

Author: Roy, S, Sellier, Y, Charlier, C, Viseux-Wahl, E, Rousseau, A, Université de Versailles Saint-Quentin-en-Yvelines - Département de maïeutique (UVSQ ESF), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Equipe d’Accueil 73-28, Université Paris Descartes, Sorbonne Paris Cité, Paris, Assistance publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France, Partenaires INRAE, CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), University Paris Descartes Sorbonne Paris Cité, Imagine Institute, Paris, École de sages-femmes Hôpital Foch (ESF Foch), Hôpital Foch [Suresnes], and Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ)
Subjects: Human papillomavirus, HPV vaccination, Information, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Abstract: Objectives: Vaccination against human papillomaviruses (HPV) prevents over 70% of precancerous lesions leading to cervical cancer. In 2016 in France, 19.5% of girls aged 16 benefited from a comprehensive immunisation strategy, contrarily to countries like Sweden and Great-Britain where that rate nears 80%. The study aim was to evaluate the impact on HPV vaccination of information given to parents of girls aged 11 to 14.Study design: A descriptive study used questionnaires to evaluate parents’ knowledge and opinion on HPV vaccination before and after reading an information leaflet. It included parents of girls aged 11 to 14 not previously vaccinated against HPV. Results: There were 106 questionnaires analysed. The initial level of information was poor: 10 of 11 questions assessing knowledge scored below 50% of correct answers. After reading the leaflet, knowledge increased significantly while adherence rose by 74%. Among the 51% initially undecided, 20% intended on vaccinating their daughter after being informed. Conclusion: The leaflet enhanced knowledge and strengthened intention to vaccinate. However, parents’ adherence to vaccination remained moderate. Digital information must be provided alongside communication campaigns by healthcare professionals. This requires identifying levers and barriers and adapting vaccination strategies.
Published: 2021

23. Lymphovascular space invasion and estrogen receptor status in high-grade serous ovarian cancer - A multicenter study by the FRANCOGYN group

Author: Camille Mimoun, Jerome Lorenzini, Geoffroy Canlorbe, Vincent Lavoué, Marion Deberti, Pierre Collinet, Cherif Akladios, Alexandre Bricou, Cyril Touboul, Charles Coutant, Xavier Carcopino, Cyrille Huchon, Yohann Dabi, Gilles Body, Pierre-Adrien Bolze, Sofiane Bendifallah, Lobna Ouldamer, CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Nutrition, croissance et cancer (U 1069) (N2C), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Centre National de la Recherche Scientifique (CNRS)-Institut de recherche pour le développement [IRD] : UMR237-Aix Marseille Université (AMU)-Avignon Université (AU), CHI Créteil, Hôpital Jeanne de Flandre [Lille], Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER, CHU Strasbourg, CHU Pontchaillou [Rennes], Chemistry, Oncogenesis, Stress and Signaling (COSS), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hospices Civils de Lyon, Departement de Neurologie (HCL), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), CHI Poissy-Saint-Germain, Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Avignon Université (AU)-Aix Marseille Université (AMU)-Institut de recherche pour le développement [IRD] : UMR237-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UR)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-CRLCC Eugène Marquis (CRLCC)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), and Jonchère, Laurent
Subjects: Oncology, Adult, medicine.medical_specialty, [SDV.CAN]Life Sciences [q-bio]/Cancer, Kaplan-Meier Estimate, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, 03 medical and health sciences, 0302 clinical medicine, [SDV.CAN] Life Sciences [q-bio]/Cancer, Internal medicine, Serous ovarian cancer, Overall survival, Medicine, Humans, Estrogen Receptor Status, Pathology Examination, Aged, Retrospective Studies, Aged, 80 and over, Ovarian Neoplasms, 030219 obstetrics & reproductive medicine, business.industry, Overall Survival, Lymphovascular Space Invasion, Obstetrics and Gynecology, Middle Aged, Prognosis, Lymphovascular, 3. Good health, Predictive factor, [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Serous fluid, Recurrence-Free Survival, Reproductive Medicine, Multicenter study, Receptors, Estrogen, 030220 oncology & carcinogenesis, Lymphatic Metastasis, Female, France, business, High-Grade Serous
Abstract: International audience; BACKGROUND: The aim of this study was to evaluate the impact of Lymphovascular Space Invasion (LVSI) on Overall Survival (OS) and Recurrence-Free Survival (RFS) in patients managed for high-grade serous epithelial ovarian cancer (HGSOC). MATERIALS AND METHODS: Retrospective multicenter study by the FRANCOGYN research group between January 2001 and December 2018. All patients managed for HGSOC and for whom histological slides for the review of LVSI were available, were included. The characteristics of patients with LVSI (LVSI group) were compared to those without LVSI (No LVSI group). A Cox analysis for OS and RFS analysis was performed in all populations. RESULTS: Over the study period, 410 patients were included in the thirteen institutions. Among them, 289 patients had LVSI (33.9%). LVSI was an independent predictive factor for poorer Overall and Recurrence-Free Survival. LVSI affected OS (p
Published: 2021

24. The ENDOPAIN 4D Questionnaire: A New Validated Tool for Assessing Pain in Endometriosis

Author: Anne Oppenheimer, Anne Puchar, Pierre Panel, Arnaud Fauconnier, Joseph Du Cheyron, Xavier Fritel, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Centre Hospitalier de Versailles André Mignot (CHV), 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, and Centre hospitalier universitaire de Poitiers (CHU Poitiers)
Subjects: endometriosis, medicine.medical_specialty, pain symptoms in endometriosis, Urinary system, [SDV]Life Sciences [q-bio], Endometriosis, Article, 03 medical and health sciences, 0302 clinical medicine, Cronbach's alpha, Pain assessment, Internal medicine, medicine, pain assessment, 030212 general & internal medicine, 10. No inequality, 030219 obstetrics & reproductive medicine, business.industry, Minimal clinically important difference, General Medicine, questionnaires, medicine.disease, 3. Good health, Clinical trial, Assessing Pain, validation study, Medicine, Observational study, business
Abstract: International audience; Objectives: To study the measurement properties, the responsiveness and the minimal clinically important difference of the ENDOPAIN-4D: a new questionnaire for assessing pain in endometriosis. Methods: A prospective, observational, multicentre study was conducted including all women ≥18 years consulting for symptomatic proven endometriosis between 1 January 2017 and 30 June 2018 and volunteering to participate. Each patient had to answer a new self-administered patient-reported outcome (PRO) questionnaires (the ENDOPAIN-4D) at inclusion (T0) and 12 months after medical or surgical treatment (T1). Criteria defined by COSMIN were used to validate the questionnaire's measurement properties. The minimal clinically important difference was esti-mated by the anchor-based method. Results: The study included 199 women. The ENDOPAIN-4D score had a four dimensional structure with good internal consistency (measured by Cronbach α): I) pain-related disability (α = 0.79), II) painful bowel symptoms (α = 0.80), III) dyspareunia (α = 0.83), and IV) painful urinary tract symptoms (α = 0.77). They produced four subscores that can be summed to obtain a single score (α = 0.61). The ENDOPAIN-4D total score ranged from 0 to 94.00 (mean ± SD: 46.7 ± 22). The total score was significantly correlated with the PROs used in endome-triosis. Sensitivity to change was good with large effect sizes (ES) (mean of the differences: 36.3 p = 1.8 10−7, ES 0.76). The minimal clinically important difference of the global score was determined to be 10.9. Conclusions: The ENDOPAIN-4D questionnaire is easy to use, valid, and effective in assessing patient reported pain symptoms in women treated for endometriosis. This new instrument can be used as the primary outcome for future clinical trials and as a tool for routine patient follow-up.
Published: 2021

25. The Underestimated Prevalence of Neglected Chronic Pelvic Pain in Women, a Nationwide Cross-Sectional Study in France

