Greenhouse gas emissions and energy efficiencies for soybeans and maize cultivated in different agronomic zones: A case study of Argentina.

Of all human activities, agriculture has one of the highest environmental impacts, particularly related to Greenhouse Gas (GHG) emissions, energy use and land use change. Soybean and maize are two of the most commercialized agricultural commodities worldwide. Argentina contributes significantly to this trade, being the third major producer of soybeans, the first exporter of soymeal and soybean oil, and the third exporter of maize. Despite the economic importance of these crops and the products derived, there are very few studies regarding GHG emissions, energy use and efficiencies associated to Argentinean soybean and maize production. Therefore, the aim of this work is to determine the carbon and energy footprint, as well as the carbon and energy efficiencies, of soybeans and maize produced in Argentina, by analyzing 18 agronomic zones covering an agricultural area of 1.53millionkm2. Our results show that, for both crops, the GHG and energy efficiencies at the Pampean region were significantly higher than those at the extra-Pampean region. The national average for production of soybeans in Argentina results in 6.06ton/ton CO2-eq emitted to the atmosphere, while 0.887ton of soybean were produced per GJ of energy used; and for maize 5.01ton/ton CO2-eq emitted to the atmosphere and 0.740ton of maize were produced per each GJ of energy used. We found that the large differences on yields, GHGs and energy efficiencies between agronomic regions for soybean and maize crop production are mainly driven by climate, particularly mean annual precipitation. This study contributes for the first time to understand the carbon and energy footprint of soybean and maize production throughout several agronomic zones in Argentina. The significant differences found in the productive efficiencies questions on the environmental viability of expanding the agricultural frontier to less suitable lands for crop production.

Continued pregnancy and vaginal delivery after 32 weeks of gestation for monoamniotic twins.

OBJECTIVE: To report the outcomes of 38 monoamniotic twin pregnancies managed homogeneously to assess whether continuing the pregnancy past 32 weeks of gestation and vaginal delivery are reasonable options. STUDY DESIGN: Single-centre retrospective study including all monoamniotic pregnancies managed over a 20-year period at Port-Royal Obstetrics Department, Paris, France. METHODS: In the study department, both continuation of the pregnancy up to 36 weeks of gestation and vaginal delivery are allowed for monoamniotic pregnancies in some conditions. Perinatal outcomes are described and then compared according to mode of delivery for patients who gave birth at or after 32 weeks of gestation. RESULTS: Three of the 38 pregnancies included fetal malformations; in two of these cases, both fetuses died in utero at 26 weeks of gestation. In cases without malformations, one twin died in utero in two women at 28.0 and 29.2 weeks of gestation, and both fetuses died in two other women at 24.0 and 24.5 weeks of gestation. Mean gestational age at delivery was 32.9 weeks (range 24.0-36.3). Five women gave birth between 22 and 26 weeks of gestation, six women gave birth between 27 and 31 weeks of gestation, and 27 women gave birth at or after 32 weeks of gestation (26 after excluding those with fetal malformations). No intrauterine or neonatal deaths were observed at or after 32 weeks of gestation. The 28 infants delivered vaginally did not differ significantly from the 22 infants born by caesarean section in terms of umbilical artery pH or 5-min Apgar scores. CONCLUSION: Continuation of monoamniotic pregnancies beyond 32 weeks of gestation and trial of vaginal delivery are both reasonable options if the parents agree, and optimal surveillance is provided.

[Pregnancy in women aged 43 years or older: maternal and perinatal risks]. / Grossesse à 43 ans et plus: risques maternels et périnataux.

