The impact of chorionicity on pregnancy outcome and neurodevelopment at 2 years old among twins born preterm: the EPIPAGE-2 cohort study.

OBJECTIVE: To compare the short- and mid-term outcomes of preterm twins by chorionicity of pregnancy. DESIGN: Prospective nationwide population-based EPIPAGE-2 cohort study. SETTING: 546 maternity units in France, between March and December 2011. POPULATION: A total of 1700 twin neonates born between 24 and 34 weeks of gestation. METHODS: The association of chorionicity with outcomes was analysed using multivariate regression models. MAIN OUTCOME MEASURES: First, survival at 2-year corrected age with or without neurosensory impairment, and second, perinatal, short-, and mid-term outcomes (survival at discharge, survival at discharge without severe morbidity) were described and compared by chorionicity. RESULTS: In the EPIPAGE 2 cohort, 1700 preterm births were included (850 twin pregnancies). In all, 1220 (71.8%) were from dichorionic (DC) pregnancies and 480 from monochorionic (MC) pregnancies. MC pregnancies had three times more medical terminations than DC pregnancies (1.67 versus 0.51%, P < 0.001), whereas there were three times more stillbirths in MC than in DC pregnancies (10.09 versus 3.78%, P < 0.001). Both twins were alive at birth in 86.6% of DC pregnancies compared with 80.0% among MC pregnancies (P = 0.008). No significant difference according to chorionicity was found regarding neonatal deaths and morbidities. Likewise, for children born earlier than 32 weeks, the 2-year follow-up neurodevelopmental results were not significantly different between DC and MC twins. CONCLUSIONS: This study confirms that MC pregnancies have a higher risk of adverse outcomes. However, the outcomes among preterm twins admitted to neonatal intensive care units are similar irrespective of chorionicity. TWEETABLE ABSTRACT: Monochorionicity is associated with adverse perinatal outcomes, but outcomes for preterm twins are comparable irrespective of their chorionicity.

Neurodevelopment at 2 years and umbilical artery Doppler in cases of very preterm birth after prenatal hypertensive disorder or suspected fetal growth restriction: EPIPAGE-2 prospective population-based cohort study.

OBJECTIVE: To investigate the association between absent or reversed end-diastolic flow (ARED) on umbilical artery Doppler ultrasound and poor neurological outcome at 2 years of age after very preterm birth associated with suspected fetal growth restriction (FGR) or maternal hypertensive disorders. METHODS: The study population comprised all very preterm (22-31 completed weeks) singleton pregnancies delivered because of suspected FGR and/or maternal hypertensive disorders that had umbilical artery Doppler and 2-year follow-up available included in EPIPAGE-2, a prospective, nationwide, population-based cohort of preterm births in France in 2011. Univariate and two-level multivariable logistic regression analyses were used to assess the association of ARED in the umbilical artery, as compared with normal or reduced end-diastolic flow, with severe or moderate neuromotor and/or sensory disability and with an Ages and Stages Questionnaire (ASQ) score below a threshold. This was defined as a score more than 2 SD below the mean in any of the five domains, at age 2, adjusting for gestational age at delivery. ASQ is used to identify children at risk of developmental delay requiring reinforced follow-up and further evaluation. Descriptive statistics and bivariate tests were weighted according to the duration of the inclusion periods. RESULTS: The analysis included 484 children followed up at 2 years of age, for whom prenatal umbilical artery Doppler ultrasound was available. Among them, 8/484 (1.6%) had severe or moderate neuromotor and/or sensory disability, and 156/342 (45.4%) had an ASQ score below the threshold. Compared with normal or reduced end-diastolic flow in the umbilical artery (n = 305), ARED (n = 179) was associated with severe or moderate neuromotor and/or sensory disability (adjusted odds ratio (OR), 11.3; 95% CI, 1.4-93.2) but not with an ASQ score below the threshold (adjusted OR, 1.2; 95% CI, 0.8-1.9). CONCLUSION: Among children delivered before 32 weeks of gestation due to suspected FGR and/or maternal hypertensive disorder who survived until 2 years of age, prenatal ARED in the umbilical artery was associated with a higher incidence of severe or moderate neuromotor and/or sensory disability. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Is homecare management associated with longer latency in preterm premature rupture of membranes?

