[Simulation training for French obstetrics and gynecology residents: A national survey in 2022]. / Formation initiale par la simulation pour les internes français de gynécologie et obstétrique : état des lieux en 2022.

OBJECTIVES: To evaluate the use of simulation among French Obstetrics and Gynecology residency programs. METHODS: A survey was conducted with all 28 French residency program directors. The questionnaire covered equipment and human resources, training programs, types of simulation tools and time spent. RESULTS: Of the cities hosting a residency program, 93% (26/28) responded regarding equipment and human resources, and 75% (21/28) responded regarding training program details. All respondents declared having at least one structure dedicated to simulation. A formal training program was reported by 81% (21/26) of cities. This training program was mandatory in 73% of the cases. There was a median number of seven senior trainers involved, three of whom had received a specific training in medical education. Most of declared simulation activities concerned technical skills in obstetrics and surgery. Simulations to practice breaking bad news were offered by 62% (13/21) of cities. The median number of half-days spent annually on simulation training was 55 (IQR: 38-83). CONCLUSION: Simulation training is now widely available among French residency programs. There remains heterogeneity between centers regarding equipment, time spent and content of simulation curricula. The French College of Teachers of Gynecology and Obstetrics has proposed a roadmap for the content of simulation-based training based on the results of this survey. An inventory of all existing "train the trainers" simulation programs in France is also provided.

[In the case of premature live birth, is very early rupture of the membranes an additional risk factor for morbidity and mortality?] / En cas de naissance vivante prématurée, la rupture très précoce des membranes est-elle un facteur de risque supplémentaire de morbi-mortalité ?

OBJECTIVE: To describe survival rate after preterm premature rupture of membranes (PPROM) before 25 weeks of gestation and compare neonatal morbidity and mortality among those born alive with a control group of infants born at a similar gestational age without premature rupture of membranes. METHODS: We conducted a retrospective single-centre study at Port-Royal maternity, from 2007 to 2015, comparing neonatal outcomes between liveborninfants exposed to PPROM prior to 25 weeks of gestation (WG) and a control group not exposed to premature rupture of the membranes. For each live-born child, the next child born after spontaneous labor without PPROM was matched for gestational age at birth, sex, and whether or not they received antenatal corticosteroid therapy. The primary endpoint was severe neonatal complications assessed by a composite endpoint including neonatal deaths, grade 3-4 HIV, bronchopulmonary dysplasia, leukomalacia and stade 3-4 retinopathies. RESULTS: Among 77 cases of very premature rupture of the membranes, 55 children were born alive. Among these, the average gestational age at birth was 28 WG and 1 day. The rate of severe neonatal complications did not differ between the two groups (43.6% in the PPROM group vs. 36.4%, P=0.44) and the survival rate at discharge was also similar in the two groups (85.5% vs. 83.6%, P=0.98). CONCLUSIONS: In our cohort and among livebirths after 24 WG, PPROM before 25 WG was not associated with an increased risk of morbidity and mortality compared to children born at the same gestational age after a spontaneous labor with intact membranes.

Trends in perinatal health in metropolitan France from 1995 to 2016: Results from the French National Perinatal Surveys.

OBJECTIVE: To study trends in the main indicators of perinatal health, medical practices and risk factors in France since 1995. POPULATION AND METHOD: All live births during one week in 1995 (n=13,318), 2003 (n=14,737), 2010 (n=14,903) and 2016 (n=13,384). Data were from interviews of women in postpartum wards and from medical records and were compared between years. RESULTS: Between 1995 and 2016, maternal age and body mass index increased steadily. Pregnancies that occurred with use of contraception increased from 7.4% in 2010 to 9.3% in 2016. Smoking during pregnancy (16.6%) did not decrease since 2010. The frequency of more than three ultrasounds during pregnancy was 48.5% in 1995 and 74.7% in 2016. Deliveries in large public hospitals increased steadily. The caesarean section rate has been relatively stable since 2003 (20.4% in 2003, 21.1% in 2010 and 20.4% in 2016). The rate of induction of labour was 22% in 2010 and 2016. Overall, 83.8% of women had epidural analgesia/anaesthesia in 2016. Rates of pre-term birth in 2016 ranged from 7.5% among all live births to 6.0% among live born singletons; for singletons, this rate increased steadily from 1995 to 2016, whereas there was no clear trend for low birth weight. Exclusive breastfeeding decreased from 60.3% in 2010 to 52.2% in 2016. CONCLUSION: Routine national perinatal surveys highlight successful policies and recommendations but also point out some health indicators, practices, preventive behaviours and risk factors that need special attention.

