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1.
Gynecol Obstet Fertil Senol ; 51(5): 239-248, 2023 05.
Artigo em Francês | MEDLINE | ID: mdl-36858178

RESUMO

OBJECTIVES: To revise the 1983 colposcopic terminology form the French Society of Colposcopy and cervicovaginal pathology (SFCPCV). METHODS: All the three following steps of colposcopic examination were considered for the description of various colposcopic features: inspection without coloration, followed by the application of acetic acid and iodine staining. This revised terminology now includes the different possible colposcopic aspects of the normal cervix, including the ectropion and the normal transformation zone. It also includes colposcopic appearance of abnormal glandular cervical epithelium and of vaginal epithelium. The revised nomenclature was reviewed by all the board of the SFCPCV and was finally approved during the 45th annual conference of the SFCPCV. RESULTS: Abnormal transformation zone grade (TAG) 1a and 1b have been brought together under the sole TAG1 designation. TAG2a and TAG2b now correspond to TAG2, whereas TAG2c corresponds to TAG3. Colposcopic report should mention the interpretability of the colposcopic examination, with the precise type of the squamocolumnar junction (1, 2 or 3), the colposcopic impression, the size of any TAG and finally mention whether one or multiple biopsies were taken and their precise location. Colposcopic impression must give priority to the most pejorative colposcopic aspect which takes precedence over others. CONCLUSION: When performing colposcopy, one should keep in mind that this examination only relies on the interpretation of various colposcopic signs and images with this not guaranteeing for diagnosis. Only histological analysis of a possible guided cervical biopsy provides for a precise diagnosis.


Assuntos
Neoplasias do Colo do Útero , Feminino , Gravidez , Humanos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/patologia , Colo do Útero/patologia , Colposcopia/métodos , Biópsia/métodos , Ácido Acético
2.
Neuropsychiatr Enfance Adolesc ; 71(1): 44-51, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36540656

RESUMO

Objectives: This study aims to determine the rates of clinically-significant anxiety and depressive symptoms during the immediate postpartum in a sample of women referred to a university maternity department, as well as the associated risk factors and the relations with the level of maternal bonding. Patients and methods: During the third national lockdown for the COVID-19 pandemic (February-April 2021), on days 2-3 after delivery 127 mothers were administrated the Edinburgh postnatal depression scale (EPDS), the state-trait anxiety inventory (STAI-YA), the mother-to-infant bonding scale (MIBS) and questions issued from the coronavirus health impact survey questionnaire (CRISIS). Results: The rate of perinatal clinically-significant symptoms were 17% for depression (EPDS cut-off ≥ 12) and 15% for anxiety (STAI-YA cut-off ≥ 40). In the multivariate analysis, being a single mother, risk of being infected by the SARS-CoV2, risk that a close relative might be infected by the SARS-CoV2 and the length of stay in maternity were associated with an increased EPDS total score, while breastfeeding was associated with a lower EPDS total score. Six variables remained positively associated with the STAI-YA total score in the multivariate model: the maternal level of academic achievement, a hospitalization during the pregnancy, peripartum medical complications, risk of being infected by the SARS-CoV2, risk of a close relative being infected by the SARS-CoV2 and physical fatigue. Low but statistically significant correlations were found between the MIBS total score and the EPDS total score (rs = 0.26) and with the STAI-YA total score (rs = 0.26). Discussion: The observed rates of anxiety and depressive symptoms were in the same range as those reported in observational studies conducted in high-resource countries during the COVID-19 pandemic. Risk of being infected by the SARS-CoV2 was both an independent risk factor for anxiety and depressive symptoms. The relations between the measure of maternal bonding and the severity of maternal emotional symptoms call for a better consideration of the long-term consequences of the pandemic on children's socio-emotional development.