OBJECTIVES: The proportion of women with advanced age at the time of delivery increases constantly, partly due to assisted reproductive technologies. Maternal morbidity is known to increase with maternal age, whereas data on perinatal outcomes are controversial. Risks of maternal and perinatal complications may be elevated among older pregnant women. The purpose of this study is to quantify these risks among 43 years or older women in comparison with women aged 25 to 35 years, the age known to be optimal for a pregnancy. PATIENTS AND METHODS: A retrospective study was conducted during three years (2008-2010) in a level 3 maternity unit, comparing maternal and perinatal outcomes between women who were at least 43 years old and a control group composed of drawn lots mothers between 25 and 35 years of age at the time of delivery. Maternal and perinatal outcomes were studied using uni- and multivariate analysis. As in vitro fertilization (IVF) and twin pregnancy are associated with maternal age and several complications, we compared 43 years or older women with a control group using three categories: "43 years or older without IVF", "43 years or older with IVF and singleton" and "43 years or older with IVF and twin". RESULTS: Three hundred and sixty one women aged at least 43 years at the time of delivery (mean age: 44.6 years) were compared with 361 women aged 25 to 35 years (mean age: 31.0 years). Cesarean and preterm delivery rates were significantly higher in the study group (43.5% vs. 21.7% and 18.4% vs. 6.5% respectively, p<0.05), with higher risks after adjustment (adjusted OR=2.3 [1.6-3.4] and 2.4 [1.3-4.3], respectively). Gestational hypertension and preeclampsia rates were significantly higher among the 43 years or older women compared with the control group (11.1% vs 3.6% and 8.3% vs. 3.1% respectively, P<0.05) but this difference was not significant in multivariate analysis. The rate of preterm delivery was four fold higher among the 43 years or older women with IVF and twin in comparison with those who have a spontaneous pregnancy (52.3% vs. 13.0%, P<0.001). Cesarean delivery rate was also significantly increased in this subgroup. CONCLUSION: Most women having a spontaneous singleton pregnancy at 43 years or older have an uneventful pregnancy outcome. However, in comparison with the women aged 25 to 35 years, they have significantly higher risks of cesarean and preterm delivery. These risks significantly increase with IVF and twin pregnancy among older women. Women aged 43 years or older should be informed about these risks to make an enlightened decision, particularly when IVF is needed.

Association between oocyte donation and maternal and perinatal outcomes in women aged 43 years or older.

BACKGROUND: Although older maternal age is a risk factor for pregnancy complications, an increasing number of women delay conception until the age of 40, and some must resort to IVF with oocyte donation. Our objective was to study the association between IVF, both with and without oocyte donation, and maternal and perinatal outcomes in a population of older women. METHODS: This retrospective study covered all women, aged 43 or more, who gave birth between 2008 and 2010. Univariate and multivariate analyses with logistic regression models were used to compare maternal and perinatal outcomes as a function of mode of conception: without IVF, with IVF using own oocytes or with IVF and oocyte donation. RESULTS: The study included 380 women, including 40 who had IVF without oocyte donation (10.5%) and 104 who had both (27.4%). There were 326 singleton and 54 multiple pregnancies. Overall, the complication rate was high: 8.7% pre-eclampsia, 6.1% gestational diabetes, 20.2% preterm delivery and 8.2% very preterm delivery (before 33 weeks), 44.8% Cesarean sections and 7.4% severe post-partum hemorrhage (PPH). The pre-eclampsia rate differed significantly between the groups (3.8% after no IVF, 10.0% after IVF only and 19.2% after IVF with oocyte donation, P< 0.001). After adjustment, the risk of pre-eclampsia was significantly higher in women with donated oocytes compared with pregnant women without IVF [adjusted OR = 3.3 (1.2-8.9)]. The rate of twin pregnancy was significantly higher in women with IVF and oocyte donation (39.4 versus 15.0% with IVF only and 2.5% without IVF, P< 0.001). Twin pregnancy was significantly associated with the risk of preterm delivery [adjusted OR = 8.9 (4.0-19.9)] and PPH [adjusted OR = 3.5 (1.3-9.5)]. CONCLUSION: In women aged 43 years or older, pregnancies obtained by IVF with oocyte donation are associated with higher rates of pre-eclampsia and twin pregnancies than those obtained without IVF or with IVF using their own oocytes.

[Comparison of two bedside tests performed on cervicovaginal fluid to diagnose premature rupture of membranes]. / Analyse comparative de deux tests diagnostiques de rupture prématurée des membranes dans les sécrétions cervico-vaginales.