PURPOSE: According to national guidelines, conventional management of preterm premature rupture of membranes (PPROM) is hospitalization until induction. Outpatient management could be another option. Our objective was to compare latency period between patients managed in hospital versus outpatients. METHODS: A retrospective before/after monocentric study that occured from 2002 to 2015. Were included all patients with PPROM prior to 35 weeks with homecare inclusion criteria. The primary outcome measure was to study length of latency period (delay between PPROM and delivery). Second outcome measures were maternal and perinatal morbidities and mortalities. RESULTS: Among the 395 women included after PPROM, 191 were managed as outpatients and 204 in hospital. In the outpatient group, the length of latency period was longer than in the inpatient group [39 (IQR 20 to 66) versus 21 (IQR 13 to 42) days; p < 0.001]. Clinical chorioamnionitis was observed in 30 (15.7%) in outpatient group versus 49 (24.0%) in inpatient group (p = 0.039). Concerning neonatal outcome, there were less neonatal transfer (49.2% versus 77.2%, p < 0.001), less respiratory distress syndrome (29.4% versus 47.5%; p < 0.001), less neonatal sepsis (13.9% versus 22.1%; p = 0.037), less bronchodysplasia (2.7% versus 9.8%; p = 0.004), and less pulmonary arterial hypertension (4.8% versus 10.3%; p = 0.040) in the outpatient group than in the inpatient group. CONCLUSION: Home management seems to be a safe option to hospitalization in selected patients with PPROM. However, a randomized study would be required to approve those results.

Does an intrauterine exchange transfusion improve the fetal prognosis in parvovirus infection cases?

BACKGROUND: Almost 20% of parvovirus B19 foetal infections require intrauterine transfusions. In addition, myocardial dysfunction has been observed in severe parvovirus B19 infections. One objective of an intrauterine exchange transfusion (IUET) is to avoid an overload during the transfusion. Our aim was to study the obstetrical and neonatal outcomes in cases of IUETs performed for foetal parvovirus infections and to compare our survival rate to those studies in which simple in utero transfusions were chosen. STUDY DESIGN AND METHODS: This was a retrospective monocentre study of all patients followed up for parvovirus B19 infections in which IUETs were performed. An IUET was indicated when foetal hydrops was observed and/or when severe foetal anaemia was diagnosed though an elevation in the middle cerebral artery peak systolic velocity. The characteristics of each pregnancy and the neonatal outcomes were studied until hospital discharge. RESULTS: Thirty-five IUETs were performed in 26 foetuses. The median gestational age of the first IUET was 22.6 weeks. Only one foetal bradycardia incidence was recorded during the procedure. Three medical pregnancy terminations were observed in our series, secondary to severe cerebral anomalies confirmed in the magnetic resonance imaging. Five in utero deaths occurred, in which 2 of the foetuses underwent multiple IUETs. All the neonates had normal haemoglobin levels at birth, and none were transferred to the neonatal intensive care unit. The overall survival rate was 70%. CONCLUSION: IUETs exhibit a survival rate similar to that of simple intrauterine transfusions in foetal parvovirus infection cases.

Prognosis for deliveries in face presentation: a case-control study.