Author: Henri Panjo, Arnaud Fauconnier, Xavier Fritel, Virginie Ringa, Marie Zins, F. Margueritte, Marcel Goldberg, Demarquay, Sandrine, Sexualité et soins (Genre, Sexualité, Santé) (CESP - INSERM U1018 - Equipe 7), 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-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, CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Cohortes épidémiologiques en population (CONSTANCES), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université Paris Cité (UPCité), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), and The French CONSTANCES cohort is funded by the Agence nationale de la recherche (ANR-11-INBS-0002 grant), the Caisse Nationale d’Assurance Maladie des travailleurs salariés-CNAMTS, the Institut de Recherche en Santé Publique/Institut Thématique Santé Publique, the Ministère de la santé et des sports, the Ministère délégué à la recherche, the Institut national de la santé et de la recherche médicale, the Institut national du cancer et Caisse nationale de solidarité pour l’autonomie. CONSTANCES is also partly funded by MSD, AstraZeneca and Lundbeck managed by INSERM-Transfert.
Subjects: Moderate to severe, medicine.medical_specialty, Cross-sectional study, Women's health, [SDV]Life Sciences [q-bio], Population, Reproductive age, chronic pelvic pain, dysmenorrhea, Article, 03 medical and health sciences, 0302 clinical medicine, women’s health, Medicine, 030212 general & internal medicine, education, education.field_of_study, 030219 obstetrics & reproductive medicine, non-menstrual chronic pelvic pain, business.industry, Obstetrics, Pelvic pain, dyspareunia, General Medicine, Confidence interval, [SDV] Life Sciences [q-bio], medicine.symptom, business, Cohort study
Abstract: Dysmenorrhoea, dyspareunia, and non-menstrual chronic pelvic pain (NMCPP) are symptoms that are probably underreported and neglected. This study aimed to assess the prevalence and overlapping relations between these symptoms among a general population of French women of reproductive age. A cross-sectional study among the nationwide CONSTANCES cohort study recruiting a representative sample of women within different French areas was constructed. Women aged 18–49 years (n = 21,287) who reported periods in the previous three months and experienced intercourse at least once were asked about prevalence of three types of chronic pelvic pain: mild, moderate and severe dysmenorrhea, dyspareunia assessed according to its frequency, NMCPP from a binary question. Between the start of 2012 through the end of 2017, 21,287 women were enrolled, 39.8% of them (95% confidence interval (CI), 39.2–40.5) reported moderate to severe dysmenorrhea, 20.3% (95% CI, 18.7–21.9) of the youngest group (18–24 years) reported severe dysmenorrhea. Dyspareunia was reported to happen often or always by 7.9% (95% CI, 7.5–8.2) and peaked among the youngest women at 12.8% (95% CI, 11.5–14.1). NMCPP was reported by 17.0% (95% CI, 16.5–17.5). Moreover, 7.5% (95% CI, 6.4–8.6) of the women reported two or more types of severe or frequent pain. More attention should be paid to this substantial proportion (7.5%) of French women of reproductive age who experience multiple, severe and frequent pelvic pain symptoms.
Published: 2021
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26. Ovarian protection and fertility preservation in women with cancer: A French national registry analysis between 2005 and 2014

Author: Martin Koskas, Claire Gauche Cazalis, Juliette Phelippeau, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), and Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)
Subjects: Adult, Organs at Risk, endocrine system, medicine.medical_specialty, Adolescent, endocrine system diseases, [SDV]Life Sciences [q-bio], medicine.medical_treatment, media_common.quotation_subject, Fertility, Gonadotropin-Releasing Hormone, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Neoplasms, Humans, Medicine, Registries, Fertility preservation, media_common, Cryopreservation, Chemotherapy, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics, Patient Selection, Ovary, Fertility Preservation, Obstetrics and Gynecology, Cancer, Oocyte cryopreservation, medicine.disease, 3. Good health, Reproductive Medicine, 030220 oncology & carcinogenesis, Oocytes, Female, France, National registry, business, Hormone
Abstract: Ovarian failure is a common effect of treatment for cancer. The aim of this study was to describe the practices concerning ovarian protection and fertility preservation in young women treated for cancer.Women between 15 and 49 years old diagnosed with cancer between 2005 and 2014 were studied, abstracted from a representative French National Healthcare database. To assess practices concerning ovarian protection, gonadotropin-releasing hormone (GnRH) agonist consumption and ovarian transposition were analyzed. For fertility preservation, GnRH agonist consumption, ovarian cryopreservation and oocyte cryopreservation were analyzed. Explanatory variables were analyzed using a multilevel model.A total of 2447 women were identified. Among the 553 patients exposed to ovarian failure, 74 (13%) had ovarian protection (67 received GnRH agonists, 7 underwent ovarian transposition). Among the 227 women exposed to fertility alteration, 53 (23%) had fertility preservation (37 received GnRH agonists, 16 had ovarian or oocyte cryopreservation). Factors associated with ovarian protection were age under 40 years old (OR = 1.56 [1.5-1.62], p = 0.006) and diagnosis of breast cancer (OR = 1.15 [1.08-1.22], p 0.001). The only factor associated with fertility preservation was breast cancer (OR = 1.17 [1.1-1.24], p 0.001). The five-year probability of pregnancy was 3.8% and 9.8% (p = 0.26) for women with and without fertility preservation, respectively.Over the last decade, ovarian protection and fertility preservation concerned 13% and 23%, respectively, of young French women treated for cancer. Awareness about ovarian protection and fertility preservation remain insufficient and need to be extended to improve this major aspect of cancer management.
Published: 2019

27. Is training sufficient for ultrasound operators to diagnose deep infiltrating endometriosis and bowel involvement by transvaginal ultrasound?

Author: A. Roséfort, Cyrille Huchon, Arnaud Fauconnier, A. Paternostre, S. Estrade, J.-P. Bernard, Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Centre Hospitalier Versailles, 78000 Le Chesnay, France, and parent
Subjects: Adult, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Health Personnel, Endometriosis, Diagnostic accuracy, Ultrasound operator training, Sensitivity and Specificity, 03 medical and health sciences, 0302 clinical medicine, Bowel endometriosis, medicine, Humans, Ultrasonography, 030219 obstetrics & reproductive medicine, Transvaginal ultrasonography, business.industry, Transvaginal ultrasound, Ultrasound, Rectum, Obstetrics and Gynecology, Deep infiltrating endometriosis, Confidence interval, Intestines, Reproductive Medicine, 030220 oncology & carcinogenesis, Female, Clinical Competence, Radiology, business
Abstract: International audience; Objectives: To assess and compare the diagnostic accuracy of transvaginal ultrasonography (TVUS) by trained or untrained ultrasound operators in deep infiltrating endometriosis (DIE) imaging, for diagnosing DIE and bowel involvement. Methods: This was an observational study of patients with clinically suspected DIE operated in a reference center. TVUS was performed pre-operatively by a trained or/and untrained ultrasound operator to search for DIE and rectal involvement. During surgery, DIE was diagnosed according to macroscopic and histological criteria. Sensitivity (Se), specificity (Sp) and c-index were calculated with 95% confidence intervals for trained and untrained operators, if TVUS results were significantly predictive of DIE and rectal involvement at p < 0.05. Results: 115 patients were included: 100 (87%) had DIE and 34 (29.6%) had bowel involvement. TVUS was performed by a trained ultrasound operator for 70 patients and by an untrained one for 56 patients. When performed by a trained operator, TVUS significantly predicted DIE with a Se of 58% (95% CI, 46–70), a Sp of 87.5% (95% CI, 63–100) and a c-index of 0.73 (95% CI, 0.59–0.87). TVUS performed by an untrained operator was not significantly predictive of DIE (p = 0.58). Rectal involvement was significantly predicted by TVUS performed by a trained operator with a Se of 40% (95% CI, 23–59), a Sp of 93% (95% CI, 86–100) and a c-index of 0.67 (95% CI, 0.56–0.77). None of the untrained ultrasound operators diagnosed a bowel involvement. Conclusion: TVUS is not sufficient to diagnose DIE and bowel involvement, in particular when performed by untrained ultrasound operators.
Published: 2019

28. Arabin pessary to prevent adverse perinatal outcomes in twin pregnancies with a short cervix: a multicenter randomized controlled trial (PESSARONE)

Author: 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
Subjects: 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
Published: 2022