OBJECTIVE: To compare the performance of two rapid tests for the diagnosis of premature rupture of membranes (PROM) based on the detection of the insulin-like growth factor-binding protein-1 (IGFBP-1) and placental α-microglobulin-1 (PAMG-1) in cervicovaginal secretions. METHODS: A case-control prospective study. Pregnant women between 24 and 41(6/7) weeks' of gestation, consulting for profuse amniotic fluid loss (group 1) or for other reasons without any rupture of membrane (group 2) were included in the study. Successively, AmniSure(®) test (PAMG-1) without speculum, and then Actim™Prom test (IGFBP-1) during speculum examination were performed during the same visit. RESULTS: Eighty subjects (40 in each group) were included between 25(1/7) to 41(1/7) weeks of gestation. AmniSure(®) diagnostic test demonstrated a sensitivity and specificity of 95 % (82.4-99.4) and 94.8 % (79.3-98) respectively and a positive and negative predictive value of 95 % (84.7-100) and 94.8 % (87.9-100) respectively. Actim™Prom diagnostic test demonstrated a sensitivity and specificity of 97.5 % (85.7-100) and 97.4 % (82.4-99.4) respectively and a positive and negative predictive value of 97.5 % (88.5-100) and 97.4 % (92.5-100) respectively. CONCLUSION: Both tests have similar performance to diagnose premature rupture of membranes.

[Value of fetal scalp pH sampling early during the first stage of labour]. / Anomalies du RCF précocement au cours du travail : intérêt du pH au scalp.

OBJECTIVE: When fetal heart rate (FHR) abnormalities occur early during the first stage of labour, the risk of caesarean increases. In this study, we assessed the value of fetal scalp pH sampling on delivery mode, among women with FHR abnormalities before or at 5 cm cervical dilatation. METHODS: It is a retrospective observational study setting in a tertiary maternity center. All women with a live singleton cephalic fetus at term, who had a fetal scalp pH sampling, between January and July 2009, were included. We compared vaginal delivery and neonatal morbidity rates according to cervical dilatation at the time of the first fetal scalp pH sampling (≤ 5 or >5 cm). Neonatal morbidity was defined by pH at birth less or equal to 7.10 and/or 5 minutes Apgar score less or equal to 7 and/or neonatal transfer. RESULTS: During the study period, 108 women had at least one fetal scalp pH sampling, 8.5% of eligible women. Forty-six (42.6%) had a first pH at or before 5 cm cervical dilatation. The vaginal delivery rate was 62% and increased with increasing cervical dilatation at the time of the first fetal scalp pH (P<0.001). Among women who had fetal scalp pH early during the first stage of labour (≤ 5 cm), 50% delivered vaginally versus 71% when the fetal scalp pH was performed after 5 cm (P=0.026). The frequency of pH at birth less or equal to 7.10 was lower when the fetal scalp pH was performed before or at 5 cm (4.4% versus 16.9%, P=0.04). Neonatal morbidity rates were similar in both groups. CONCLUSION: In this study, when FHR abnormalities occur early during the first stage of labour, use of fetal scalp pH sampling allows a vaginal delivery in half of cases without an increase in neonatal morbidity.

[Termination of pregnancy and placenta previa, interest of performing feticide before the labor induction?]. / Interruption médicale de grossesse et placenta praevia, intérêt d'un fœticide précoce?