Objectifs: Cette étude a pour objectif de déterminer la fréquence des symptômes dépressifs et anxieux maternels lors de la période du post-partum immédiat dans un groupe de femmes venant d'accoucher sur un service universitaire, ainsi que les facteurs de risques associés et les conséquences sur le lien mère-enfant. Patients et méthodes: Au tout début de la pandémie de COVID-19 (entre les mois de février et avril 2021), 127 femmes venant d'accoucher ont complété dans les 2 à 3 jours qui suivent l'accouchement l'Edinburgh postnatal depression scale (EPDS), le State-trait anxiety inventory (STAI-YA), le Mother-to-infant bonding scale (MIBS) et le Coronavirus health impact survey questionnaire (CRISIS). Résultats: La fréquence des symptômes dépressif cliniquement significatifs était de 17 % et de 15 % pour les symptômes anxieux. Le risque d'infection par le SARS-CoV2 était associé à la sévérité de ces symptômes dans les analyses multivariées. Des corrélations statistiquement significatives ont été mis en évidence entre le score MIBS et le score EPDS (rs = 0.26) et avec le score STAI-YA (rs = 0.26). Discussion: La fréquence des symptômes anxieux et dépressifs du péripartum étaient comparable avec d'autres études conduites dans les pays à haut niveau de ressource au cours de la pandémie de COVID-19. Le risque d'infection par le SARS-CoV2 est associé à des niveaux plus élevés de symptômes anxieux et dépressifs, à côté des autres facteurs connus de symptômes émotionnels du post-partum. Les liens retrouvés entre ces symptômes et le niveau de lien mère-enfant invitent à être attentif aux conséquences à long-terme de la pandémie sur le développement socio-émotionnel du nourrisson. Conclusion: Des études complémentaires sont nécessaires pour confirmer ces résultats et déterminer les conséquences potentiellement délétères sur le développement des interactions mère-enfant et du nourrisson.

3.
Gynecol Obstet Fertil Senol ; 50(3): 229-235, 2022 Mar.
Artigo em Francês | MEDLINE | ID: mdl-34871786

RESUMO

OBJECTIVE: To compare the efficacy and safety of oral misoprostol 25µg compared to vaginal dinoprostone in the induction of labor at term. METHODS: Analytic, retrospective study of patients induced at term by prostaglandins with an unfavorable cervix, over two consecutive periods from 01/01/2019 to 19/02/2020 and from 20/02/2020 to 07/04/2021, within a regional level III university hospital center. We compared the safety and the efficacy between the oral misoprostol Angusta® used since 20/02/2020 and the vaginal dinoprostone previously used in gel or diffuser. The primary endpoint was the rate of vaginal deliveries within 24h. Secondary endpoints were cesarean section rate, indications for cesarean section, uterine contractility abnormalities and neonatal outcomes. RESULTS: Our study found no difference in terms of efficacy with similar rates of vaginal deliveries within 24h (51.88% vs. 51.25%; P=0.87) and caesarean sections (misoprostol group: 19.42% vs. dinoprostone group: 16.62%; P=0.33). However, the tolerance criteria revealed in the dinoprostone group an increase in tachysystole (misoprostol group: 9.28% vs. dinoprostone group: 16.90%; P=0.003) and acidosis (arterial pH<7.10, misoprostol group: 3.83% vs. dinoprostone group: 9.29%; P=0.006). CONCLUSION: No difference in efficacy was found between the two induction techniques. Oral misoprostol 25µg seems to be better tolerated from a maternal and fetal point of view.


Assuntos
Misoprostol , Ocitócicos , Administração Intravaginal , Cesárea , Dinoprostona , Feminino , Humanos , Recém-Nascido , Trabalho de Parto Induzido/métodos , Misoprostol/efeitos adversos , Gravidez , Estudos Retrospectivos
4.
Gynecol Obstet Fertil Senol ; 50(3): 236-239, 2022 03.
Artigo em Francês | MEDLINE | ID: mdl-34915137