PURPOSE: To estimate the maternal and fetal prognosis for attempted vaginal deliveries of fetuses in face compared with vertex presentations. To evaluate the factors associated with a cesarean during labor for fetuses in face presentation. METHODS: This case-control study collected all the cases of face presentation in a university hospital level-3 maternity ward between 22 and 42 weeks of gestation over a 16-year period. For each case, we selected three control cases with vertex presentations delivered the same day. Cesareans before labor were excluded. RESULTS: We compared 60 attempted vaginal deliveries of fetuses in face presentation with 174 of fetuses in vertex presentation. The cesarean rate during labor was more than three times higher for the face presentations (31.7 vs 9.2%, P < 0.0001). Arterial pH values and Apgar scores were similar in both sets of newborns. After logistic regression, the factors associated with a cesarean during labor were nulliparity and early diagnosis of the presentation (i.e., before 5 cm dilatation). The initial position (mentum-anterior vs. transverse or posterior) was not significantly associated with the mode of delivery. CONCLUSIONS: In face presentations, attempted vaginal delivery triples the cesarean risk. Nonetheless, more than two-thirds of these women give birth vaginally without any impairment of neonatal condition.

[Abortion in Hauts-de-France: When to expect the first appointment?] / Interruption volontaire de grossesse dans les Hauts-de-France : quel délai pour un premier rendez-vous ?

BACKGROUND: According to the French National Authority for Health ("Haute Autorité de santé"), the first appointment for an abortion should take place within five days of the request. Whether this deadline is met or not in the Hauts-de-France region is not known. AIM: The aim of this study was to measure the time needed to get a first appointment for an abortion in Hauts-de-France. METHOD: We conducted a telephone survey of health facilities, family planning and registered practitioners practicing abortions in the Hauts-de-France region, to determine the next appointment available for a woman requesting an abortion. The calls took place between April 10 and 14, 2017. The time needed to get a first appointment (means±standard deviations) was calculated for the region, the departments, the districts and the health facilities and practitioners. RESULTS: We contacted 93 health facilities and practitioners and 70 were included in the study. The time needed to get a first appointment for an abortion in Hauts-de-France was measured at 5.25±5.20 days: 6.32±4.72 days for health facilities, 3.84±5.11 days for gynecologists, 5.22±5.88 days for general practitioners and 0.67±0.58 days for private-practice midwives. Fifty-six percent of health facilities and practitioners gave the appointment within five days. Between the districts, the average time varied from 1 to 15.5 days. CONCLUSION: The average time needed to get a first appointment for an abortion in Hauts-de-France was near the 5-day deadline recommended by the French National Authority for Health. The training of private practice midwives and general practitioners may be the first step in shortening it in some districts where access to health care is limited.

Bulky fibroid and pregnancy: myomectomy is possible during pregnancy.

When bulky fibroids are discovered during pregnancy, they can become acutely complicated. The question of their resection thus arises. The authors report a case of a woman who was diagnosed at eight weeks' gestation by ultrasound and then by MRI, with a uterine fibroma measuring 22x12x15 cm.

Neonatal outcome after fetal anemia managed by intrauterine transfusion.

UNLABELLED: In-utero transfusion is now well under control and improves the survival of foetuses monitored for fetal anemia with a survival rate of more than 80 %. The aim was to evaluate short-term neonatal outcome after fetal severe anemia managed by intrauterine transfusions. We did a retrospective study of all neonates born after management of severe fetal anemia (n = 93) between January 1999 and January 2013 in our regional center. The two main causes of anemia were maternal red blood cell alloimmunization (N = 81, 87 %) and Parvovirus B19 infection (N = 10, 10.8 %). In the alloimmunization group, phototherapy was implemented in 85.2 % of cases with a maximum level of bilirubin of 114.4 ± 60.7 (mg/dl). Transfusion and exchange transfusion were, respectively, required in 51.9 % and in 34.6 % of cases. One neonate presented a convulsive episode, and we observed three neonatal deaths. In the parvovirus group, none of the child had anemia at birth and no management was necessary. CONCLUSION: Contemporary management of Rhesus disease is associated with encouraging neonatal outcomes. In case of Parvovirus infection, no specific management is necessary at. But, in all cases of fetal anemia, children should be followed up with particular attention to neurologic development. WHAT IS KNOWN: • In-utero transfusion is now well under control and improves the survival of fetuses monitored for fetal anemia. • Limited studies are available on the effect of IUT on postnatal outcome in infants with a history of fetal anemia. What is New: • Contemporary management of severe Rhesus disease is associated with encouraging neonatal outcomes. • The majority of infants can be managed with phototherapy and a limited number of top-up transfusions and exchange transfusions. In case of Parvovirus infection, the short-term neonatal outcome is excellent.

