[Cervical ripening and labor induction: Evaluation of single balloon catheter compared to double balloon catheter and dinoprostone insert]. / Méthodes de maturation cervicale et déclenchement du travail : évaluation de la sonde simple ballonnet comparée à la sonde double ballonnet et aux prostaglandines.

OBJECTIVE: To compare the effectiveness of single balloon catheter with double balloon catheter and dinoprostone insert for cervical ripening and labor induction on unfavourable cervix. METHODS: this is a comparative, retrospective, one-center trial. Were included singleton pregnancy in cephalic presentation. Were excluded cicatricial uterus. The outcomes were vaginal delivery rate, caesarean section rate, modification in Bishop score, time from induction to delivery, second time prostaglandin E2 resort, oxytocin administration resort, maternal or neonatal adverse events. RESULTS: Were included 108 patients: 45 in single balloon catheter group, 32 in double balloon catheter group, 31 in dinoprostone insert group. Vaginal delivery rate was similar in single balloon catheter group (78 %) compared with others groups (75 % in double balloon catheter and 71 % in dinoprostone insert group respectively). Oxytocin administration resort was superior in single balloon catheter group. There was no significant difference on others outcomes. Labor induction costs were 9euros in single balloon catheter group, versus 55 and 81 euros in double balloon catheter group and dinoprostone insert group respectively. CONCLUSIONS: Single balloon catheter seems just as effective as double balloon catheter and dinoprostone insert with its major asset the low cost for labor induction.

Does knowledge of fetal outcome influence the interpretation of intrapartum cardiotocography and subsequent clinical management? A multicentre European study.

OBJECTIVE: To investigate whether knowledge of fetal outcome influences retrospective interpretation of cardiotocographic tracings and subsequent management recommendations. DESIGN: Prospective online study. SETTING: Seven university hospitals in five European countries. POPULATION: Forty-two intrapartum tracings from women with singleton pregnancies and uneventful antepartum courses. METHODS: Using an online questionnaire, 123 healthcare professionals interpreted 42 tracings without any knowledge of fetal outcome and provided management recommendations according to the National Institute of Clinical Excellence guidelines (intrapartum care). Two months later, 93 of the 123 participants re-interpreted the same re-ordered tracings, this time with information on the newborn's umbilical artery pH. OUTCOME MEASURES: Comparison of the evaluation of tracing features, overall tracing classification, and management recommendations between the initial analysis and re-interpretation. RESULTS: In newborns with umbilical artery pH ≤ 7.05, knowledge of the pH value led to significant changes in the evaluation of all basic tracing features. In this group, classification of tracings as 'normal' decreased 76% (8.8-2.1%, P < 0.001), whereas classification as 'pathologic' increased 51% (44.7-67.5%, P < 0.001). In newborns with pH 7.06-7.19, classification of tracings as 'normal' decreased 36% (22.4-14.4%, P < 0.001), and in those with pH ≥ 7.20, classification of tracings as 'pathologic' decreased 40% (23.4-14.1%, P < 0.001). In the group of newborns with umbilical artery pH ≤ 7.05, the recommendations 'no attention needed' decreased 75% (10.2-2.6%, P < 0.001), and the number of recommendations 'rapid reversal of hypoxic cause or immediate delivery' increased 70.3% (42.1-71.7%, P < 0.001). CONCLUSIONS: When provided with information on adverse fetal outcome, healthcare professionals provide a more pessimistic evaluation of basic tracing features, overall classification, and clinical management recommendations. TWEETABLE ABSTRACT: Knowledge of adverse fetal outcome leads to more pessimistic CTG evaluation and management recommendations.

[Cervical ripening: is there an advantage for a double-balloon device in labor induction?]. / Maturation cervicale: y a-t-il un avantage à utiliser un double ballonnet pour le déclenchement du travail?

OBJECTIVES: To compare efficiency of a double-balloon to vaginal prostaglandins for cervical ripening in patients with unfavourable cervix. PATIENTS AND METHODS: Fifty patients induced with a double-balloon were compared to 50 patients receiving vaginal prostaglandins. Matching criteria were age, parity, history of uterine scar, gestational age and Bishop score. The primary outcome was failure induction. Secondary outcomes included improvement in Bishop score, ripening-to-delivery interval, caesarean section rate, maternal and neonatal morbidity. RESULTS: Risk of failed induction (16% in the double-balloon group vs. 14% in the prostaglandins group) and caesarean section rate (28% vs. 36%) were similar in the two groups. The proportion of favourable cervix and the time to obtain a better Bishop score were similar with the two methods. Maximal pain score during cervical ripening was significantly lower in the double-balloon group (P<0.001). Ripening-to-delivery interval (30.4 h ± 15.6h vs. 28.9 h ± 20.5h) was not different between the two groups. There was no difference about maternal and neonatal outcomes. DISCUSSION AND CONCLUSION: The double-balloon was as efficient as vaginal prostaglandins. The ripening-to-delivery interval was not different between the two groups. The main advantage of this device could be a better tolerance favourishing patient satisfaction.

[Diagnosis and management of uterine perforations after intrauterine device insertion: a report of 11 cases]. / Diagnostic et prise en charge des perforations utérines par dispositif intra-utérin: à partir de 11 cas.