29. Adaptation of independent midwives to the COVID-19 pandemic: A national descriptive survey

Author: Sophie Baumann, Anne Rousseau, Sylvain Gautier, Laurent Gaucher, Yann Bourgueil, Olivier Saint-Lary, 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, Health Service and Performance Research (HESPER), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, EA Management des Organisations de Santé (EA MOS), École des Hautes Études en Santé Publique [EHESP] (EHESP)-PRES Sorbonne Paris Cité, 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, Hôpital Raymond Poincaré [AP-HP], EA 7285, and We thank the ACCORD network (Assembler, Coordonner, COmprendre, Rechercher, D?battre en soins primaires) for their reflection and help in the construction of the questionnaire. ACCORD is composed of the National College of GP Instructors (CNGE), National Federation of Multiprofessional Health Houses (AVECSant?), Research Institute of Health Care Centres (IJFR), URE RETINES (Risque, Epid?miologie, Territoire, INformations, Education en sant?) Universit? de Nice, National Association of Health Teams in Primary Care (ASALEE), Mission RESPIRE (EHESP) and the Midwifery Department, EA 7285, Versailles Saint Quentin University group. We thank Adrien Gantois as president of the French national college of midwives (Coll?ge National des Sages-Femmes de France) and the French union of midwives (Organisation nationale syndicale des sages-femmes) for the distribution of the survey, and Jo Ann Cahn for editing our English.
Subjects: Adult, Male, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Nurse Midwives, [SDV]Life Sciences [q-bio], Population, Context (language use), 030204 cardiovascular system & hematology, Midwifery, Article, 03 medical and health sciences, 0302 clinical medicine, midwife practice, Pregnancy, Surveys and Questionnaires, Pandemic, Adaptation, Psychological, Maternity and Midwifery, Obstetrics and Gynaecology, medicine, Humans, 030212 general & internal medicine, Adaptation (computer science), education, education.field_of_study, SARS-CoV-2, Health services research, Obstetrics and Gynecology, COVID-19, Middle Aged, health services research, 3. Good health, Family medicine, Anxiety, Mainland, Female, France, medicine.symptom, Psychology, survey study
Abstract: Highlights • Midwives have adapted their activities without waiting for instructions from the authorities. • Birth preparation activities suffer most from this adaptation. • Adaptation of activities raises questions about how best to ensure continuity and safety of care., Objective : The main objective of this survey was to identify how independent midwives, mainly working in primary care, adapted their practices at the beginning of the COVID-19 pandemic in France. Our assumption was that this practice adaptation would vary according to both geographical area (timing of pandemic effect) and whether they practiced alone or in a group. Design We conducted an online national survey of independent midwives in France from March 16–23, 2020. Setting All districts in mainland France and the overseas territories. Participants Respondents from the population of all independent midwives working in France. Measurements and findings The primary outcome measure was the proportion of midwives reporting that they had adapted their practices to the context of the COVID-19 pandemic, and the rank, in order of frequency, of the postponed or cancelled activities. Results : Of the 1517 midwives who responded, i.e., 20.3% of the independent midwives in France, 90.6% reported adapting one or more of their practices . The main adjustment was the postponement or cancellation of consultations deemed non-essential, listed in descending order: postpartum pelvic floor rehabilitation (n=1270, 83.7%), birth preparation (n=1188, 78.3%), non-emergency preventive gynaecology consultation (n=976, 64.3%), early prenatal interview (n=170, 11.2%), and postnatal follow-up (n=158, 10.4%). Key conclusions Without guidelines, each midwife had to decide individually if and how to adapt her practice. Postpartum pelvic floor rehabilitation and birth preparation have been strongly affected. The results of this national survey indicate that a large majority of midwives have adapted their practices, independently of the local course of the pandemic, and that this reduction of contacts with women raises questions in this period of anxiety about intermediate-term adaptations to guarantee the continuity and safety of care. Implications for practice This study's results can be used to develop tools to handle cancelled consultations. Video, also called virtual, visits and coordination between independent practitioners and hospitals are probably the major challenges in the current context.
Published: 2021
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30. ‘A caesarean section is like you've never delivered a baby’: A mixed methods study of the experience of childbirth among French women

Author: Schantz, Clémence, Pantelias, Anne-Charlotte, de Loenzien, Myriam, Ravit, Marion, Rozenberg, Patrick, Louis-Sylvestre, Christine, Goyet, Sophie, Institut du Fer à Moulin (IFM - Inserm U1270 - SU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Santé, vulnérabilités et relations de genre au sud (SAGESUD - ERL Inserm U1244), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité)-Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité), Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), École de sages-femmes Hôpital Foch (ESF Foch), Hôpital Foch [Suresnes], Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy], Institut Mutualiste de Montsouris (IMM), We would like to thank all women who participated in this study, the student midwives who administered the cohort questionnaires (Marie Choquel, Elisabeth Meot, Jessica Narboni and Inès Vaudry), Alexandre Dumont for his advice on the research, Virginie Rozée for her advice on a first draft of this article, MSH-Paris Nord for technical and financial support, and Fondation Mustela who funded publication of this article., ANR-16-CE36-0001,HYPMEDPRO,L'hypermédicalisation des naissances comme problème public : trajectoires matérielles, controverses publiques, changements institutionnels(2016), École des hautes études en sciences sociales (EHESS), Institut de Recherche pour le Développement (IRD)-Université de Paris (UP)-Institut de Recherche pour le Développement (IRD)-Université de Paris (UP), centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy], the student midwives who administered the cohort questionnaires (Marie Choquel, Elisabeth Meot, Jessica Narboni and In?s Vaudry), and Virginie Roz?e for her advice on a first draft of this article
Subjects: H1-99, [SHS.SOCIO]Humanities and Social Sciences/Sociology, QH471-489, Reproduction, [SDV]Life Sciences [q-bio], satisfaction, childbirth, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, biomedicalization, sexuality, Social sciences (General), gender, Original Article, biotechnology
Abstract: International audience; The experience of childbirth has been technologized worldwide, leading to major social changes. In France, childbirth occurs almost exclusively in hospitals. Few studies have been published on the opinions of French women regarding obstetric technology and, in particular, caesarean section. In 2017–2018, we used a mixed methods approach to determine French women's preferences regarding the mode of delivery, and captured their experiences and satisfaction in relation to childbirth in two maternity settings. Of 284 pregnant women, 277 (97.5%) expressed a preference for vaginal birth, while seven (2.5%) women expressed a preference for caesarean section. Vaginal birth was also preferred among 26 women who underwent an in-depth interview. Vaginal birth was perceived as more natural, less risky and less painful, and to favour mother–child bonding. This vision was shared by caregivers. The women who expressed a preference for vaginal birth tended to remain sexually active late in their pregnancy, to find sexual intercourse pleasurable, and to believe that vaginal birth would not enlarge their vagina. A large majority (94.5%) of women who gave birth vaginally were satisfied with their childbirth experience, compared with 24.3% of those who underwent caesarean section. The caring attitude of the caregivers contributed to increasing this satisfaction. The notion of women's ‘empowerment’ emerged spontaneously in women's discourse in this research: women who gave birth vaginally felt satisfied and empowered. The vision shared by caregivers and women that vaginal birth is a natural process contributes to the stability of caesarean section rates in France.
Published: 2021

31. How to predict para-aortic node involvement in advanced cervical cancer? Development of a predictive score. A FRANCOGYN study

