[A new low-cost webcam-based laparoscopic training model]. / Intérêt et performances d'un pelvitrainer portable pour l'entraînement à la laparoscopie.

OBJECTIVES: To validate a new laparoscopy home training model (GYN Trainer®) in order to practise and learn basic laparoscopic surgery. PATIENTS AND METHOD: Ten junior surgical residents and six experienced operators were timed and assessed during six laparoscopic exercises performed on the home training model. RESULTS: Acquisition of skill was 35%. All the novices significantly improved performance in surgical skills despite an 8% partial loss of acquisition between two training sessions. Qualitative evaluation of the system was good (3.8/5). DISCUSSION AND CONCLUSION: This low-cost personal laparoscopic model seems to be a useful tool to assist surgical novices in learning basic laparoscopic skills.

[Failed forceps extraction: risk factors and maternal and neonatal morbidity]. / Facteurs de risque et morbidité maternelle et néonatale des échecs d'extraction instrumentale par forceps.

OBJECTIVES: To evaluate risk factors associated with failed forceps delivery and to compare the maternal and neonatal morbidity. PATIENTS AND METHODS: In this retrospective case-control study, all failed forceps delivery cases were analyzed from January 2005 to June 2008 and were compared to a successful forceps delivery cohort. RESULTS: The rate of failed forceps extraction was 4.4% (40/918). Specific risk factors were extraction above a fœtal station of S+2 (OR=43.03; IC 95%: 3.8-475.41), occipito-posterior position (OR=34.64; IC 95%: 4.08-293.5), and biparietal diameter higher than 95mm (OR=10.74; IC 95%: 1.4-82.41). Maternal and neonatal morbidity was few in both groups. CONCLUSIONS: Diagnosis of presentation level and variety of presentation are necessary before instrumental extraction. A "trial of forceps" should be performed with caution in a setting where a caesarean delivery could follow. Vacuum extraction could be interesting in case of occipito-posterior position.

[Is the socioeconomic deprivation EPICES score useful in obstetrics?]. / Intérêt de l'échelle d'évaluation de la précarité EPICES en obstétrique.

OBJECTIVES: To describe a validated and multifactorial deprivation score to study the relationship between socioeconomic deprivation and perinatal risks. PATIENTS AND METHODS: The index of deprivation EPICES (Evaluation of Precarity and Inequalities in Health Examination Centers) was used to characterize the deprivation status of 234 women in post-partum in comparison with perinatal morbidity. The cutoff value of 30.7 was the threshold to define deprivation. RESULTS: Two hundred and eight patients were included in this retrospective study from whom 48 (23%) had a score of deprivation higher than 30.7. Maternofetal morbidity was more severe in deprived patients. DISCUSSION AND CONCLUSION: The current results show that the EPICES score could be a useful obstetrical tool for the identification of deprived women during pregnancy.