RESUMO

OBJECTIVE: The COVID-19 lockdown led to the establishment of a national lockdown in France from March 17th to May 11th, 2020. The purpose of our study is to evaluate the impact of lockdown on the rate of hospitalization for threatened preterm delivery and on the rate of preterm delivery. METHODS: Multicenter retrospective epidemiological study carried out over the lockdown period from March 15th to May 31st, 2020 compared to the same period over the previous two years (2018 and 2019) in Picardy hospitals (University Hospital center Amiens Picardie, Hospital Center of Beauvais, Compiègne and Saint-Quentin). RESULTS: In total, 608 patients were included. Our study shows a decrease in hospitalisations (207 in 2019 vs. 176 in 2020). We find a significant reduction in Premature Ruptures of Membranes (16.9% [73/432] in 2018/2019 vs. 9.7% [17/176] in 2020; P=0.02) and also in the preterm delivery rate (9.3% (276/2961) in 2018/2019 vs. 6.8% [96/1416] in 2020; P<0.05). CONCLUSION: A reduction in the rate of preterm birth is observed during the first lockdown's period. It would also be interesting to evaluate the psychological impact of lockdown.


Assuntos
COVID-19 , Nascimento Prematuro , Controle de Doenças Transmissíveis , Feminino , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , SARS-CoV-2
5.
Gynecol Obstet Fertil Senol ; 50(3): 266-271, 2022 Mar.
Artigo em Francês | MEDLINE | ID: mdl-34481099

RESUMO

Peripartum cardiomyopathy is a rare and unpredictable pregnancy-related pathology. Idiopathic cardiomyopathy is characterized by a heart failure secondary to left ventricular systolic dysfunction appearing towards the end of pregnancy or in the months following delivery with a non-specific clinic presentation. Through reviewing previous research, our critical literature review wishes to bring a concise and objective summarize for a better understanding of physiopathology, evocative symptoms and knowing of factors influencing prognosis in order to standardize peripartum management. The treatment remains mainly symptomatic but other promising treatments are still in development. In conclusion, early detection and treatment allow a better cardiac function recovery reducing cardiac transplantation.


Assuntos
Cardiomiopatias , Complicações Cardiovasculares na Gravidez , Transtornos Puerperais , Disfunção Ventricular Esquerda , Cardiomiopatias/complicações , Cardiomiopatias/diagnóstico , Cardiomiopatias/terapia , Feminino , Humanos , Período Periparto , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/terapia , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/etiologia , Transtornos Puerperais/terapia , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/terapia
6.
Gynecol Obstet Fertil Senol ; 48(6): 514-519, 2020 06.
Artigo em Francês | MEDLINE | ID: mdl-32145453

RESUMO

Inflammatory Bowel Diseases (IBD) are chronic conditions affecting young people in their reproductive age. Patient misinformation can be responsible for a self-imposed infertility as well as a suboptimal observance during pregnancy. The aim of this work was to review the influence of IBD and pregnancy on one another at each gestational stage and according to current literature. IBD activity is a major influential factor. In case of a well-controlled IBD, fertility won't be affected and pregnancy will take place without increase risk of complications. With the exception of thalidomide and methotrexate, most of treatments used in IBD are compatible with pregnancy and breastfeeding. Each flare should be optimally managed. Vaginal delivery is a safe option except for patients with active anoperineal lesions. Cesarean section should be systematically discuss in patient with ileal pouch-anal anastomosis.


Assuntos
Doenças Inflamatórias Intestinais/complicações , Complicações na Gravidez/terapia , Resultado da Gravidez , Cesárea , Colite Ulcerativa/complicações , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/cirurgia , Doença de Crohn/complicações , Doença de Crohn/tratamento farmacológico , Doença de Crohn/cirurgia , Parto Obstétrico , Feminino , Fertilização , Feto/efeitos dos fármacos , Idade Gestacional , Humanos , Recém-Nascido , Infertilidade , Doenças Inflamatórias Intestinais/tratamento farmacológico , Doenças Inflamatórias Intestinais/cirurgia , Masculino , Metotrexato/efeitos adversos , Gravidez , Complicações na Gravidez/epidemiologia , Talidomida/efeitos adversos
7.
J Gynecol Obstet Hum Reprod ; 49(4): 101693, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31978624