BACTERIAL COMMUNITY DYNAMICS AND ECOTOXICOLOGICAL ASSESSMENT DURING BIOREMEDIATION OF SOILS CONTAMINATED BY BIODIESEL AND DIESEL/BIODIESEL BLENDS.

The gradual introduction of biodiesel in the Brazilian energy landscape has primarily occurred through its blending with conventional petroleum diesel (e.g., B20 (20% biodiesel) and B5 (5% biodiesel) formulations). Because B20 and lower-level blends generally do not require engine modifications, their use as transportation fuel is increasing in the Brazilian distribution networks. However, the environmental fate of low-level biodiesel blends and pure biodiesel (B100) is poorly understood and the ecotoxicological-safety endpoints of biodiesel-contaminated environments are unknown. Using laboratory microcosms consisting of closed reactor columns filled with clay loam soil contaminated with pure biodiesel (EXPB100) and a low-level blend (EXPB5) (10% w/v), this study presents soil ecotoxicity assessement and dynamics of culturable heterotrophic bacteria. Most-probable-number (MPN) procedures for enumeration of bacteria, dehydrogenase assays and soil ecotoxicological tests using Eisenia fetida have been performed at different column depths over the course of incubation. After 60 days of incubation, the ecotoxicity of EXPB100-derived samples showed a decrease from 63% of mortality to 0% while EXPB5-derived samples exhibited a reduction from 100% to 53% and 90% on the top and at the bottom of the reactor column, respectively. The dehydrogenase activity of samples from EXPB100 and EXPB5 increased significantly compared to pristine soil after 60 days of incubation. Growth of aerobic bacterial biomass was only observed on the top of the reactor column while the anaerobic bacteria exhibited significant growth at different column depths in EXPB100 and EXPB5. These preliminary results suggest the involvement of soil indigenous microbiota in the biodegradation of biodiesel and blends. However, GC-FID analyses for quantification of fatty acid methyl esters (FAMEs) and aliphatic hydrocarbons and targeted sequencing of 16S rRNA tags using illumina platforms will provide important insights into the profiles and underlying mechanisms of (bio)diesel biodegradation in soil environments.

Does a combination of ultrasound, MRI, and biochemical amniotic fluid analysis improve prenatal diagnosis of esophageal atresia?

OBJECTIVE: Prenatal diagnosis of esophageal atresia (EA) remains a challenge. Our objective was to evaluate the combination of sonography, magnetic resonance imaging (MRI), and amniotic fluid biochemical markers in prenatal diagnosis of EA. STUDY DESIGN: A retrospective study of all cases with prenatal suspicion of EA from January 2008 to May 2013 in our regional reference center was carried out. Patients were included if all the three tests were performed. For each test, sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) were evaluated. Each test was compared using Fisher's exact test. RESULTS: Fifteen patients were referred at a median gestational age of 28(+5) weeks (24-36) for suspicion of EA on the basis of small or non-visualized fetal stomach bubble and/or polyhydramnios. Se, Sp, PPV, and NPV for sonographic pouch sign/MRI/biochemical amniotic fluid were respectively 40/100/100/45.5%, 80/100/100/71.4%, and 90/60/81.8/75%. MRI was the best predictive test (p = 0.007). CONCLUSION: In case of ultrasound prenatal suspicion of EA (with or without visualization of the pouch sign), an MRI at 30-32 weeks using fast imaging employing steady-state acquisition should be proposed. Biochemical amniotic fluid may be helpful and should be evaluated in a larger study.

