Cesarean section complications according to degree of emergency during labour.

OBJECTIVE: Evaluate the complications rate of cesarean section delivery based on degree of labour emergency. STUDY DESIGN: Monocentric (Lille, France), retrospective study of all term, singleton, and cesarean deliveries during labour. Three groups were categorized based on the degree of emergency according to a color code: green (no time limit between surgical decision and birth), orange (birth within 30 min), and red (birth within 20 min). Scheduled cesareans were excluded. Complications were defined as minor/major and intra-/post-operative. RESULTS: A total of 881 patients were included. Among these, 303 (34.5 %) were in the green group, 353 (40.1 %) in the orange group, and 225 (25.4 %) in the red group. Major intra-operative complications, mainly postpartum hemorrhage, were more frequent in the red group compared with the green group (16.9 % vs. 9.9 %, p = 0.05; OR 1.9; 95 % CI [1.1-3.1]). Among the minor complications, there was no difference on moderate postpartum hemorrhage and four times uterine artery wounds in the red group (1.7 % vs. 7.1 %, respectively; p = 0.007; OR 4.6; 95 % CI [1.6-12.6]). The overall major post-operative complication rate, mainly infectious morbidity, was 6.1 % and this was more frequent in the red group compared with the green group (12.4 % vs. 1.7 %, respectively; p < 0.0001; OR 8.5; 95 % CI [3.2-22.3]). CONCLUSION: Pre- and post-operative complications of cesarean section delivery during labour (i.e., emergency cesarean) increase with the degree of labour emergency. It would be ideal to identify women in labour who are at increased risk of emergency cesarean earlier, so that the situation does not escalate to a red code cesarean.

[Compliance to the color codes protocol according to the indication of cesarean and to the decision-to-delivery interval]. / Évaluation du respect du protocole des codes couleurs selon l'indication de césarienne et le délai décision-naissance.

OBJECTIVE: Evaluation of the compliance of the color codes protocol according to the indication of ceasarean section and on the decision-to-delivery interval according to the color code, the operator and the period. METHODS: This is a retrospective monocentric study including women who had to undergo an emergency cesarean section after 37 weeks of amenorrhea in the Jeanne-de-Flandre hospital between 2015 and 2017. Three groups were created: cesarean section with green code, orange code and red code. We compared population characteristics and obstetrical data, then drew up a reassessed color code and analyzed the correspondence between the initial color code and the reassessed one. Finally, we considered the respect of decision-to-delivery interval according to color code, operator level and period. RESULTS: Eight hundred and eighty-one patients were included, amongst which 303 (34%) fell into the green c-section, 353 (40%) into the orange c-section and 225 (26%) into the red c-section. In the three groups, there was a significant consistency between the initial color code and the reassessed one, with a kappa agreement test of 95% 0.95 (0.93-0.97). The average decision-to-delivery interval was 37±20min for the green c-section, 20±6min for the orange c-section and 12±3min for the red c-section with a significant respect of the decision-to-delivery interval according to color code P<0.001. The decision-to-delivery interval was similar considering the operator level and the period. CONCLUSION: In our study, we observed the compliance with color code regarding the indication of ceasarean section and the respect of the decision-to-delivery interval whatever the time of occurrence and the operator.

[Changes in the utero-placental and fetal cerebral circulations induced by nicotine in the ovine fetus]. / Modifications des circulations utéro-placentaire et cérébrale foetales induites par la nicotine chez le foetus ovin.

Foetal and maternal circulations were studied in 5 gestating sheep given an intra-muscular nicotine injection (10 mg) daily for 65 days beginning on the 60th day of gestation. Six control sheep and 5 others given a placebo injection comprised the control group. Placental (Rp), cerebral (Rc) and uterine (Ru) vascular resistances were measured by Doppler at the following sites: umbilical arteries, foetal cerebral arteries, uterine arteries. Measurements were taken at 80, 100 and 130 days of gestation. The Doppler resistance indices were comparable in the control and placebo group. The cerebral Doppler resistance indices were comparable in the three groups at 80 and 100 days, but there was a significant increase at day 130 in the nicotine group (p < 0.01). This increase was in favour of reduced cerebral perfusion. The umbilical indices were slightly higher at 80 and 130 days in the nicotine group (p < 0.01). The cerebro-placental ratio (Rc/Rp) remained unchanged in the controls, but increased significantly in the nicotine fetuses (p < 0.05) confirming a redistribution of the fetal blood flow away from the brain. There was no significant difference in the uterine resistances at 80 and 100 days in the nicotine group (p < 0.01), but they increase between 100 and 130 days. In the control and placebo groups, delivery occurred at normal gestation dates. In these two groups, two lambs (10%) were stillborn. In the nicotine group, premature delivery occurred in two sheep and 8 of the 13 lambs (63%) were stillborn.(ABSTRACT TRUNCATED AT 250 WORDS)

[Refinement of a new Doppler sensor for studying fetal hemodynamic disorders (animal model)]. / Mise au point d'un nouveau capteur Doppler pour l'étude des perturbations hémodynamiques foetales (modèle animal).

Fetal Doppler techniques applied in the human have furnished information of the regional haemodynamics of fetal circulation but has in general been associated with haemodynamic data obtained by vessel puncture, i.e. arterial pressure or blood gases. With animal models, further data can be obtained in the course of induced pathologies or during dynamic test (hypoxia, drugs). Several studies on utero-placental haemodynamics have been conducted using electromagnetic sensors and implanted catheters. This type of technique is only possible for certain vessels (usually the cord vessels) and, for example, cannot be used to investigate the cerebral area. The aim of this work was to develop a Doppler sensor which could be implanted in utero on the fetus and would permit a real time measurement of the major fetal blood flows. The sensor was made of 2 continuous Doppler transducers (13 mm x 4 mm) with a 45 degrees inclinasion to the sensor surface and carried on a parallellopipedic support system measuring 20 mm x 6 mm. The active surface of the transducer has a silicone film covering. The sensor is placed on the skin of the fetus, facing the artery to be explored, and oriented towards capture of a quality signal. The sensor is then sutured to the skin and the coaxial leads of the 2 transducers are exposed through the skin of a pregnant ewe. The leads are connected to a Doppler control panel later after the operative period. Three sensors can be implanted simultaneously to monitor umbilical, cerebral and uterine blood flows.(ABSTRACT TRUNCATED AT 250 WORDS)