RESUMO

OBJECTIVE: External cephalic version (ECV) is a procedure during which the fetus is rotated from breech or transversal to cephalic presentation. Our aim was to assess the outcomes of successful ECV in terms of obstetrical and immediate neonatal outcomes relative spontaneous cephalic presentation. METHODS: We performed a retrospective single-center observational study from January 2007 to December 2017. All included participants benefited from trial of labor with delivery of the fetus in cephalic presentation. They were divided into two groups depending on whether an ECV had been successfully performed or cephalic presentation was spontaneous. RESULTS: The cephalic presentation after ECV and spontaneous cephalic groups comprised 55 and 244 patients, respectively. The two groups differed significantly in terms of the proportion of induced labor (20 [36.4 %] and 56 [22.9 %], p = 0.04), use of oxytocin during labor (31 [56.4 %] and 100 [49.9 %], p = 0.04), duration of labor (342 ± 183 min and 279 ± 140 min, p = 0.008), spontaneous delivery (38 [69.1 %] and 199 [81.5 %], p = 0.04), intrapartum cesarean section (9 [16.4 %] and 16 [6.6 %], p = 0.02), occiput-posterior variety at birth (20 [36.4 %] and 56 [22.9 %], p = 0.04), and brace umbilical positioning at birth (3 [5.4 %] and 2 [0.8 %], p = 0.04), respectively. There were no significant intergroup differences in terms of APGAR score, cord arterial pH/lactates, or reanimation/intensive care admission. CONCLUSION: A successful ECV does not seem to guaranty an identical labor progress and obstetrical outcome as spontaneous cephalic presentations. Immediate neonatal state, on the other hand, seems unaffected by a history of ECV.


Assuntos
Parto Obstétrico/métodos , Apresentação no Trabalho de Parto , Resultado da Gravidez , Versão Fetal/estatística & dados numéricos , Adulto , Índice de Apgar , Apresentação Pélvica/cirurgia , Cesárea/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Trabalho de Parto Induzido/estatística & dados numéricos , Gravidez , Estudos Retrospectivos , Prova de Trabalho de Parto
9.
Gynecol Obstet Fertil Senol ; 48(2): 174-180, 2020 02.
Artigo em Francês | MEDLINE | ID: mdl-31634590

RESUMO

OBJECTIVES: Increased nuchal translucency and cystic hygroma have a neonatal prognosis, when the karyotype is normal, which depends on the findings during the medical follow-up. Array comparative genomic hybridization (aCGH) has been systematically included in this follow-up by prenatal diagnosis teams. There are no guidelines and little information on the advantages of carrying out this test systematically. The aim of our study is to evaluate the contribution of the aCGH in the medical follow-up. METHODS: Fifty-one patients were included during 18 months and followed till the end of their pregnancy in prenatal diagnosis centers in Brest and Amiens. Inclusion criterion was a nuchal translucency above 3,5mm on the first trimester ultrasound. A fetal DNA ChromoQuant and aCGH analysis on chorionic villi sampling, and an ultrasound at 18 weeks of gestation were performed during the follow-up. RESULTS: The aCGH was decisive in only 2 cases. The ultrasound at 18 weeks gestation seemed to be more sensible in the detection of an abnormality. When the aCGH relieved an abnormality, the ultrasound permitted already to detect the presence of a deformity. In 10 cases, the aCGH could not be interpreted on the chorionic villi sampling. In 9 cases, an amniocentesis was performed in order to obtain this result. CONCLUSION: Given the results of this study, the aCGH was rarely determinant or decisive on the realization of a therapeutic abortion. These elements make us reflect on the necessity of maintaining this test before 14 weeks of gestation or propose it as a second-line test after the ultrasound shows signs at 18weeks of gestation.


Assuntos
Hibridização Genômica Comparativa/métodos , Medição da Translucência Nucal , Diagnóstico Pré-Natal/métodos , Aborto Terapêutico , Amniocentese , Amostra da Vilosidade Coriônica , Feminino , Testes Genéticos , Idade Gestacional , Humanos , Recém-Nascido , Cariótipo , Análise de Sequência com Séries de Oligonucleotídeos , Gravidez , Primeiro Trimestre da Gravidez , Prognóstico , Ultrassonografia Pré-Natal
10.
Gynecol Obstet Fertil Senol ; 47(12): 841-845, 2019 12.
Artigo em Francês | MEDLINE | ID: mdl-31614232