Author: C Touboul, Alexandre Bricou, Pierre Collinet, Y. Dabi, Emilie Raimond, Sofiane Bendifallah, Xavier Carcopino, Marcos Ballester, Vincent Lavoué, Cyrille Huchon, H.T. Nguyen-Xuan, Yohan Kerbage, Louise Benoit, Lobna Ouldamer, CHI Poissy-Saint-Germain, Institut Universitaire de Cancérologie [Paris] (IUC), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Groupe Hospitalier Diaconesses Croix Saint-Simon, CHU Lille, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Pontchaillou [Rennes], CRLCC Eugène Marquis (CRLCC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES), Assistance Publique - Hôpitaux de Marseille (APHM), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Institut Universitaire de Cancérologie [Sorbonne Université] (IUC), and Université de Rennes (UR)
Subjects: Oncology, medicine.medical_specialty, Multivariate analysis, [SDV]Life Sciences [q-bio], Population, Uterine Cervical Neoplasms, Logistic regression, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Internal medicine, Positron Emission Tomography Computed Tomography, Medicine, Humans, education, Lymph node, Retrospective Studies, Cervical cancer, education.field_of_study, 030219 obstetrics & reproductive medicine, Pelvic MRI, Tumor size, business.industry, Univariate, General Medicine, Middle Aged, medicine.disease, Prognosis, Advanced cervical cancer, 3. Good health, medicine.anatomical_structure, Para-aortic lymph node, Predictive model, 030220 oncology & carcinogenesis, Lymphatic Metastasis, Carcinoma, Squamous Cell, Surgery, Female, France, business
Abstract: International audience; INTRODUCTION: Node involvement is one of the main prognostic factors for cervical cancer. Para-aortic lymph node (PALN) assessment is crucial for treating advanced cervical cancer, to define irradiation fields. Objective of this study was to develop a score predicting para-aortic lymph node involvement in patients with advanced cervical cancer. PATIENTS AND METHOD: We performed a multicenter, retrospective, study on 9 French centers from 2000 to 2015, including patients with advanced squamous cell cervix carcinoma who had PALN status assessed by imaging and/or by surgery. Factors associated with a risk of PALN involvement were determined by univariate and multivariate analysis using a logistic regression model. A score was then developed and validated. RESULTS: A total of 1446 patients treated for cervical cancer were included. Of these, 498 had an advanced squamous cell cervical cancer. Ninety-one patients (18.3%) had positive PALN. After univariate and multivariate analysis, tumor size on pelvic MRI, initial SCC, and suspected pelvic node involvement on PET-CT were included in our score. This model allowed the population to be divided into 3 risk groups. Area under the ROC curve of the score was 0.81 (95%CI = 0.72-0.90). In the low-risk group, 9% (28/287) had PALN involvement, whereas in the high-risk group, 43% (22/51) had PALN involvement. CONCLUSION: We developed a simple score predicting PALN involvement in advanced cervical cancers. Three risk groups can be defined, and patients considered to be at low risk may avoid para-aortic staging as well as extensive field irradiation.
Published: 2021

32. Perinatal outcome after planned vaginal delivery in monochorionic compared with dichorionic twin pregnancy

Author: 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).
Subjects: 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 (
Published: 2021

33. Preoperative ct or pet/ct to assess pelvic and para-aortic lymph node status in epithelial ovarian cancer? A systematic review and meta-analysis

Author: Roman Rouzier, Jean Louis Benifla, Cyrille Huchon, Arnaud Fauconnier, Camille Mimoun, 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 [Hopital Lariboisière - Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Institut Curie [Paris], Institut National de la Santé et de la Recherche Médicale (INSERM), Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, HAL UVSQ, Équipe, Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université de Paris (UP)
Subjects: Medicine (General), medicine.medical_specialty, PET/CT, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Clinical Biochemistry, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Diagnostic accuracy, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, R5-920, 0302 clinical medicine, [SDV.CAN] Life Sciences [q-bio]/Cancer, medicine, Lymph node, PET-CT, Lymph node metastasis, Receiver operating characteristic, business.industry, Area under the curve, Gold standard (test), Epithelial ovarian cancer, 3. Good health, Meta-analysis, [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, medicine.anatomical_structure, [SDV.IB.IMA] Life Sciences [q-bio]/Bioengineering/Imaging, 030220 oncology & carcinogenesis, Lymphadenectomy, Lymph, Radiology, Systematic Review, business, CT
Abstract: International audience; Background: In advanced epithelial ovarian cancer (EOC), the LION trial restricted lym-phadenectomy indication to patients with suspect lymph nodes before and during surgery. Preoperative imaging is used to assess lymph node status, and particularly CT and PET/CT. The aim of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of preoperative CT and PET/CT to detect lymph node metastasis (LNM) in patients with EOC; Methods: Databases were searched from January 1990 to May 2019 for studies that evaluated the diagnostic accuracy of preoperative CT and PET/CT to detect LNM in patients with EOC with histology as the gold standard. Pooled diagnostic accuracy was calculated using bivariate random-effects models and hierarchical summary receiver operating curve (HSROC). This study is registered with PROSPERO number CRD42020179214; Results: A total of five studies were included in the meta-analysis: four articles concerned preoperative CT and four articles concerned preoperative PET/CT, involving 106 and 138 patients, respectively. For preoperative CT, pooled sensitivity was 0.47 95% CI [0.20–0.76], pooled specificity was 0.99 95% CI [0.75–1.00] and area under the curve (AUC) of the HSROC was 0.91 95% CI [0.88–0.93]. For preoperative PET/CT, pooled sensitivity was 0.81 95% CI [0.61–0.92], pooled specificity was 0.96 95% CI [0.91–0.99] and AUC of the HSROC was 0.97 95% CI [0.95–0.98]; Conclusions: PET/CT has a very high diagnostic accuracy, especially for specificity, to detect LNM in EOC and should be realized systematically, additionally to CT recommended to evaluate peritoneal spread, in the preoperative staging of patients with an advanced disease.
Published: 2021

34. Pressurized intra-peritoneal aerosol chemotherapy (PIPAC): increased intraperitoneal pressure does not affect distribution patterns but leads to deeper penetration depth of doxorubicin in a sheep model

Author: Myriam Mimouni, Pierre Adenot, Julien Cohen, François Vialard, Arnaud Fauconnier, Thomas Lilin, Christophe Richard, Valérie Gelin, Pascale Chavatte-Palmer, Martine Letheule, Benoit Lecuelle, Cyrille Huchon, Michèle Dahirel, Olivier Sandra, Anne Tarrade, Biologie de la Reproduction, Environnement, Epigénétique & Développement (BREED), 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), Service de gynécologie et obstétrique [CHI Poissy-Saint Germain], CHI Poissy-Saint-Germain, Centre de recherche biomédicale (CRBM), École nationale vétérinaire d'Alfort (ENVA)-Université Paris-Est (UPE), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Hôpital Lariboisière-Fernand-Widal [APHP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: Cancer Research, medicine.medical_treatment, PIPAC, Ovary, [SDV.CAN]Life Sciences [q-bio]/Cancer, Andrology, Caecum, 03 medical and health sciences, chemistry.chemical_compound, Peritoneal cavity, 0302 clinical medicine, Drug Delivery Systems, Peritoneum, Genetics, medicine, Pressure, Animals, Doxorubicin, Tissue Distribution, DAPI, Intraperitoneum pressure, Cecum, RC254-282, Peritoneal Neoplasms, Aerosols, Cell Nucleus, Chemotherapy, Antibiotics, Antineoplastic, Sheep, biology, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Penetration (firestop), [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, biology.organism_classification, medicine.anatomical_structure, Oncology, chemistry, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Female, Omentum, Peritoneal carcinomatosis, medicine.drug, Research Article
Abstract: Background Pressurized Intra-Peritoneal Aerosol Chemotherapy (PIPAC) is an innovative treatment against peritoneal carcinomatosis. Doxorubicin is a common intra-venous chemotherapy used for peritoneal carcinomatosis and for PIPAC. This study evaluated the impact of increased PIPAC intraperitoneal pressure on the distribution and cell penetration of doxorubicin in a sheep model. Methods Doxorubicin was aerosolized using PIPAC into the peritoneal cavity of 6 ewes (pre-alpes breed): N = 3 with 12 mmHg intraperitoneal pressure (“group 12”) and N = 3 with 20 mmHg (“group 20”). Samples from peritoneum (N = 6), ovarian (N = 1), omentum (N = 1) and caecum (N = 1) were collected for each ewe. The number of doxorubicin positive cells was determined using the ratio between doxorubicine fluorescence-positive cell nuclei (DOXO+) over total number of DAPI positive cell nuclei (DAPI+). Penetration depth (μm) was defined as the distance between the luminal surface and the location of the deepest DOXO+ nuclei over the total number of cell nuclei that were stained with DAPI. Penetration depth (μm) was defined as the distance between the luminal surface and the location of the deepest DOXO+ nuclei. Results DOXO+ nuclei were identified in 87% of samples. All omental samples, directly localized in front of the nebulizer head, had 100% DOXO+ nuclei whereas very few nuclei were DOXO+ for caecum. Distribution patterns were not different between the two groups but penetration depth in ovary and caecum samples was significantly deeper in group 20. Conclusions This study showed that applying a higher intra-peritoneal pressure during PIPAC treatment leads to a deeper penetration of doxorubicin in ovarian and caecum but does not affect distribution patterns.
Published: 2021