OBJECTIVE: Intrauterine device insertion is common. It is however not harmless and uterine perforation can be serious. PATIENTS AND METHODS: Eleven cases of uterine perforation after intrauterine device insertion were listed at Tourcoing hospital between 2005 and 2009. They were analyzed to identify risk factors of uterine perforation and specify management. RESULTS: The main symptom was pelvic pain (4 cases), pregnancy occurrence (3 cases) or inability to remove the IUD (2 cases). The intrauterine device was set during the first 9 months of post-partum in 7 cases, 2 patients were still breastfeeding. Seven patients underwent laparoscopy, 2 needed switch for laparotomy, one was treated by laparotomy only and one was lost of follow-up. DISCUSSION AND CONCLUSION: Incidence of uterine perforation after IUD insertion ranges from 0,1 to 3/1000. Pelvic pain is the most revealing symptom. Fifteen percent of perforations complicate with adjacent organ lesion. Perforation incidence seems greater if the intrauterine device is set during the 6 first weeks of post-partum and breastfeeding, but non influenced by operator practical experience. Ultrasound follow-up of patients carrying intrauterine device is controversial. Facing a suspicion of ectopic intrauterine device, pelvic ultrasound examination is the first step imaging modality and using 3D could be useful. If it fails to localize the intrauterine device, an abdominal X-ray must be performed. Ectopic intrauterine device removal is recommended.

[Demography and training of residents in gynaecology and obstetrics: results of a national survey]. / Démographie et formation des internes en gynécologie et obstétrique : résultats d'une enquête nationale.

OBJECTIVE: To survey French trainees in obstetrics and gynaecology on the general demographic evolution and the quality of training. MATERIAL AND METHODS: A questionnaire was sent to the 919 trainees in obstetrics and gynaecology during the academic year 2010-2011. RESULTS: Answer rate was 38.5%. Almost all trainees (99.4%) wish to have a two-year hospital position before applying for consultant or beginning a private practice; 60.4% of these trainees declare this option realistic. Trainees demography is marked by an increasing number of young doctors to train and a feminization. DISCUSSION AND CONCLUSION: The need of a debate is crucial to assure quality of training after the recent increase in the number of residents and trainees reforms.

Ovarian cancer molecular pathology.

Ovarian cancer (OVC) is the fourth leading cause of cancer mortality among women in Europe and the United States. Its early detection is difficult due to the lack of specificity of clinical symptoms. Unfortunately, late diagnosis is a major contributor to the poor survival rates for OVC, which can be attributed to the lack of specific sets of markers. Aside from patients sharing a strong family history of ovarian and breast cancer, including the BRCA1 and BRCA2 tumor suppressor genes mutations, the most used biomarker is the Cancer-antigen 125 (CA-125). CA-125 has a sensitivity of 80 % and a specificity of 97 % in epithelial cancer (stage III or IV). However, its sensitivity is 30 % in stage I cancer, as its increase is linked to several physiological phenomena and benign situations. CA-125 is particularly useful for at-risk population diagnosis and to assess response to treatment. It is clear that alone, CA-125 is inadequate as a biomarker for OVC diagnosis. There is an unmet need to identify additional biomarkers. Novel and more sensitive proteomic strategies such as MALDI mass spectrometry imaging studies are well suited to identify better markers for both diagnosis and prognosis. In the present review, we will focus on such proteomic strategies in regards to OVC signaling pathways, OVC development and escape from the immune response.

[Fetal microchimerism: self and non-self, finally who are we?]. / Microchimérisme fœtal: soi et non soi, finalement qui sommes-nous?

For a long time, the conventional view was that the fetus and maternal vascular system are kept separate. In fact there is a two-way traffic of immune cells through the placenta and the transplacental passage of cells is in fact the norm. The fetal cells can persist in a wide range of woman's tissue following a pregnancy or an abortion and she becomes a chimera. Fetal cells have been found in the maternal circulation and they were shown to persist for almost three decades in humans, thus demonstrating long-term engraftment and survival capabilities. Microchimerism is a subject of much interest for a number of reasons. Studies of fetal microchimerism during pregnancy may offer explanations for complications of pregnancy, such as preeclampsia, as well as insights into the pathogenesis of autoimmune disease which usually ameliorates during pregnancy. The impact that the persistence of allogenic cells of fetal origin and the maternal immunological response to them has on the mother's health and whether it is detrimental or beneficial to the mother is still not clear. Although microchimerism has been implicated in some autoimmune diseases, fetal microchimerism is common in healthy individuals. On the beneficial side, it has been proposed that genetically disparate fetal microchimerism provides protection against some cancers, that fetal microchimerism can afford the mother new alleles of protection to some diseases she has not, that fetal microchimerism can enlarge the immunological repertoire of the mother improving her defense against aggressor. Fetal cells are often present at sites of maternal injury and may have an active role in the repair of maternal tissues.

[Is fetal microchimerism beneficial for the fetus or the mother]. / Microchimérisme fœtal : un bien ou un mal pour le fœtus et sa mère ?

There is a two-way traffic of cells through the placenta during the pregnancy (feta and maternal microchimerisms). Fetal cells migrate in the maternal body where they are present long after birth. The fetal microchimerism may be deleterious for the mother when implicated in the induction of autoimmune diseases and of repeated abortion. Usually fetal microchimerism is beneficial for the mothers. Fetal cells can repair damaged tissues, transmit paternal resistance alleles, improve the directory of T cell receptors. In cancer, the effects are more contrasted, beneficial and protective for certain cancers, harmful and favouring the development for the others. The phenomenon of fetal and maternal microchimerisms inspires numerous questions and offers new perspectives on the biology of pregnancy and cancer, on pathogenesis of auto-immunity, of the transplantations, without forgetting the biology of the heredity because these cells could bring resistance or risk alleles for some diseases from the father towards the mother through the fetus, through the mother to the fetus, from the first fetus of a first pregnancy to the next fetus through the woman.