RESUMO

OBJECTIVES: Ultrasonography plays a key role in surveillance of gastroschisis. Indeed, ultrasound should allow an early diagnosis of its specific complications all the while avoiding their over-diagnosis which could induce an unnecessary prematurity in these fragile children. The aim of this study was to evaluate the relevance of ultrasonography in the surveillance of this malformation. METHODS: We conducted a retrospective single center study from 2008 until 2018 including all cases of apparently isolated gastroschisis followed during the prenatal period and surgically treated in our institution. Prenatal data gathered during the ultrasound follow-up were compared to those observed during surgery. RESULTS: Thirty-one cases of gastroschisis were included. Regarding the abdominal wall defect, the latter was described prenatally as tight in seven cases with a weak correlation, and as situated to the right of the umbilical cord insertion in 11 cases with a high correlation to the per-operative observations. Sonographic observations were responsible for inducing birth in 14 cases (45%), of which 12 due to the presence of a specific gastroschisis complication, confirmed in five cases (42%, weak correlation). Pre- and post-natal correlation for compression/atresia/stenosis and eviscerated bowel inflammation were very weak in both cases, with a respective tendency of over- and under-diagnosis. CONCLUSIONS: Diagnosing the specific complications of gastroschisis by ultrasound is difficult, even though ultrasonography is responsible for many anticipated births. Thus, this monitoring should be performed by experienced sonographers on devices with appropriate settings. In addition, reproducible parameters such as oligohydramnios or increased bowel dilations should alone be indications of anticipated birth.


Assuntos
Gastrosquise/diagnóstico por imagem , Encaminhamento e Consulta , Ultrassonografia Pré-Natal , Adulto , Correlação de Dados , Feminino , Gastrosquise/diagnóstico , Gastrosquise/cirurgia , Humanos , Recém-Nascido , Gravidez , Estudos Retrospectivos , Adulto Jovem
11.
Arch Pediatr ; 25(4): 295-300, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29628409

RESUMO

OBJECTIVE: Although ketamine analgesia is effective in reducing pain and facilitating the tracheal intubation of newborns in the delivery room, no data on the neurological effects of this treatment are available. This study compared the neurodevelopmental outcomes at 2 years of age in a cohort of preterm newborns having received ketamine prior to tracheal intubation at birth (the ketamine group) and in a control group. METHODS: We included newborns delivered at less than 33 weeks gestational age (WGA) having undergone tracheal intubation at birth. The Ages and Stages Questionnaire (ASQ) was completed at 1 and 2 years of age. The development quotient (DQ) was calculated from the revised Brunet-Lezine score assessed at a corrected age of 2 years. RESULTS: There were no statistically significant differences between the ketamine group (n=54 at 1 year and n=51 at 2 years) and the control group (n=16 at 1 and 2 years) in terms of the mean±standard deviation DQ at the age of 2 (98±12 vs. 103±9, respectively; P=0.17) and the ASQ score at the age of 2 (221±44 vs. 230±39, respectively; P=0.55). DISCUSSION: This prospective cohort of 51 preterm newborns having received ketamine at birth did not reveal any differences in terms of neurological development at the age of 2 (relative to a control group and the literature data). These preliminary results must be confirmed in a randomized trial with longer follow-up.


Assuntos
Analgésicos/administração & dosagem , Salas de Parto , Recém-Nascido Prematuro , Intubação Intratraqueal , Ketamina/administração & dosagem , Estudos de Casos e Controles , Desenvolvimento Infantil , Pré-Escolar , Estudos de Coortes , Seguimentos , Humanos , Lactente , Recém-Nascido , Dor/prevenção & controle
13.
J Gynecol Obstet Hum Reprod ; 47(5): 191-196, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29510271