35. Morbidity associated with planned cesarean deliveries performed before the scheduled date: A cohort study

Author: 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)
Subjects: 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.
Published: 2021

36. Variation between hospital caesarean delivery rates when Robson's classification is considered: An observational study from a French perinatal network

Author: 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
Subjects: 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.
Published: 2021

37. Hystérectomie : évolution des pratiques entre 2009 et 2019 en France

Author: F. Margueritte, Annie Serfaty, Xavier Fritel, Cyrille Huchon, Arnaud Fauconnier, Audrey Chevrot, 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, Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Agence Régionale de Santé Ile-de-France [Paris] (ARS IDF), Service de gynécologie et obstétrique [Hopital Lariboisière - Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université de Paris (UP), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), and Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)
Subjects: Gynecology, medicine.medical_specialty, 030219 obstetrics & reproductive medicine, Medical Information Systems Program, Philosophy, [SDV]Life Sciences [q-bio], Surgical approach, Obstetrics and Gynecology, Assessment, Hysterectomy, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Reproductive Medicine, medicine, 030212 general & internal medicine
Abstract: Resume Objectifs L’hysterectomie est l’intervention la plus pratiquee chez une femme. Nous avons souhaite realiser un etat des lieux de l’hysterectomie en France en 2019. Nous avons egalement evalue les variations au cours du temps des indications et des voies d’abord de l’hysterectomie, ceci au regard des differents evenements ayant pu etre a l’origine de la modification des pratiques. Methodes Nous avons utilise le Programme de Medicalisation des Systemes d’Information en medecine, chirurgie, obstetrique et odontologie afin d’extraire l’ensemble des actes relatifs a une hysterectomie quelle que soit sa voie d’abord de 2009 a 2019. Resultats Environ 60 000 hysterectomies ont ete realisees en France en 2019. La voie d’abord chirurgicale la plus frequemment utilisee est desormais la cœlioscopie, realisee dans 30 % des hysterectomies, suivie des voies d’abord laparotomique (29 %), puis vaginale (26 %) et coelio-vaginale (15 %). Les procedures cœlioscopiques sont realisees plus souvent en structures hospitalieres publiques que privees. Une annexectomie est associee a 41 % des hysterectomies. Une diminution du nombre d’hysterectomie a ete observee entre 2008 et 2019, passant d’environ 72 000 en 2008 a environ 60 000 en 2019. Cette diminution survient au cours d’une periode au cours de laquelle sont apparue de nouvelles therapeutiques ainsi que de nouvelles recommandations. Conclusion L’evolution du nombre d’hysterectomies est correlee au developpement d’alternatives therapeutiques pour les pathologies pour lesquelles etait classiquement realisee une hysterectomie.
Published: 2021

38. Patient-reported outcome measures in endometriosis

Author: Arnaud Fauconnier, Anne Oppenheimer, Jerome Bouaziz, Alba Nicolas-Boluda, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), and Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)
Subjects: Quality of life, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Endometriosis, Context (language use), Review, Prom, Disease, 03 medical and health sciences, 0302 clinical medicine, Patient satisfaction, Quality of life (healthcare), medicine, 030212 general & internal medicine, Intensive care medicine, 030219 obstetrics & reproductive medicine, business.industry, General Medicine, medicine.disease, Patient reported outcome measures, female genital diseases and pregnancy complications, 3. Good health, Clinical trial, Medicine, Patient-reported outcome, business
Abstract: International audience; Patient Reported Outcome Measures (PROM) evoke measurements that allow capturing patients’ perspectives on their condition. In endometriosis care, physicians’ understanding of the effect of the disease and the treatment on patients is often poor. The use of PROMs in endometriosis clinical practice can facilitate patient-provider communication and the implementation of patient-centered care, improve patients’ quality of life, as well as provide a tool for patients’ self-management of the disease. Today, PROMs are extensively used in research and clinical trials, however they are barely used in clinical practice. The development of digital tools facilitating capturing PROMs can contribute to their use by physicians in routine endometriosis care. However, all PROMs are not adapted to be used in routine care in the context of endometriosis. The objective of this study was to present a catalogue of available PROMs for routine endometriosis care and evaluate them according to selected criteria. To do so, we explored the different PROMs currently in the literature. Consequently, 48 PROM were identified as tools used to evaluate various dimensions of the impact of endometriosis on patients. The selected PROMs were evaluated for their potential to be used as a standard in clinical practice in endometriosis. The selected catalogue of PROMs is the starting point for the integration of digital tools to capture PROMs and the development of patient-centered dashboards to be used by patients and clinicians in endometriosis care and self-management to improve care processes, patient satisfaction, quality of life, and outcomes.
Published: 2021

39. Prognosis impact of posttreatment pelvic MRI in patients treated for stage IB2-IIB cervical cancer with chemoradiation therapy

Author: Cyril Touboul, Olivier Graesslin, François Golfier, Marcos Ballester, Sophie Knight, Alexandre Bricou, Yohan Kerbage, Pierre Adrien Bolze, Sofiane Bendifallah, Cyrille Huchon, Ludivine Dion, Emilie Raimond, Yohann Dabi, Florence Rodriguez, Vincent Lavoué, Lobna Ouldamer, Geoffroy Atrous, Xavier Carcopino, Pierre Collinet, Myriam Mimouni, Tiphaine Moussilmani, Julien Mancini, Jonchère, Laurent, Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Avignon Université (AU)-Aix Marseille Université (AMU)-Institut de recherche pour le développement [IRD] : UMR237-Centre National de la Recherche Scientifique (CNRS), Hôpital Nord [CHU - APHM], Biostatistique et technologies de l'information et de la communication (BioSTIC) - [Hôpital de la Timone - APHM] (BiosTIC ), Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Assistance Publique - Hôpitaux de Marseille (APHM), Hospices Civils de Lyon (HCL), Groupe Hospitalier Diaconesses Croix Saint-Simon, Hôpital Jeanne de Flandre [Lille], Nutrition, croissance et cancer (U 1069) (N2C), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Chemistry, Oncogenesis, Stress and Signaling (COSS), Université de Rennes (UR)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHI Créteil, Institut Mère Enfant Alix de Champagne, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), CHI Poissy-Saint-Germain, Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-CRLCC Eugène Marquis (CRLCC)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Centre National de la Recherche Scientifique (CNRS)-Institut de recherche pour le développement [IRD] : UMR237-Aix Marseille Université (AMU)-Avignon Université (AU), Hôpital de la Timone [CHU - APHM] (TIMONE)-Assistance Publique - Hôpitaux de Marseille (APHM), Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: medicine.medical_specialty, Survival, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, medicine.medical_treatment, Uterine Cervical Neoplasms, [SDV.CAN]Life Sciences [q-bio]/Cancer, Disease, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, Hysterectomy, 030218 nuclear medicine & medical imaging, Lesion, 03 medical and health sciences, 0302 clinical medicine, [SDV.CAN] Life Sciences [q-bio]/Cancer, Predictive Value of Tests, Recurrence, medicine, Humans, In patient, Pelvic MRI, Stage (cooking), Neoplasm Staging, Retrospective Studies, Cervical cancer, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, Chemoradiotherapy, General Medicine, Middle Aged, medicine.disease, Prognosis, Magnetic Resonance Imaging, 3. Good health, Survival Rate, Oncology, Chemoradiation, 030220 oncology & carcinogenesis, Female, Surgery, Radiology, Neoplasm Recurrence, Local, medicine.symptom, business
Abstract: International audience; OBJECTIVES: To evaluate the performances of systematic posttreatment pelvic magnetic resonance imaging (PPMRI) in predicting prognosis of patients treated with chemoradiation therapy (CRT) for locally advanced cervical cancer (LACC). MATERIALS AND METHODS: Multi-institutional data from 216 patients presenting FIGO IB2-IIB cervical cancer for which PPMRI was performed following CRT were retrospectively reviewed. Incomplete response was defined as the identification of persistent lesion on PPMRI. Primary endpoints were patients’ 5-year recurrence free (RFS) and overall (OS) survivals. Secondary endpoint was the identification of residual histologic disease on hysterectomy specimens when completion surgery was performed. RESULTS: PPMRI identified an incomplete response in 102 (47.2%) cases. A 70% or more reduction in tumor size on PPMRI was identified as the best predictive cut-off for recurrence (37.7% sensitivity and 78.7% specificity) and death (50% sensitivity and 77.9% specificity) with significant impact on those risks (HRa: 0.42; 95%CI: 0.23-0.77 and HRa: 0.18; 95%CI: 0.06-0.50, respectively). Completion hysterectomy was performed in 117 (54.4%) cases, with histologic residual disease in 55 (47.4%). PPMRI demonstrated 74.5% sensitivity and 50.8% specificity in predicting residual disease. Although survival of patients with complete response at PPMRI was not impacted by completion hysterectomy, it significantly increased 5-year RFS and OS of those with incomplete response: 38.7% vs. 65.3% (p
Published: 2021