[Transabdominal chorionic villus sampling using biopsy forceps or needle: pregnancy outcomes by technique used]. / Biopsies de trophoblaste transabdominales à la pince ou à l'aiguille: issues de grossesse selon la technique utilisée.

OBJECTIVES: To compare pregnancy outcomes after transabdominal chorionic villus sampling using biopsy forceps or needle. MATERIALS AND METHODS: Retrospective bicentric study including all women who had a transabdominal chorionic villus sampling between 2005 and 2009 (172 using biopsy forceps and 160 using needle). The primary endpoint was the rate of fetal loss, after excluding medical abortion due to the result of the biopsy. The secondary endpoint was the rate of premature rupture of the membrane. All cases were reviewed to try to determine the responsibility of the biopsy. RESULTS: The pregnancy outcomes were not different between the two groups: 4 (4.4%) fetal losses in the biopsy forceps group and 6 (7.4%) in the needle group (P=0.52). Only one case (1.2%) of fetal loss can be attributed to the biopsy, using a needle, and none (0%) following a forceps biospy (P=0.29). The rate of premature rupture of the membrane was comparable in the two groups. CONCLUSION: The pregnancy outcomes following chorionic villus sampling using a biopsy forceps or a needle seem comparable.

[Fellowship in Canada: instructions]. / Fellowship au Canada : mode d'emploi.

In North America, postdoctoral fellowships are proposed to physicians and surgeons after their residency to obtain an expertise in a specific domain of their speciality. In obstetrics and gynecology, three fellowship programs are accredited by the Royal College of Physicians and Surgeons of Canada: maternal fetal medicine, gynaecological oncology and reproductive endocrinology and infertility. A two-year fellowship in Canada provides a great professional and personal experience. We present here the organization of these programs and the conditions to be admitted in a fellowship program in Canada.

[Management of ten patients with complete septate uterus: hystersocopic section of and obstetrical outcome]. / Prise en charge chirurgicale des patientes présentant un utérus cloisonné total: à propos de 10 cas.

INTRODUCTION: Septate uterus is the principal müllerian anomaly, but complete septate uterus is uncommon and often associated with frequent obstetrical complications. Surgical section of the septum is however possible. MATERIAL AND METHOD: We report patients with a complete septum uterus operated in our department between 2002 and 2006. We performed a hysteroscopic section of the cervical, uterine and vaginal septum at discovery of the anomaly. The accuracy of imaging exams, frequency of associated malformations, past obstetrical events and reproductive outcome post surgery were analyzed. RESULTS: The surgical technique was based on section of the cervical part with scissors and hysteroscopic section of the uterine septum; no perforation was noted. Four patients required a second procedure to achieve complete uterine section. Five patients became pregnant after surgery, 8 pregnancies are reported: 2 term delivery, 1 preterm delivery, 4 miscarriages and 1 ectopic pregnancy. CONCLUSION: Complete surgical section of the cervical and uterine septum in case of complete septum uterus is safe. However, we cannot conclude about the obstetrical benefit of this surgical technique. A longer follow-up is needed.

Mouse chick chimera: a new model to study the in ovo developmental potentialities of mammalian somites.

Chimeras were prepared by transplanting somites from 9-day post-coïtum mouse embryos or somitic dermomyotomes from 10-day post-coïtum mouse embryos into 2-day-old chick embryos at different axial levels. Mouse somitic cells then differentiated in ovo in dermis, cartilage and skeletal muscle as they normally do in the course of development and were able to migrate into chick host limb. To trace the behavior of somitic myogenic stem cells more closely, somites arising from mice bearing a transgene of the desmin gene linked to a reporter gene coding for Escherichia coli beta-galactosidase (lacZ) were grafted in ovo. Interestingly, the transgene was rapidly expressed in myotomal muscles derived from implants. In the limb muscle mass, positive cells were found several days after implantation. Activation of desmin nls lacZ also occurred in in vitro cultures of somite-derived cells. Our experimental method facilitates investigation of the mechanisms of mammalian development, allowing the normal fate of implanted mouse cells to be studied and providing suitable conditions for identification of descendants of genetically modified cells.

[Immunohistochemistry in pathology of the breast. Current diagnostic and prognostic contributions]. / Immunohistochimie en pathologie mammaire. Apports diagnostiques et pronostiques actuels.