OBJECTIVES: Study of maternal morbidity when termination of pregnancy (TOP) is associated with placenta previa and study of the interest of performing feticide before labor induction. PATIENTS AND METHODS: This is a retrospective case control study with two groups of matched women: the case group (women with placenta previa) and the control group (women without placenta previa). Maternal morbidity have been studied and compared between the two groups and in the case group, between women who had feticide between labor induction and women who did not have feticide. RESULTS: Between 1996 and 2009, we identified 15 cases of TOP with placenta previa (seven complete placentas previa and eight low lying placenta including partial and marginal placenta previa) who have been matched with 29 women. In the case group, eight women had feticide before labor induction, six women had no feticide and one woman had feticide the same day of labor induction. Maternal morbidity was increased in this group but without major complications (four hemorrhages during labor, two postpartum hemorrhages, four transfused patients and mean difference of hemoglobin level was 1.5 g/dl in the case group versus no hemorrhage during labor, no postpartum hemorrhage, no transfusion and mean difference of hemoglobin level was 0.5 g/dl in the control group; P<0.005). Performing feticide before labor induction allowed a non-significant reduction of mean loss of hemoglobin and of the number of women who needed transfusions. CONCLUSION: A vaginal delivery in cases of TOP with placenta previa and even totally recovering seems a reasonable solution; performing feticide before labor induction could decrease loss of blood but further studies are needed.

[Nifedipine or nicardipine in management of threatened preterm delivery: an observational population-based study]. / Utilisation de la nifédipine et de la nicardipine dans le traitement de la menace d'accouchement prématurée: données observationnelles en population.

OBJECTIVE: For the first line tocolysis, calcium channel blockers (CCB)--oral nifedipine (Adalate®) or intravenous nicardipine (Loxen®)--are frequently used in France. No study compared nifedipine and nicardipine in management of threatened preterm delivery. From data of a French observational study, we compared factors associated with the use of nifedipine and nicardipine. Efficacy and tolerance of the two treatments were also compared. METHODS: It was a secondary analysis of EVAPRIMA study, a practice survey describing management of threatened preterm delivery in 107 French maternity units. Only women who received calcium channel blockers in their first line tocolytic therapy were included. We studied obstetrical factors associated with the choice of nifedipine or nicardipine. We also analyzed factors associated with a delivery within seven days following admission using univariate and multivariate analysis. Adverse secondary effects were compared between women who received nifedipine or nicardipine. RESULTS: Three hundred and four women received calcium channel blockers for their first line tocolytic therapy, in 73 maternity units: 93 (30.6%) women received oral nifedipine and 211 (69.4%) intravenous nicardipine. The same CCB was always prescribed in 69 maternity units. Admission after in utero transfer was less frequent among women who received nifedipine (6.5% versus 17.1%, P=0.01). Premature rupture of the membranes was also less frequent among women who received nifedipine (4.3% versus 13.7%, P=0.02), in comparison with women who received nicardipine. Median duration between admission for threatened preterm labor and delivery was longer when nifedipine was used (44 days versus 36 days, P=0.04). After adjustment on obstetrical factors, the risk to have a delivery within 7 days following admission was not significantly different between nifedipine and nicardipine groups (adjusted OR=0.5 [0.2-1.2]). Among women who received nifedipine only two cases (2.1%) of adverse event were reported with only one case needing a switch of treatment. Thirteen (6.2%) cases of adverse event were reported among women who received nicardipine (P=0.16); in three cases it motivated a switch. However, due to bias and limits inherent in such studies, our results should be interpreted cautiously. CONCLUSION: Nicardipine is the first choice for French obstetricians in management of severe threatened preterm delivery. However, intravenous nicardipine does not increase gestational duration in comparison with oral nifedipine.

[Is vaginal delivery in twin pregnancy still an option? An analysis of the literature data]. / L'accouchement par voie basse des grossesses gémellaires est-il encore une option raisonnable ? Analyse des données de la littérature.

The aim of this review was to analyze the nature of the data and practices reported in the literature in order to determine if vaginal delivery of twin gestations with a first twin in cephalic presentation after 34 weeks still remains an option. Compared to cesarean, large retrospective population-based studies demonstrated increased neonatal morbidity and mortality of the second twin associated with vaginal delivery. Some then suggested systematic planned cesarean could protect second twins from increased neonatal mortality and morbidity. These results have not been confirmed in hospital retrospective studies in which candidates for vaginal delivery were carefully selected, and second twin delivery actively managed, with internal version when the fetal head is above a 0 station in case of cephalic presentation and with systematic immediate total breech extraction in case of non cephalic presentation. Taking into account the poor external validity of the population-based studies, and the reassuring results of the hospital retrospective studies, attempted vaginal delivery after 34 weeks, when the first twin is in cephalic presentation, still appears as a safe option in low risk populations. Progress in the assessment of the risks associated with the mode of delivery could result from a large nationwide observational prospective study, a randomized trial being, even more than in the breech delivery issue, an inappropriate method for evaluating these risks.