40. High seroprevalence but short‐lived immune response to SARS‐CoV‐2 infection in Paris

Author: Pierre Charneau, Philippe Souque, Evelyne Dufour, Marion Gransagne, Stéphane Petres, Ana Ines Lalanne, Thierry Rose, Isabelle Turbiez, François Dejardin, François Anna, Odile Richard-Le Goff, Olivier Helynck, Maude Guillot-Delost, Sophie Goyard, Alexia Savignoni, François-Clément Bidard, Zaineb Choucha, Fabien Nevo, Franck Perez, Delphine Louis, Véronique Gillon, Yves L. Janin, A Gobillion, Nicolas Escriou, Olivier Lantz, Laboratoire commun Pasteur-TheraVectys, Institut Pasteur [Paris]-TheraVectys, Biologie Cellulaire des Lymphocytes - Lymphocyte Cell Biology, Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur [Paris], Institut Curie [Paris], Virologie Moléculaire et Vaccinologie / Molecular Virology and Vaccinology, Institut Pasteur [Paris], Laboratoire d’innovation : vaccins – Innovation lab : vaccines, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Immunité et cancer (U932), Institut Curie [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Plateforme technologique Production et purification de protéines recombinantes – Production and Purification of Recombinant Proteins Technological Platform (PPR), Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS), Anticorps en thérapie et pathologie - Antibodies in Therapy and Pathology, Chimie et Biocatalyse, This work was made possible thanks to the financial support obtained through the URGENCE nouveau coronavirus fundraising campaign of Institut Pasteur and the financial support of the Fondation Total. This study was funded in part by a grant from Fondation de France and by Institut Curie Institutional funding. The luciferin synthesis development has been supported by DARRI (ValoExpress 2016-2018). LuLISA development has been supported by IARP Pasteur-Carnot MI (2019-2020)., Institut Pasteur [Paris] (IP)-TheraVectys, Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pasteur [Paris] (IP), Université Paris-Saclay, Institut Curie [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), Lassailly-Bondaz, Anne, Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Curie [Paris], Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), and Centre National de la Recherche Scientifique (CNRS)-Institut Pasteur [Paris]
Subjects: 0301 basic medicine, Male, Time Factors, Antibodies, Viral, SARS‐CoV‐2, MESH: Antibodies, Neutralizing, Serology, 0302 clinical medicine, Seroepidemiologic Studies, Epidemiology, MESH: COVID-19, Immunology and Allergy, 030212 general & internal medicine, Research Articles, MESH: Immunoglobulin G, 0303 health sciences, education.field_of_study, MESH: Paris, 3. Good health, Titer, Research Article|Basic, ELISA, Female, medicine.symptom, Bioluminescence, Adult, MESH: Pandemics, medicine.medical_specialty, Paris, Population, Immunology, Anosmia, Immunity to infection, Biology, Asymptomatic, Virus, 03 medical and health sciences, COVID‐19, Internal medicine, medicine, Humans, Basic, education, Pandemics, 030304 developmental biology, LuLISA, MESH: Seroepidemiologic Studies, MESH: Humans, SARS-CoV-2, business.industry, MESH: Time Factors, COVID-19, MESH: Adult, Ageusia, Antibodies, Neutralizing, MESH: Male, 030104 developmental biology, Immunization, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Immunoglobulin G, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female, MESH: Antibodies, Viral, 030215 immunology
Abstract: International audience; Background Although the COVID-19 pandemic peaked in March/April 2020 in France, the prevalence of infection is barely known. Herein, we assessed the serological response against the SARS-CoV-2 virus in a large population working in one institution of the Paris conurbation. We set up two high-throughput and sensitive methods to assess SARS CoV-2 Nucleoprotein and Spike protein-specific IgG response along with a pseudo-neutralization assay in sera. We studied 1847 participants who also answered a web-based survey on clinical symptoms.Methods and Results In May-July 2020, 11% (95% CI: 9.7-12.6) of serums were positive for IgG against the SARS-CoV-2 N and S protein and 9.5% (CI:8.2-11.0) were pseudo-neutralizer. The prevalence of immunization was 11.6% (CI:10.2-13.2) considering positivity in at least one assays. In 5% (CI:3.9-7.1) of RT-qPCR positive individuals, no systemic IgGs were detected. Among immune individuals, 21% had been asymptomatic.Anosmia and ageusia occurred in 52% of the IgG-positive individuals and in 3% of the negative ones. In contrast, 30% of the anosmia-ageusia cases were seronegative suggesting that the true prevalence of infection may reach 16.6%. In sera obtained 4-8 weeks after the first sampling anti-N and anti-S IgG titers and pseudo-neutralization activity declined by 31%, 17% and 53%, respectively with half-life of 35, 87 and 28 days, respectively.Conclusions The population studied being not particularly exposed to SARS-CoV-2 infection is representative of active workers in the Paris conurbation, suggesting that the current epidemiological models may underestimate the true prevalence of infection. The short lifespan of the serological systemic responses hinders retrospective assessment of the epidemic extent.
Published: 2020
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41. PROGNOSTIC VALUE OF POSTTREATMENT FEDG-PET IMAGING FOLLOWING COMBINED CHEMORADIATION THERAPY IN LOCALLY ADVANCED CERVICAL CANCER