In breast pathology, immunohistochemistry (IHC) allows the resolution of differential diagnostic problems regarding a primary tumor. With a basic antibody panel, it allows precise identification of undifferentiated, morphologically similar or unusual tumors. In case of doubt on invasiveness, IHC reveals the epithelial basement membrane and myoepithelial cells. A specific marker of breast tissue does not exist at the present time, but IHC guides the physician in the direction of breast in case of unknown secondary tumor or to confirm the primary breast site or to indicate the breast as primary site in case of two morphologically similar tumors. For the prognosis, IHC improves the detection of occult metastases (serous fluids, node, bone marrow, etc.). During the last few years, its indications have increased considerably with the possibility of performing, with paraffin slides, the detection of estrogen and progesterone receptors, growth factors and their receptors, oncoproteins, cell proliferation-related proteins, etc. The effects on the prognosis and chemotherapy sensitivity evaluation are obvious. But the pathologists must be very demanding because the clinical use of these new data by the physicians will be possible only after an excellent methodological and clinical validation in relation to the classical prognostic factors.

Change in motor neurone activity modifies the differentiation of a slow muscle in chick embryo.

Slow-tonic anterior latissimus dorsi (ALD) muscle properties were studied following chronic spinal cord stimulation in chick embryo. Stimulation at a fast rhythm was applied from day 7, 8 or 10 of development until the end of embryonic life. When stimulation was applied from day 7 up to day 18 of development, ALD muscle exhibited at day 18 a large decrease in half time to peak of tetanic contraction, a large proportion of fast type II fibres and an increase in fast myosin light chain content as compared to control muscle. When stimulation started at day 8 of development, changes in properties of ALD muscle were reduced when compared to the previous experimental series. Indeed, no fast type II fibres were observed within the muscle, even when stimulation was prolongated until the 20th day of embryonic development. In addition, chronic stimulation at a fast rhythm initiated at day 10 of development did not modify ALD muscle differentiation. The present results indicate that a fast pattern of motor neurone activity can induce some slow-to-fast transformations of ALD muscle fibres. However, after the first week of embryonic life, ALD myotubes appeared refractory to these transformations. The possible mechanisms responsible for the transformation of slow myotubes and for their further loss of plasticity are discussed.

Effects of low and high frequency patterns of stimulation on contractile properties, enzyme activities and myosin light chain accumulation in slow and fast denervated muscles of the chicken.

The effects of denervation and direct stimulation in fast and slow latissimus dorsii muscles were investigated in chicken. In slow ALD muscle, denervation resulted in an incompleteness of the relaxation, a decrease in MDH and CPK activities and an increase in fast myosin light chains (MLC) accumulation. Direct stimulation at either fast or slow rhythm prevented the effects of denervation on relaxation and CPK activity but was ineffective on MDH activity and fast MLC accumulation. Moreover, direct stimulation of denervated ALD caused rhythm-dependent change in tetanic contraction. In fast PLD muscle, the main changes in muscle properties following denervation were a slowing down of the time course of the twitch and an incompleteness of the relaxation, a decrease in LDH and CPK activities and in LC3F accumulation. Stimulation at a high frequency partly prevented the effects of denervation and resulted in a large accumulation of LC3F, while a low frequency stimulation did not restore the twitch time to peak, increased MDH activity and induced synthesis of slow MLC. This study emphasizes the role of muscle activity and its pattern in some properties of slow and fast chicken muscles following denervation.

In vitro differentiation in the absence of nerve of avian myoblasts derived from slow and fast muscle rudiments.

Slow anterior latissimus dorsi (ALD) and fast posterior latissimus dorsi (PLD) muscles of 9-day-old quail embryos were cultured in vitro without neurons for 1 to 12 weeks. Several differences could be observed between ALD- and PLD-derived cells. PLD cultures proliferated less rapidly than ALD cultures. ALD-derived muscle fibres exhibited wide Z lines, numerous mitochondria, and a poorly developed sarcotubular system, while PLD-derived muscle fibres exhibited narrow Z lines, few mitochondria, and an abundant sarcotubular system. Staining for myofibrillar ATPase revealed that all well-differentiated ALD-derived muscle fibres were of the beta' type, while PLD-derived fibres were of beta and beta R types. These results show that myoblasts from slow and fast muscle rudiments can express in vitro some of the characteristic features of slow and fast muscle fibres, independently of motor innervation.