RESUMO

INTRODUCTION: Breech presentation and twin pregnancy are regarded as stressful situations for medical staff. This stress is often associated with an increased likelihood of intervention during labor - especially when the on-shift obstetrician lacks experience. MATERIAL AND METHODS: We performed a 2-year prospective, observational study of cesarean section (CSDs) and assisted vaginal (AVDs) deliveries in a tertiary maternity unit for attempted vaginal deliveries of breech presentations and twin pregnancies. The obstetric management decisions taken by a group of four registrars were compared with those taken by a group of 11 experienced obstetricians. Changes over time in practice were also monitored. RESULTS: Registrars managed 66 and 52 breech presentations and twin pregnancies respectively (30 and 27 in the experienced group). Groups' neonatal outcomes were similar. There were no intergroup differences in proportions of CSDs for either breech presentations (25 [37.5%] vs. 15 [50%] in the registrar and experienced groups, respectively; P=0.26) or twin pregnancies (11 [21.1%] vs. 6 [22.2%], respectively; P=0.91) or in proportion of AVDs for twin pregnancies (41 [78.8%] vs. 21 [77.8%], respectively; P=0.91). Proportions of CSDs for breech presentation and AVDs for twin pregnancies did not change over time in either group. However, proportion of CSDs for twin pregnancies increased over time in the registrar group (P=0.004). DISCUSSION: Well-trained registrars appeared to have acquired the skills required to safely manage an obstetric ward; this pleads to maintain clinical practice during residency to preserve low CSD and AVD rates.


Assuntos
Apresentação Pélvica/terapia , Parto Obstétrico/estatística & dados numéricos , Internato e Residência , Obstetrícia/educação , Resultado da Gravidez , Gravidez de Gêmeos , Apresentação Pélvica/cirurgia , Cesárea/estatística & dados numéricos , Feminino , Humanos , Curva de Aprendizado , Gravidez , Estudos Prospectivos
15.
Arch Pediatr ; 24(11): 1076-1082, 2017 Nov.
Artigo em Francês | MEDLINE | ID: mdl-28988636

RESUMO

INTRODUCTION: Women hospitalized for preterm labor require clear information about prematurity. This study assessed whether or not specific written information about prematurity delivered at admission to the unit combined with an oral explanation from a pediatrician would decrease women's anxiety compared to an oral explanation alone. MATERIAL AND METHODS: This was a prospective, single-center observational study. Women were included in the high-risk pregnancies department and distributed into two groups: receiving "only oral" information for a prenatal clinical consultation with a senior pediatrician or receiving "combined" oral information+a booklet about prematurity given to the women at admission. The primary endpoint was the change in anxiety-state (before and after the information procedure) evaluated by the State Trait Anxiety Inventory-Y (STAI-Y). RESULTS: The anxiety score before receiving information did not differ between the two groups (STAI-Y-A "combined" group: 46.7±3.0 vs. "only oral" group: 42.7±2.74; P=0.55). After consultation with a pediatrician, the acute anxiety-state score STAI-Y-A decreased significantly in the "combined" group (-6.7±1.9) compared to the "only oral" group (-2.5±4.6; P<0.05). DISCUSSION: A booklet about prematurity combined with oral information from a pediatrician reduced patients' anxiety more than oral information alone. Given that the psychology of the mother interacts with the pregnancy, it is necessary to provide clear and adapted information. Giving a booklet appears to be one of the modalities to improve information. Other modalities such as video documents have to be studied.


Assuntos
Ansiedade/etiologia , Mães/psicologia , Pediatria , Nascimento Prematuro , Cuidado Pré-Natal , Revelação da Verdade , Adulto , Feminino , Humanos , Gravidez , Estudos Prospectivos , Adulto Jovem
16.
J Gynecol Obstet Hum Reprod ; 46(9): 669-673, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28866125