[Comparison of vaginal prostaglandins with oral misoprostol as a second line of cervical ripening after using a cervical balloon catheter]. / Comparaison des prostaglandines vaginales au misoprostol oral en 2e ligne de maturation cervicale après recours à un ballonnet de dilatation cervicale.

OBJECTIVE: To compare vaginal prostaglandins with oral misoprostol as a second line of cervical ripening after using a cervical balloon catheter. MATERIAL AND METHODS: This is a retrospective monocentric study (Lille, France), according to a "before"/"after" design. The inclusion criteria were a singleton pregnancy, with a fetus in cephalic presentation, a term >37 WA, with a cervix having a Bishop score lower than 6 after a first line of maturation by cervical balloon catheter. Two groups were formed: "before" corresponding to the continuation of maturation by vaginal prostaglandins, from March 2019 to November 2019, and "after": corresponding to the continuation of maturation by oral misoprostol, from June 2020 to December 2020. The primary outcome was vaginal delivery rate. RESULTS: One hundred women were included in each group. The rate of vaginal delivery was similar between the 2 groups (76% vs 81%, p=0.39), as were the times between the start of induction and the birth and between the start of induction and the transition to birth room. There was no difference in the indication for caesarean section, with in particular an identical rate of caesarean sections for induction failure (p=0.52). Subgroup analysis in obese women showed a significantly higher rate of vaginal delivery in the "after" group (OR=4.17;95% CI [1.02;17.07]). CONCLUSION: The vaginal delivery rate is similar when using vaginal prostaglandins or oral misoprostol as second line cervical ripening after use of a cervical balloon catheter.

[Couder's maneuver. Knowledge and practices in a French university maternity hospital]. / Manœuvre de Couder. Connaissances et pratiques dans une maternité universitaire française.

BACKGROUND: During childbirth, the performance of a systematic Couder's maneuver could be linked to a reduction in the risk of perineal tear. OBJECTIVE: To know the practices and knowledge of childbirth professionals regarding the Couder's maneuver. To measure the effect of a training program for juniors. MATERIALS AND METHODS: Single-center questionnaire survey of senior and junior obstetricians and midwives. Before-and-after study in juniors to evaluate maneuver training. RESULTS: One hundred and twenty-five caregivers responded to the questionnaire: (19 physicians and 46 senior midwives; 21 residents and 39 midwifery students). Only one third of the respondents said they practiced the Couder's maneuver "always or almost always" (41/125, 32.8%) and less than one third felt "very comfortable" with the maneuver (34/125, 27.2%), with large differences according to profession and senior vs junior status. Being a doctor (vs midwife) was significantly related to systematic or frequent practice of the maneuver (70.0 vs 15.3%, ORMH=42.7 [9.4; 192.3]) as was being a senior (vs junior) (46.2 vs 18.3%, ORMH=15.9 [3.5; 72.9]). Less than half of the seniors surveyed had received education in maneuvering. Of those who did not practice the maneuver, the majority did not consider its systematic practice to be useful (19/26, 73.1%), and one third considered it potentially harmful (8/26, 30.8%). Theoretical and practical training of the juniors significantly improved their knowledge. CONCLUSION: There are great differences in the practice of the Couder's maneuver. It deserves to be better known, practiced and evaluated.

[Should French pregnant women be vaccinated against pertussis during pregnancy?] / Faut-il vacciner les femmes enceintes françaises contre la coqueluche ?