Author: Julien Mancini, Emilie Raimond, Yohan Kerbage, Marcos Ballester, Cyril Touboul, Xavier Carcopino, Ludivine Dion, Vincent Lavoué, Myriam Mimouni, Yohann Dabi, Cyrille Huchon, Alexandre Bricou, Sophie Knight, Pierre Collinet, François Golfier, Olivier Graesslin, Geoffroy Atrous, Lobna Ouldamer, Pierre Adrien Bolze, Sofiane Bendifallah, Institut méditerranéen de biodiversité et d'écologie marine et continentale (IMBE), Centre National de la Recherche Scientifique (CNRS)-Institut de recherche pour le développement [IRD] : UMR237-Aix Marseille Université (AMU)-Avignon Université (AU), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Intercommunal de Créteil (CHIC), Hospices Civils de Lyon (HCL), Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Groupe Hospitalier Diaconesses Croix Saint-Simon, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Nutrition, croissance et cancer (U 1069) (N2C), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Chemistry, Oncogenesis, Stress and Signaling (COSS), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Reims (CHU Reims), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Centre d’Études et de Conservation des Œufs et du Sperme [CHU Jean Verdier] (CECOS), Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Avignon Université (AU)-Aix Marseille Université (AMU)-Institut de recherche pour le développement [IRD] : UMR237-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Rennes (UR)-CRLCC Eugène Marquis (CRLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Jonchère, Laurent, Service de Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], 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 de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-CRLCC Eugène Marquis (CRLCC)-Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)
Subjects: Adult, medicine.medical_specialty, Neoplasm, Residual, Locally advanced, Uterine Cervical Neoplasms, [SDV.CAN]Life Sciences [q-bio]/Cancer, Disease, Completion surgery, Disease-Free Survival, 03 medical and health sciences, 0302 clinical medicine, [SDV.CAN] Life Sciences [q-bio]/Cancer, Humans, Medicine, In patient, chemoradiation, Neoplasm Staging, Retrospective Studies, Cervical cancer, 030219 obstetrics & reproductive medicine, business.industry, FEDG-PET, Medical record, Obstetrics and Gynecology, Chemoradiotherapy, Pet imaging, Middle Aged, medicine.disease, 3. Good health, Treatment Outcome, Reproductive Medicine, Positron-Emission Tomography, 030220 oncology & carcinogenesis, Vaginal brachytherapy, Female, France, Radiology, prognosis, Neoplasm Recurrence, Local, Radiopharmaceuticals, business
Abstract: International audience; Objectives - To evaluate the performances of posttreatment FEDG-PET to predict the prognosis of patients treated with concurrent chemoradiotherapy (CT/RT) for locally advanced cervical cancer. Materials and methods - The medical records of 131 patients treated in 9 French academic institutions for IB2-IIB cervical cancer and for which a posttherapy FEDG-PET was performed were reviewed. All patients received CT/RT, possibly completed with vaginal brachytherapy (VBT) and completion surgery. Posttreatment FEDG-PET was performed within 3 months after completion of CT/RT or VBT. Incomplete metabolic response (IMR) was defined as the persistence of FEDG uptake. Results - An IMR was identified in 44 (33.6 %) cases. IMR was associated with higher risk of recurrence (aHR = 2.8; 95 %CI: 1.3-5.7; p = 0.006) and death (aHR = 4.5 ;95 %CI: 1.4-13.8; p = 0.009). Completion surgery was performed in 61 (46.9 %) patients with histologic cervical residual disease identified in 31 (50.8 %). FEDG-PET sensitivity and specificity in predicting cervical residual disease following CT/RT was 48.4 % (95 %CI: 30.8-66) and 80 % (95 %CI: 65.7-94.3), respectively. Conclusions - In patients treated with CT/RT for locally advanced cervical cancer, despite limited performances to predict cervical residual disease, posttreatment FEDG-PET is predictive of patients' prognosis and long-term outcome.
Published: 2020

42. Do high-dose progestins impair sexual function in women treated for endometriosis? A prospective observational longitudinal study

Author: Mathilde Perot, Joseph Du Cheyron, Pierre Panel, Stéphane Verdun, Arnaud Fauconnier, Anne Oppenheimer, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), and Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)
Subjects: Adult, medicine.medical_specialty, Longitudinal study, Visual Analog Scale, Visual analogue scale, medicine.drug_class, Libido, Sexual Behavior, Population, Endometriosis, sexual function, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Internal medicine, Surveys and Questionnaires, medicine, sexual activity questionnaire, Humans, 030212 general & internal medicine, Longitudinal Studies, Prospective Studies, Sexual Dysfunctions, Psychological, education, education.field_of_study, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics and Gynecology, General Medicine, medicine.disease, 3. Good health, Dyspareunia, Quality of Life, Observational study, Female, France, Progestins, Sexual function, business, Progestin
Abstract: International audience; Introduction: High-dose progestins are used as an effective therapy for painful symptoms of endometriosis but their impact on sexual function has been poorly studied. The study aims to assess the impact of high-dose progestin on sexual function among women treated for endometriosis. Material and methods: In this bicenter prospective observational study, women with endometriosis who received medical or surgical treatment for endometriosis and who were sexually active were included. They completed the Sexual Activity Questionnaire (SAQ, a validated tool) before (T0) and 12 months after (T1) endometriosis treatment. We classified patients into two groups according to whether they were using high-dose progestins at T1: a high-dose progestin group and a control group. The main outcome was sexual function measured by the SAQ score (from 0 to 30) at T1. The secondary outcomes were each individual SAQ item, the dyspareunia 100-mm visual analog scale (VAS) and the quality of life assessed with EuroQoL Group 5D Index (EQ-5D) at T1. We also assessed the change in dyspareunia VAS and quality of life between T0 and T1. The Ethics Committee of Ile-de-France (Act 2004-806, 9 August 2004) approved the study. Results: Among 214 women included, 25 (12%) were exposed to high-dose progestins at T1. The SAQ score of women exposed to high-dose progestins was significantly lower compared with the control group, with or without adjustment for covariates (15.5 ± 6.3 vs 18.3 ± 6.2, P =.03, adjusted effect size −0.44 [95% CI −0.86 to −0.02], P =.04). High-dose progestin intake at T1 was associated with a lower subscore on two SAQ items: pleasure (1.8 ± 0.8 vs 2.2 ± 0.9, P =.02), and satisfaction with frequency of intercourse (1.2 ± 1.2 vs 1.8 ± 1.1, P =.02). In the overall population, dyspareunia VAS and quality of life assessed by EQ-5D improved between T0 and T1 (45 ± 29 at T0 vs 28 ± 29 at T1, P
Published: 2020

43. A snapshot of the Covid-19 pandemic among pregnant women in France

Author: 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
Subjects: 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.
Published: 2020

44. COVID-19 in breast cancer patients: a cohort at the Institut Curie hospitals in the Paris area

Author: Vuagnat, Perrine, Frelaut, Maxime, Ramtohul, Toulsie, Basse, Clémence, Diakité, Sarah, Noret, Aurélien, Bellesoeur, Audrey, Servois, Vincent, Héquet, Delphine, Laas, Enora, Kirova, Youlia, Cabel, Luc, Pierga, Jean-Yves, Paoletti, Xavier, Cottu, Paul, Bidard, François-Clément, Université de Picardie Jules Verne (UPJV), Université Paris Descartes - Faculté de Médecine (UPD5 Médecine), Université Paris Descartes - Paris 5 (UPD5), Institut Curie, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Service de Gynécologie-Obstétrique [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Tenon [APHP], Département de radiothérapie oncologique [Paris], Service d'Oncologie Médicale, Cancer et génôme: Bioinformatique, biostatistiques et épidémiologie d'un système complexe, MINES ParisTech - École nationale supérieure des mines de Paris-Institut Curie-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de recherche translationnelle, Institut Curie [Paris], Gynécologie-obstétrique et médecine de la reproduction - Maternité [CHU Tenon], CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Cancer et génome: Bioinformatique, biostatistiques et épidémiologie d'un système complexe, Institut Curie [Paris]-MINES ParisTech - École nationale supérieure des mines de Paris, and Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: [SDV]Life Sciences [q-bio], [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Published: 2020

45. 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

Author: 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)
Subjects: 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.
Published: 2020

46. Clinical Interest of Combining Transcriptomic and Genomic Signatures in High-Grade Serous Ovarian Cancer

Author: Roman Rouzier, Tatiana Popova, Marc-Henri Stern, Fatima Mechta-Grigoriou, Yann Kieffer, Claire Bonneau, Département d'Oncologie Médicale [Centre René-Huguenin, Saint-Cloud], Hôpital René HUGUENIN (Saint-Cloud), Unité de génétique et biologie des cancers (U830), Université Paris Descartes - Paris 5 (UPD5)-Institut Curie [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), and Institut Curie [Paris]
Subjects: 0301 basic medicine, Oncology, medicine.medical_specialty, lcsh:QH426-470, endocrine system diseases, [SDV]Life Sciences [q-bio], [SDV.CAN]Life Sciences [q-bio]/Cancer, mesenchymal, Transcriptome, 03 medical and health sciences, 0302 clinical medicine, BRCA1/2, Internal medicine, medicine, Serous ovarian cancer, Genetics, HGSOC, Genetics (clinical), ComputingMilieux_MISCELLANEOUS, Original Research, business.industry, fibrosis, Genomic signature, Patient survival, medicine.disease, 3. Good health, Serous fluid, lcsh:Genetics, 030104 developmental biology, homologous recombination deficiency, 030220 oncology & carcinogenesis, Molecular Medicine, prognosis, Homologous Recombination Deficiency, business, Ovarian cancer, Patient stratification
Abstract: High-grade serous ovarian cancer is one of the deadliest gynecological malignancies and remains a clinical challenge. There is a critical need to effectively define patient stratification in a clinical setting. In this study, we address this question and determine the optimal number of molecular subgroups for ovarian cancer patients. By studying several independent patient cohorts, we observed that classifying high-grade serous ovarian tumors into four molecular subgroups using a transcriptomic-based approach did not reproducibly predict patient survival. In contrast, classifying these tumors into only two molecular subgroups, fibrosis and non-fibrosis, could reliably inform on patient survival. In addition, we found complementarity between transcriptomic data and the genomic signature for homologous recombination deficiency (HRD) that helped in defining prognosis of ovarian cancer patients. We also established that the transcriptomic and genomic signatures underlined independent biological processes and defined four different risk populations. Thus, combining genomic and transcriptomic information appears as the most appropriate stratification method to reliably subgroup high-grade serous ovarian cancer patients. This method can easily be transferred into the clinical setting.
Published: 2020