RESUMO

OBJECTIVES: To determine the efficacy of colposcopy plus ZedScan, which measures changes in tissue electrical impedance, for detecting intraepithelial high-grade lesions compared to colposcopy alone. METHODS: A prospective study conducted at a university hospital colposcopy clinic. Patients referred following abnormal cervical cytology or colposcopic follow up were examined by colposcopy plus ZedScan to assess the cervix. The results of ZedScan directed and colposcopically directed biopsies were compared. RESULTS: Ninety-one patients were included in this study. The median age was 33 years. Eighty (88%) were referred with abnormal cytology; LSIL 45%, ASCUS 27%, ACS-H 8%, HSIL 7%, AGC 1% and 12% follow-up postconisation or colposcopic follow up. Colposcopy alone detected 18 high-grade lesions with 64 women undergoing biopsy with a total of 115 biopsies being taken with a sensitivity of 60% and NPV estimated at 81.7%. ZedScan with colposcopy increased the detection of high-grade lesions by 47.3%, identifying 27 high-grade lesions and one case of invasive cancer. Sensitivity was 93.1% and NPV estimated at 91.3%. A combination of normal colposcopy practice and ZedScan had a sensitivity and NPV of 100%. CONCLUSION: ZedScan used in conjunction with the colposcopy improves sensitivity in detecting high-grade lesions at the expense of a moderate increase in the number of biopsies.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Colposcopia/métodos , Espectroscopia Dielétrica , Neoplasias do Colo do Útero/diagnóstico , Adulto , Biópsia , Carcinoma de Células Escamosas/patologia , Colo do Útero/diagnóstico por imagem , Colo do Útero/patologia , Citodiagnóstico , Detecção Precoce de Câncer/métodos , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Valor Preditivo dos Testes , Prognóstico , Neoplasias do Colo do Útero/patologia , Adulto Jovem
17.
Arch Pediatr ; 24(10): 934-941, 2017 Oct.
Artigo em Francês | MEDLINE | ID: mdl-28893488

RESUMO

BACKGROUND: Neonatal early onset sepsis (EOS) remains an important etiology of neonatal morbidity and mortality. Diagnosis is difficult due to a lack of sensitivity and specificity markers. In France, the management of newborn infants suspected of infection includes the analysis of gastric suction. The objective of the study was to identify early clinical signs in newborn infants with suspected neonatal sepsis to differentiate a likely infection with pathogen bacteria in the gastric suction culture (Streptococcus agalactiae or Escherichia coli) from a possible infection without such pathogen bacteria. METHODS: We conducted a retrospective study in the Amiens University Hospital. All term newborn infants born between 1 January and 31 December 2013 and hospitalized for suspected EOS were included. Suspicion of EOS was considered when there were arguments to treat by antibiotics for a period of at least 5 days. RESULTS: Fifty-eight newborn infants were included, 25 had a likely EOS and 33 a possible EOS. Newborn infants with a likely EOS were less mature (P<0.01) with more clinical signs at birth (P<0.01). The most common clinical signs were: hyperthermia (P=0.01), somnolence (P<0.01), and hypotonia (P=0.01). After adjusting for the term, the presence of hyperthermia was no longer significantly different between the two groups (P=0.059), the other clinical signs remained significantly different. CONCLUSION: The presence of neonatal symptoms at birth appears to be a useful clinical marker of probable neonatal EOS.


Assuntos
Infecções Bacterianas/diagnóstico , Infecções Bacterianas/microbiologia , Sepse Neonatal/diagnóstico , Sepse Neonatal/microbiologia , Bactérias/patogenicidade , Feminino , Humanos , Recém-Nascido , Masculino , Estudos Retrospectivos
18.
J Gynecol Obstet Hum Reprod ; 46(4): 339-342, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28643661

RESUMO

OBJECTIVES: To study the influence of anaesthesia (local by cervical block vs. general or spinal anaesthesia) on height and volume of resection specimens in case of conization treatment for cervical intraepithelial neoplasia (CIN). METHODS: Prospective observational study of all patients who underwent a first treatment by loop electrosurgical excision procedure (LEEP) for CIN. Height of fresh resection specimens was first measured by the operator and then by the pathologist after formaldehyde fixation. Volume of fresh specimens was measured in a measuring cylinder by fluid displacement. RESULTS: One hundred patients were included and 35% of LEEP were performed under local anaesthesia. There was a significant difference in height of specimens depending on anaesthesia mode: after fixation, the average height was 11.2mm in the general or spinal anaesthesia group vs. 8.8mm in the local anaesthesia group (P=0.002). There was also a difference in terms of volume depending on anaesthesia mode: 1.6mL in local anaesthesia group vs. 2.3mm in general and spinal anaesthesia group (P=0.01). CONCLUSIONS: Anaesthesia mode has an impact on height and volume of LEEP specimens. In our experience, local anaesthesia could reduce LEEP specimen height.