Many countries with a high perinatal level have started a policy of vaccination of pregnant women against pertussis. To date, France has not chosen this policy. The objective was to review knowledge on pertussis mortality in infants. Compare the strategies available to protect the infant before his first vaccination, scheduled for two months of age. We proceeded to a litterature analysis, from January 1998 to 2021. Search by the following keywords used ; "Whooping cough, vaccination, pregnancy, strategy, cocooning", on the scientific basis of "Pubmed", as well as French and foreign vaccination recommendations. Currently 90% of whooping cough deaths are concerning infants under six months of age and this mortality represents 2% of mortality in the first year of life. Vaccination at birth is not effective. The cocooning strategy, which consists of vaccinating those around the child, is expensive and difficult to implement. A systematic vaccination policy for pregnant women is effective and reasonably expensive when compared to the cocooning strategy. In England, it was recently accompanied by a 78% reduction in confirmed cases of pertussis in infants under six months of age. In conclusion, compared to cocooning strategy, pertussis vaccination of pregnant women appears more effective and cost-effective, and this with each pregnancy.

Cervical maturation in breech presentation: Mechanical versus prostaglandin methods.

OBJECTIVE: Breech presentation at term accounts for around 5% of births. Few studies have evaluated the effectiveness of different induction methods for breech presentations. We aim to compare the mode of delivery after induction by intra cervical dilatation balloon compared to prostaglandin (PGE2) in breech presentation. We also evaluated the risk factors associated with a failure of induction. METHODS: Single-center retrospective study from January 2000 to December 2020 including all women induced from 36 weeks, breech presentation, with a single pregnancy without contraindication to vaginal delivery and with an unfavorable cervix (Bishop<6). The primary endpoint was the mode of delivery. Failure of induction was defined as the need of a cesarean section. RESULTS: One hundred seventy six patients were included, 96 in the balloon group and 80 in the prostaglandin group. The cesarean section rate in the balloon group was not significantly different from the prostaglandin group (34.4% vs. 26.3%, p= 0.24). Fifty percent of the patients in the balloon group required additional maturation with prostaglandins after the balloon was dropped or removed. In our overall population, the factors associated with induction failure were nulliparity (OR= 3.144; CI95%: (1.496-6.661)) and BMI > 30 kg/m2 (OR= 3.15 CI95%: (1,374 - 7,224)). CONCLUSION: Mode of delivery after mechanical methods in breech delivery induction appears similar to prostaglandins. However, it should be noted that in half of the cases, additional maturation with prostaglandin was necessary, calling into question the value of the mechanical methods. Factors associated with cesarean were maternal characteristics (nulliparity and BMI > 30 kg/m2) but not induction method.

Is the Development of Gestational Diabetes Associated With the ABO Blood Group/Rhesus Phenotype?

Aims: There are few published data on the putative association between the ABO blood group/rhesus (Rh) factor and the risk of developing gestational diabetes mellitus (GDM). Our aim was to explore the link between each one factor and GDM development. Methods: All women having given birth at Lille University Medical Center (Lille, France) between August 1st, 2017, and February 28th, 2018, were tested for GDM, using the method recommended in the French national guidelines. The risk of GDM was assessed for each ABO blood group, each Rh phenotype and combinations thereof, using logistic regression models. Results: 1194 women had at least one GDM risk factor. The percentage of GDM varied with the ABO group (p=0.013). Relative to group O women, group AB women were more likely to develop GDM (OR = 2.50, 95% CI [1.43 to 4.36], p=0.001). Compared with the Rh-positive O group, only the Rh-positive AB group had an elevated risk of developing GDM (OR = 3.02, 95% CI [1.69 to 5.39], p < 0.001). Conclusions: Our results showed that Rh-positive group AB women have a greater risk of GDM. With a view to preventing GDM, at-risk individuals could be identified by considering the ABO blood group phenotype either as a single risk factor or in combination with other risk factors.

Is it reasonable to propose vaginal delivery with twin pregnancies, when the first twin is in breech presentation?