Radiofrequency ablation of retained placenta accreta after conservative management: preliminary evaluation in the pregnant ewe and in normal human placenta in vitro.

OBJECTIVE: To evaluate radiofrequency (RF) efficiency and safety for the ablation of retained placenta in humans, using a pregnant sheep model. DESIGN: Experimental study. SETTING: Laboratory of Surgery School, Nancy, France. POPULATION/SAMPLE: Three pregnant ewes/ten human placentas. METHODS: Various RF procedures were tested in pregnant ewes on 50 placentomes (individual placental units). Reproducibility of the best procedure was then evaluated in a further 20 placentomes and on ten human term placentas in vitro after delivery. MAIN OUTCOME MEASURES: Placental tissues destruction, lesions' size, myometrial lesions. RESULTS: Low power (100 W) and low target temperatures (60 degrees C) lead to homogenous tissue destruction, without myometrial lesion. No significant difference was observed in terms of lesion size and procedure duration for in the placentomes of pregnant ewe in vivo and in human placentas in vitro. The diameter of the ablation could be correlated with the tines deployment. CONCLUSION: The placental tissue structure is very permissive to RF energy, which suggests that RF could be used for the ablation of retained placenta, providing optimal control of tissue destruction. These results call for further experimental evaluations.

Cerebral biometry in fetal magnetic resonance imaging: new reference data.

OBJECTIVES: To provide normal magnetic resonance imaging (MRI) reference biometric data of the fetal brain, to evaluate reproducibility and gender effect, to compare the two cerebral hemispheres and to compare MRI with ultrasonographic biometry, in a large cohort. METHODS: Normal cerebral fetal MRI examinations were collected prospectively and several parameters were measured: the supratentorial space (bone and cerebral fronto-occipital and biparietal (BPD) diameters), the length of the corpus callosum (LCC), the surface area, height and anteroposterior diameter of the vermis, the transverse cerebellar diameter (TCD) and the anteroposterior diameter of the pons. We evaluated the interobserver reproducibility of measurements and the possible gender effect on measurements of bone BPD, TCD and LCC. We compared right and left hemispheres, right and left atria and ultrasound and MRI measurements. RESULTS: The study included 589 fetuses, ranging from 26 to 40 weeks. Normal values (from 3(rd) to 97(th) percentile) are provided for each parameter. Interobserver agreement was excellent, with an intraclass correlation coefficient (ICC) > 0.75 for many parameters. The gender effect was evaluated in 372 cases and did not reveal any clinically meaningful difference. Comparison between the right and left cerebral hemispheres and between the right and left atria did not reveal any meaningful differences. Ultrasound and MRI measurements of BPD and TCD were compared in 94 cases and 48 cases, respectively, and the agreement was excellent (ICC = 0.85). CONCLUSIONS: We present new reproducible reference charts for cerebral MRI biometry at 26-40 weeks' gestation, from a large cohort of fetuses.

Selective use of sonographic cervical length measurement for predicting imminent preterm delivery in women with preterm labor and intact membranes.