47. Impact of surgical restaging on recurrence in patients with borderline ovarian tumors: A meta-analysis

Author: Audrey Chevrot, Cyrille Huchon, Delphine Hequet, Arnaud Fauconnier, Department of Obstetrics and Gynecology, Poissy-St Germain Hospital, Poissy, France., Institut Curie [Paris], 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], and CHI Poissy-Saint-Germain
Subjects: Adult, Reoperation, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Carcinoma, Ovarian Epithelial, Borderline ovarian tumors, 03 medical and health sciences, Ovarian tumor, 0302 clinical medicine, Recurrence, medicine, Humans, In patient, 030212 general & internal medicine, Neoplasm Staging, Retrospective Studies, Ovarian Neoplasms, 030219 obstetrics & reproductive medicine, business.industry, General surgery, Mortality rate, Obstetrics and Gynecology, Retrospective cohort study, Odds ratio, Confidence interval, 3. Good health, Observational Studies as Topic, Reproductive Medicine, Meta-analysis, Surgical restaging, Observational study, Female, Neoplasm Recurrence, Local, business, Meta-Analysis
Abstract: Objective The benefits of restaging surgery for patients with a borderline ovarian tumor (BOT) discovered on initial surgery are debatable. We performed a meta-analysis to evaluate the role of restaging surgery on recurrence in patients with BOTs. Study design We systematically reviewed published studies comparing restaging surgery and incomplete surgery in BOT patients from January 1985 to December 2017. Endpoints were recurrence and mortality rates. Study design features that possibly affected participant selection, reporting of recurrence and death, and manuscript publication were assessed. For pooled estimates of the effect of restaging surgery on recurrence, fixed-effect meta-analytical models were used. Results Of the 577 articles initially selected, four retrospective observational studies (Restaging group: 166 patients; Non-Restaging group: 394 patients) met our research criteria. No significant differences in terms of recurrence between the two groups were observed (pooled Peto Odds Ratio [OR] = 0.88; 95 % confidence interval [CI]: 0.41–1.92). The number of deaths was insufficient for statistical analysis. Conclusions This meta-analysis based on retrospective studies, suggests that restaging surgery does not significantly reduce recurrence in patients with BOT.
Published: 2020

48. Midwives’ practices related to cervical cancer screening during pregnancy: A vignette-based study

Author: Paul Berveiller, Anne Rousseau, Léa Kervella, Marie Bourdillon, Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), École de sages-femmes Hôpital Foch (ESF Foch), Hôpital Foch [Suresnes], Department of Obstetrics and Gynecology, Poissy-St Germain Hospital, Poissy, France., and Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ)
Subjects: Adult, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Uterine Cervical Neoplasms, Midwifery, Cervical cancer screening, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Surveys and Questionnaires, Maternity and Midwifery, Humans, Mass Screening, Medicine, 030212 general & internal medicine, Pap test, Early Detection of Cancer, Vaginal Smears, Cervical cancer, 030219 obstetrics & reproductive medicine, medicine.diagnostic_test, business.industry, Obstetrics, Quality of practices, Outcome measures, Obstetrics and Gynecology, Gestational age, medicine.disease, 3. Good health, Cross-Sectional Studies, Vignette, Pap smear, Gestation, Female, business, Papanicolaou Test
Abstract: International audience; Objective: To describe midwives’ practices related to cervical cancer screening and women's eligibility for screening during pregnancy. Study design: Cross-sectional vignette-based study of French midwives during February-May 2018. Main outcome measures. Participants were asked to complete an internet-based questionnaire: a clinical case-vignette about a woman eligible for cervical cancer screening during pregnancy and a short self-administered questionnaire. Results: We obtained 273 complete questionnaires from eligible midwives. Of those responding, 15% reported that they never screened for cervical cancer during pregnancy, 63.7% did so for women 25 years or older, and 51% adhered to the recommended intervals between tests. Overall, 110 (40%) midwives adhered to the complete screening protocol (age at initiation and interval). In this clinical case vignette of a woman meeting the criteria for screening, only 29% of midwives reported they would perform a Pap test at 25 weeks of gestation, while 91% would at 10 weeks. Conclusion: Midwives' practices of cervical cancer screening and their determination of women's eligibility during pregnancy vary, especially according to gestational age; Nevertheless, pregnancy is an appropriate time to screen women who meet the criteria for cervical cancer screening, especially if they are not receiving regular gynaecological care.
Published: 2020

49. Recommandations pour la pratique clinique du CNGOF : il est temps d’évoluer !

Author: L, Sentilhes, M-V, Senat, T, Schmitz, A, Fauconnier, X, Fritel, HAL UVSQ, Équipe, Pôle d'Obstétrique Reproduction Gynécologie Centre Aliénor d'Aquitaine, Hôpital Pellegrin, Bordeaux, France., Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Research Center of Epidemiology, Biostatistics and Clinical Research, Université libre de Bruxelles (ULB), 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 hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, and Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Obstetrics, [SDV] Life Sciences [q-bio], [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Gynecology, [SDV]Life Sciences [q-bio], Practice Guidelines as Topic, Humans, CNGOF, Female, France, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2020

50. Recommandations pour la pratique clinique du CNGOF : révision méthodologique du processus d’élaboration

Author: Thomas Schmitz, Loïc Sentilhes, Elie Azria, M.-V. Senat, Arnaud Fauconnier, Xavier Fritel, Cyrille Huchon, Nicolas Bourdel, Catherine Deneux-Tharaux, 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)-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 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, Hôpital Pellegrin, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, Centre hospitalier universitaire de Poitiers (CHU Poitiers), CIC - Poitiers, Université de Poitiers-Centre hospitalier universitaire de Poitiers (CHU Poitiers)-Direction Générale de l'Organisation des Soins (DGOS)-Institut National de la Santé et de la Recherche Médicale (INSERM), 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), and HAL UVSQ, Équipe
Subjects: GRADE system, 030219 obstetrics & reproductive medicine, [SDV]Life Sciences [q-bio], Grade system, Obstetrics and Gynecology, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, 3. Good health, Clinical Practice, [SDV] Life Sciences [q-bio], 03 medical and health sciences, [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, 0302 clinical medicine, Reproductive Medicine, Political science, PICO question, AGREE II consortium, 030212 general & internal medicine, Clinical practice guidelines, Humanities
Abstract: Resume Objectifs Reviser l’organisation et la methodologie des recommandations pour la pratique clinique (RPC) du College national des gynecologues et obstetriciens francais (CNGOF). Methodes Les differentes methodes d’organisation et de cotation de la preuve scientifique ont ete consultees apres recherche dans la base de donnees Medline. Resultats Le groupe RPC du CNGOF a decide d’adopter une organisation des RPC basee sur les 23 criteres AGREE II (pour Appraisal of Guidelines for REsearch and Evaluation) et de coter la preuve scientifique selon la methode GRADE (pour Grading of Recommendation Assessment, Development, and Evaluation). Conclusion En adoptant les criteres du consortium AGREE II et la cotation de la preuve selon la methode GRADE, le CNGOF augmentera la qualite de l’ensemble du processus, delivrera des messages plus cibles et facilement assimilables, pour faciliter mieux encore les prises de decisions des professionnels, au benefice espere de la sante des femmes et de leurs enfants.
Published: 2020

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