Assuntos
Anestesia Obstétrica/métodos , Conização/métodos , Eletrocirurgia/métodos , Margens de Excisão , Displasia do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/cirurgia , Adulto , Anestesia Obstétrica/efeitos adversos , Colposcopia/efeitos adversos , Colposcopia/métodos , Conização/efeitos adversos , Eletrocirurgia/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasia Residual , Resultado do Tratamento , Neoplasias do Colo do Útero/patologia , Adulto Jovem , Displasia do Colo do Útero/patologia
19.
Arch Pediatr ; 24(6): 552-556, 2017 Jun.
Artigo em Francês | MEDLINE | ID: mdl-28455093

RESUMO

Cystic lymphangiomas are usually located in the neck region. Less frequently, they can be found in the abdomen. In those cases, pre- and neonatal diagnosis is extremely difficult. We report on the case of a giant mesocolic cystic lymphangioma, diagnosed at birth, in a child who had been monitored during the prenatal period for what was believed to be a digestive dilatation. The progression was marked by excellent tolerance despite a complete lack of regression in the first 10 months of life. The authors discuss the prenatal signs that should suggest this diagnosis and an MRI, as well as management during the 1st year of life.


Assuntos
Linfangioma Cístico/diagnóstico por imagem , Mesocolo/diagnóstico por imagem , Neoplasias Peritoneais/diagnóstico por imagem , Adulto , Feminino , Humanos , Imageamento por Ressonância Magnética , Gravidez , Ultrassonografia Pré-Natal
20.
Gynecol Obstet Fertil ; 44(2): 88-95, 2016 Feb.
Artigo em Francês | MEDLINE | ID: mdl-26874400

RESUMO

OBJECTIVES: Postpartum ovarian vein thrombophlebitis is an uncommon complication that may threaten mothers' lives. The extension of thrombosis in the inferior vena cava causes a pulmonary embolisme risk and requires urgent care. The main objective of this study was, from a series of patients, to determine the clinical and paraclincal signs to suggest the diagnosis of postpartum ovarian vein thrombosis. Secondary objectives were to assess the location and extent of thrombosis and the therapeutic management of this disease at the University Hospital of Amiens. METHODS: A retrospective study was performed in the Obstetrics and Gynecology department of Amiens University Hospital between January 2011 and May 2015. Were included in this study all patients for whom the diagnosis of postpartum ovarian thrombophlebitis was confirmed by computed tomography. RESULTS: Thirteen patients had postpartum thrombosis of the ovarian vein. The incidence of this disease in our series was 0.13%. The average age of patients was 30 years. The median onset of symptoms was located on the 4th day; in 92% of cases, they appeared within 10 days after delivery. The clinical picture was not specific and the main symptoms were fever (46.1%) and abdominal pain (53.8%). Biologically inflammatory syndrome was commonly found with elevated leukocytes and CRP. Bacteriological samples were in most cases negative. Sixty-nine percent of lesions concerned the right ovarian vein; 23% had renal extension, 53.8% had inferior vena cava extension and 23% got complicated with pulmonary embolism. No maternal deaths were reported. One hundred percent of patients received anticoagulation at curative dose, the mean duration of which was 6 months. In all, 84.6% of patients received in combination antibiotic therapy with oral and parenteral initially broad spectrum. CONCLUSION: Ovarian postpartum thrombosis is a rare complication that must be evoked and sought, especially in front of a non-septic febrile abdominal pain syndrome in postpartum.


Assuntos
Hospitais Universitários , Ovário/irrigação sanguínea , Transtornos Puerperais/diagnóstico , Trombose Venosa/diagnóstico , Trombose Venosa/terapia , Dor Abdominal , Adulto , Anticoagulantes/uso terapêutico , Proteína C-Reativa/análise , Feminino , Febre , Humanos , Gravidez , Tomografia Computadorizada por Raios X , Veia Cava Inferior
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