OBJECTIVES: To determine, in a population of women with preterm labor and intact membranes, whether ultrasound cervical length measurement performed only in patients selected according to the Bishop score predicts imminent preterm delivery better than does systematic cervical length measurement in the entire population. METHODS: The Bishop score and sonographic cervical length were recorded prospectively in women with preterm labor between 24 and 34 completed weeks' gestation. Outcome measures were preterm delivery within 48 h and within 7 days. Predictive values were calculated for each marker separately and then in combination. RESULTS: Of the study population of 395 women, 17 (4.3%) and 32 (8.1%) delivered within 48 h and within 7 days, respectively, following inclusion. For delivery within 7 days, areas under the Bishop score (0.848) and sonographic cervical length (0.813) receiver-operating characteristics curves did not differ significantly. For the selective use of sonographic cervical length measurement in patients selected according to the Bishop score, the test was considered positive if the Bishop score was >or= 8, or 4-7 with cervical length

[Conservative versus radical management in cases of placenta accreta: a historical study]. / Comparaison historique de deux types de prises en charge de placenta accreta: radicale versus conservatrice.

OBJECTIVE: To compare the impact of conservative and radical strategies for placenta accreta on maternal morbidity and mortality. METHODS: We retrospectively reviewed the medical records of all patients diagnosed with placenta accreta admitted to our tertiary center from January 1993 through October 2005. Two consecutive periods, A and B, were compared: during period A (january 1993 to June 1997), our written protocol called for the systematic manual removal of the placenta, to leave the uterine cavity empty. In period B (July 1997 to October 2005), we changed our policy and attempted to treat patients with a placenta accreta conservatively. The following outcomes over the two periods were compared: need for blood product transfusion, hysterectomy, intensive care admission, duration of stay in intensive care unit, sepsis and disseminated intravascular coagulation. RESULTS: Fifty-one cases of placenta accreta were observed among 40281 deliveries (1.3/1000). Period B saw a reduction in the hysterectomy rate (11/13 versus 10/38; P < 0.01), the mean red blood cells transfused (3230+/-2170 versus 1081+/-1370 ml; P < 0.01) and disseminated intravascular coagulation (5/13 versus 1/38; P < 0.01) compared with period A. Seven cases of maternal infection were recorded during period B and none during period A (p = 0.22). CONCLUSION: Conservative management of placenta accreta appears to be a safe alternative to radical management.

First-trimester ultrasound diagnosis of skeletal dysplasia associated with increased nuchal translucency thickness.

A series of five cases of skeletal dysplasia is reported in which the diagnosis was reached at the 11-14-week routine ultrasound examination in our referral center. All five cases had increased nuchal translucency thickness (NT) associated with bone abnormalities. We review the current literature on skeletal dysplasia in the first trimester of pregnancy associated with increased NT.

[Pulmonary edema during calcium-channel blockers therapy: role of predisposing or pharmacologic factors?]. / L'oedème aigu du poumon chez des patientes en menace d'accouchement prématuré traitées par inhibiteurs calciques: place de facteurs prédisposants ou pharmacologiques spécifiques?

Calcium channel blockers of the dihydropyridin's family have been associated with the onset of an acute pulmonary edema when they are used as a treatment of preterm labor. We report here four cases of pulmonary edema in pregnant women treated with nicardipine (Loxen) for preterm labor. The physiopathology of pulmonary edema, the pharmacology of calcium channel blockers of dihydropyridin's family and the detailed analysis of our cases and those of the literature make us discuss of the role of these agents and associated population and risk factors in such complication.

[How to decide with precision, justice, and equity? Reflections on decision-making in the context of extreme prematurity. Part two: moving toward making the best possible decision: defining conditions for putting decisions into practice]. / Comment décider avec justesse, justice et équité? Réflexion sur la décision en situation d'extrême prématurité. Deuxième partie: comment tendre vers une décision optimale? Définition des conditions d'exercice de la décision.

Extreme premature child's long-term prognostic is getting better and better known, and if a resuscitation procedure is possible at birth, it won't guarantee survival or a survival free of disability. Incertitude toward individual prognosis and outcome for those children remains considerable. In this field, we are at the frontier of medical knowledge and the answer to the question, "how to decide the ante and postnatal care" is crucial. This work is focused on this problematic of decision-making in the context of extreme prematurity. It attempts to deconstruct this concept and to explicit its stakes. Thus, with the support of the medical sources and of philosophical debates, we tried to build a decision-making procedure that complies with the ethical requirements of medical care, accuracy, justice and equity. This decision-making procedure is primarily concerned with the singularity of each decision situation and it intends to link it closely to the notions of rationality and responsibility.