BACKGROUND: Breech presentation of the first twin occurs in 20% of twin pregnancies. However, the impact of delivery mode on morbimortality in breech fetuses remains controversial in the literature generally, and has been infrequently studied in twin pregnancies specifically. The aim herein was to evaluate neonatal and maternal outcomes according to delivery mode when the first twin was in breech presentation, and to compare these results with those in the current literature. MATERIAL AND METHODS: This was a single-center, retrospective study in Lille, France, from January 2010 to December 2017, including twin pregnancies in which the first twin was in breech presentation and delivery was after 32 weeks of amenorrhea. Two groups were defined: planned vaginal delivery (PVD) and planned cesarean delivery (PCD). The primary outcome was neonatal morbidities, defined as a 5-minute Apgar score < 7, cord pH < 7.10 at birth, sepsis, and acute respiratory distress syndrome. RESULTS: Among the 184 patients included, 116 attempted a vaginal delivery (63%). Morbidity did not differ between PVD and PCD for the first twin (12/116 (10.3%) versus 7/68 (10.3%), respectively, p = 0.99), the second twin (18/116 (15.5%) versus 7/68 (10.3%), respectively, p = 0.31), or either twin (27/116 (23.2%) versus 11/68 (16.2%), respectively, p = 0.25). The rate of postpartum hemorrhage was significantly lower in the PVD group (PVD 36/116 (31%) versus PCD 41/68 (58.8%), p = 0.001). CONCLUSION: PVD is a reasonable option when the first twin is in breech presentation with probably no higher neonatal mortality and morbidity and less risk of maternal severe postpartum hemorrhage.

Ultrasound assessment of fetal head position and station before operative delivery: Can it predict difficulty?

OBJECTIVE: To evaluate whether ultrasound assessment of fetal head position and station though head perineum distance (HPD), is more predictive of a difficult operative vaginal delivery (OVD) than digital examination. METHODS: Retrospective, monocentric case control study including all singleton OVD at ≥34 weeks gestation. The principal criteria for a difficult OVD were based on a composite criterion of: an OVD considered "difficult" by the birth attendant, and/or two vacuum device detachments if a vacuum was used, and/or change of instrument, and/or a cesarean delivery for OVD failure. RESULTS: Two hundred eighty-six OVDs were included, among which 65 (22.7%) were difficult. The area under the curve (AUC) for predicting difficult OVD according to fetal position from digital examination or ultrasound was 0.62 (95% CI: 0.54-0.70) and 0.66 (95% CI: 0.58-0.73), respectively. Regarding fetal station, the AUCs of HPD without and with pressure were 0.59 (95% CI: 0.51-0.66) and 0.60 (95% CI: 0.51-0.68), respectively. Factors associated with difficult OVD were posterior and transverse positions (OR: 2.931, 95% CI: 1.640-5.239; p= 0.0003), HPD without pressure (threshold of 37 mm, OR: 2.327, 95% CI: 1.247-4.245; p= 0.0080), and HPD with pressure (threshold of 17 mm, OR: 2.594, 95% CI: 1.230-5.429; p= 0.0114). CONCLUSION: Ultrasound assessment of fetal head position and station before OVD moderately predicts difficult OVD. Ultrasound assessment of posterior or transverse positions and HPD with a threshold of 37 mm (without compression of soft tissue) and 17 mm (with compression) were factors associated with difficult OVD.

[Ante- and postnatal growth charts in France - guidelines for clinical practice from the Collège national des gynécologues et obstétriciens français (CNGOF) and from the Société française de néonatologie (SFN)]. / Les courbes de croissance anté- et postnatales en France ­ recommandations pour la pratique clinique du Collège national des gynécologues et obstétriciens français (CNGOF) et de la Société française de néonatologie (SFN).

