[Human Resources for Unplanned Activities in Obstetrics and Gynecology. Consensus statements by the CNGOF, CARO, CNSF, FFRSP, SFAR, SFMP and SFN]. / Ressources humaines pour les activités non programmées en gynécologie-obstétrique. Propositions élaborées par le CNGOF, le CARO, le CNSF, la FFRSP, la SFAR, la SFMP et la SFN.

OBJECTIVE: To determine a minimum threshold of human resources (midwives, obstetricians and gynecologists, anesthesiology and intensive care units, pediatricians) to ensure the safety and quality of unplanned activities in Obstetrics and Gynecology. MATERIALS AND METHODS: Consultation of the MedLine database, the Cochrane Library and the recommendations of authorities. Meetings of representative members in different modes of practice (university, hospital, liberal) under the aegis of and belonging to the French College of Obstetricians and Gynecologists (CNGOF), the French Society of Anesthesia and Resuscitation (SFAR), the French Society of Neonatalogy (SFN), the French Society of Perinatal Medicine (SFMP), the French College of Midwives (CNSF), the French Federation of Perinatal Care Networks (FFRSP) with elaboration of a re-read text by external experts, in particular by the members of the Boards of Directors of these authorities and of Club of Anesthesiology-Intensive Care Medicine in Obstetrics (CARO). RESULTS: Different minimum thresholds for each category of caregivers were proposed based on the number of births/year. These proposed minimum thresholds can be modulated upwards according to the types (level I, IIA, IIB or III) or the activity (existence of an emergency reception service, maternal-fetal and/or surgical activity of resort or referral). Due to peak activity and the possibility of unpredictable concomitance of urgent medical procedures, it is necessary that organizations plan to use resource persons. The occupancy rate of the target beds of a maternity ward must be 85%. CONCLUSION: These proposed minimum thresholds are intended to help caregivers providing non-scheduled perinatal as well as Obstetrics and Gynecology care to make the most of the human resources allocated to institutional bodies to ensure their safety and quality.

[Fetal scalp pH during labor: Which threshold for intervention?] / pH au scalp pendant le travail : quel seuil décisionnel pour intervenir ?

OBJECTIVE: In case of abnormal fetal heart rate, there is no consensus on the decision threshold pH scalp leading to a rapid birth. The objective of this study was to compare neonatal issues and cesarean rate in two maternity using different decision thresholds of scalp pH. MATERIAL AND METHODS: A comparative retrospective study conducted in two level III maternity units between January 2013 and May 2014, one maternity unit used a decision threshold of 7.20 (maternity unit 7,20), and the other one a threshold of 7.25 (maternity unit 7,25). An adverse neonatal outcome was defined by a composite endpoint of neonatal morbidity. The risk of cesarean was assessed using a multivariate analysis. RESULTS: One hundred and four patients were included in the maternity unit 7,20 and 163 patients in the maternity 7,25. Adverse neonatal outcome was similar in both maternities (25% vs. 30,1%; P=0.4). The average pH at birth was similar in both maternities, as well as the Apgar score at 5minutes and neonatal transfer rates. However, BE<-12 was more frequent in maternity using 7,20 scalp pH threshold (7% vs. 0%; P<0.01). The cesarean rate was higher in maternity 7,25 (adjusted OR=2.23 95% CI [1.17-4.25]). CONCLUSION: It seems that a decisional threshold fixed to 7,20 could be used reasonably. It could allow to reduce cesarean rate. Other studies are, however, needed to confirm that such threshold of 7,20 does not increase the risk of severe acidosis.

Intérêt et limite de la prédiction de l'anémie fœtale par la mesure du pic systolique de vélocité dans l'artère cérébrale moyenne. A propos d'un cas d'anémie fœtale d'origine mixte

Objectif : Le but de notre travail était de décrire les difficultés diagnostiques et thérapeutiques d'un cas d'anémie fœtale dans un contexte mixte d'allo-immunisation anti-Rhésus D et d'infection materno-fœtale à cytomégalovirus (CMV).Observation : Nous rapportons un cas de grossesse avec allo-immunisation anti-D+C au cours de laquelle les mesures du pic systolique de vélocité de l'artère cérébrale moyenne n'ont jamais dépassé le seuil de 1,5 MoM (multiple de la médiane) justifiant habituellement une cordocentèse pour une transfusion in utero. L'issue néonatale a été marquée par une anémie importante à 8,2 g/dl avec transfusion sanguine ainsi que le diagnostic post-natal d'une transmission materno-fœtale d'infection à cytomégalovirus. Ce cas pose la question de la valeur du pic systolique de vélocité de l'artère cérébrale moyenne (PSV-ACM) fœtale dans les anémies d'origine autre que l'allo-immunisation érythrocytaire.Conclusion : La mesure du PSV-ACM reste une méthode efficace et non-invasive pour le diagnostic des anémies par allo-immunisation. Cependant, il n'est pas actuellement évalué pour le dépistage de l'anémie par infection à CMV. Une vigilance particulière est donc indispensable dans les anémies fœtales d'origine mixte