[How to decide with precision, justice, and equity? Reflections on decision-making in the context of extreme prematurity. Part one: the problematics of decision-making in the context of extreme prematurity]. / Comment décider avec justesse, justice et équité? Réflexion sur la décision en situation d'extrême prématurité. Première partie: problématique de la décision dans le contexte de la prématurité extrême.

Extreme premature child's long-term prognostic is getting better and better known, and if a resuscitation procedure is possible at birth, it won't guarantee survival or a survival free of disability. Incertitude toward individual prognosis and outcome for those childs remains considerable. In this field, we are at the frontier of medical knowledge and the answer to the question, "how to decide the ante and postnatal care?" is crucial. This work is focused on this problematic of decision making in the context of extreme prematurity. It attempts to deconstruct this concept and to explicit its stakes. Thus, with the support of the medical sources and of philosophical debates, we tried to build a decision-making procedure that complies with the ethical requirements of medical care, accuracy, justice and equity. This decision-making procedure is primarily concerned with the singularity of each decision situation and it intends to link it closely to the notions of rationality and responsibility.

[Quality of anonymous delivery procedures: analysis of practices and ethical issues]. / Accouchement sous X et qualité de l'anonymat des dossiers: analyse des pratiques et des enjeux éthiques.

OBJECTIVES: The purpose of this study was to assess implementation of procedures for anonymous delivery and also to determine the awareness of the medical team. MATERIAL AND METHOD: We reviewed retrospectively all deliveries performed in a Paris maternity ward during the years 2000-2003 where the mother requested application of the anonymous procedure. A questionnaire was also addressed to all physicians and midwives in the same institution in order to evaluate their knowledge of the procedures available and their point of view. RESULTS: Among the seventeen deliveries examined, the anonymous procedure was not completely fulfilled for 11 since the name of the mother could be identified. The quality of the files depended on the date at which the decision to use the anonymous procedure was made: delivery was more anonymous when the decision was made at the first consultation, less so when made later. The questionnaires revealed that professionals lacked information and were insufficiently aware of the procedures available. CONCLUSION: It appears useful to establish a standard procedure in order to better protect the parturient's wishes and comply with French law (4 March 2002). This point is particularly important since at the infant's majority, he/she may request access to personal information contained in the medical file.

[First breech twin pregnancy: Can we still accept a vaginal delivery? Comparative study of perinatal outcome with attempt of vaginal delivery versus planned cesarean: 166 cases]. / Grossesse gémellaire et siège premier à terme: peut-on encore accepter un accouchement par les voies naturelles?

OBJECTIVES: To evaluate practices and perinatal outcome in planned routes of delivery for first breech twins. MATERIALS AND METHODS: A retrospective study in first breech twin pregnancies with a gestational age of at least 35 weeks at onset of labor. Maternofetal pathologies known to be associated with a poor neonatal outcome were excluded. A low neonatal outcome was defined by at least one of the following criteria: neonatal death, 5-minute Agar Score < 7, cord blood pH < 7.10, traumatic neurological injuries, admission in neonatal intensive unit care. Neonatal and maternal outcomes were compared between attempt of vaginal delivery (AVD) and planned cesarean section (PCS). RESULTS: Among 166 included patients, an AVD has been performed in 105 cases (63.3%) and a PCS in 61 (36.8%). In AVD group, 46 women (43.8%) delivered vaginally. Low neonatal outcome was not significantly different in AVD group compared with PCS group (9 (8.6%) versus 6 (9.8%); p = 0.78 for the first twin and 7 (6.7%) versus 2 (3.3%); p = 0.49 for the second twin). There was no significant difference in maternal morbidity between the two groups. As a general rule, established practices for deciding route of delivery and labor have been applied in our department. CONCLUSION: No excess of neonatal risk in AVD group compared with PCS was observed. These results could be extrapolated to centers applying a careful protocol to decide the route of delivery and labor practices.