OBJECTIVE: To recommend the most appropriate biometric charts for the detection of antenatal growth abnormalities and postnatal growth surveillance. METHODS: Elaboration of specific questions and selection of experts by the organizing committee to answer these questions; analysis of the literature by experts and drafting conclusions by assigning a recommendation (strong or weak) and a quality of evidence (high, moderate, low, very low) and for each question; all these recommendations have been subject to multidisciplinary external review (obstetrician gynecologists, pediatricians). The objective for the reviewers was to verify the completeness of the literature review, to verify the levels of evidence established and the consistency and applicability of the resulting recommendations. The overall review of the literature, quality of evidence and recommendations were revised to take into consideration comments from external reviewers. RESULTS: Antenatally, it is recommended to use all WHO fetal growth charts for EFW and common ultrasound biometric measurements (strong recommendation; low quality of evidence). Indeed, in comparison with other prescriptive curves and descriptive curves, the WHO prescriptive charts show better performance for the screening of SGA (Small for Gestational Age) and LGA (Large for Gestational Age) with adequate proportions of fetuses screened at extreme percentiles in the French population. It also has the advantages of having EFW charts by sex and biometric parameters obtained from the same perspective cohort of women screened by qualified sonographers who measured the biometric parameters according to international standards. Postnatally, it is recommended to use the updated Fenton charts for the assessment of birth measurements and for growth monitoring in preterm infants (strong recommendation; moderate quality of evidence) and for the assessment of birth measurements in term newborn (expert opinion). CONCLUSION: It is recommended to use WHO fetal growth charts for antenatal growth monitoring and Fenton charts for the newborn.

Thrombotic events during long-term follow-up of obstetric antiphospholipid syndrome patients.

Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by arterial and/or venous thromboses and/or pregnancy-associated morbidity. Some patients develop only obstetric complications (obstetric APS), but data on the frequency of thrombotic events during the follow-up of these patients are scarce. This study was undertaken to evaluate the rate of thrombotic events after obstetric APS diagnosis according to the 2006 revised criteria. In total, 32 obstetric APS patients were retrospectively studied, with mean follow-up of 50 ± 37 months. After delivery, aspirin was prescribed to all patients as primary thrombosis prevention. The thrombosis rate was 3.3/100 patient-years and was 4.6, 4.5 and 10/100 patient-years when we considered at least two antiphospholipid antibody positivities (among lupus anticoagulant, anticardiolipin and anti-ß2-glycoprotein-I), antinuclear antibody positivity or systemic lupus erythematosus-associated APS patients, respectively. The thrombosis rate was high after obstetric APS diagnosis, even for patients taking aspirin. Larger, prospective studies are needed to confirm this high frequency and determine the associated risk factors.

[Impact of a protocol based on the new national recommendations on the use of oxytocin and its maternal-fetal consequences: A single-center before/after study]. / Impact d'un protocole basé sur les nouvelles recommandations nationales sur le recours à l'oxytocine et ses conséquences maternofoetales : étude monocentrique de type avant/après.

OBJECTIVE: Evaluate oxytocin use and impact on maternal and fetal morbidity before and after implementation of a protocol based on national recommendations. MATERIALS AND METHODS: A single-center retrospective before-and-after study (Lille, France). A service protocol to harmonize the use of oxytocin was implemented in May 2017 following national recommendations. Data were collected from January to March 2016 for period 1, and from January to March 2019 for period 2. Nulliparous patients in spontaneous labor=37SA delivering a live newborn in cephalic presentation were included. The primary outcome was the use of oxytocin. RESULTS: Five hundred eighty-seven patients were included, 302 for period 1 and 285 for period 2. The rate of oxytocin use was 48% (n=144) in 2016 versus 28% (n=79) in 2019 (P<0.001). Total labor time was significantly longer after protocol implementation (425.7min vs. 510.4min ; P<0.001). The cesarean section rate was identical between the 2 periods (7.0% vs. 6.0%; P=0.62). The rate of postpartum hemorrhage greater than 500mL was higher in period 1 (17.7% vs. 10.9%; P=0.019), as was the occurrence of a pH<7.05 (5.4% vs. 1.1%; P=0.004). CONCLUSION: The implementation of a protocol contributed to a decrease in the use of oxytocin and thus would allow a decrease in the rate of postpartum hemorrhage and neonatal acidosis, but with an increase in the duration of labor.