[Management of fetal growth restriction in France: Survey of teaching hospitals and tertiary referral centers]. / Prise en charge du retard de croissance intra-utérin en France : enquête auprès des centres hospitalo-universitaires et maternités de type III.

OBJECTIVES: French Guidelines on Fetal Growth Restriction (FGR) were published in December 2013. It seemed interesting to us to carry out an inventory on the management of FGR in teaching hospitals and tertiary referral centers MATERIAL AND METHODS: We carried out a retrospective survey on the academic year 2020/2021. All teaching hospitals and level III maternity in mainland France were contacted (67). The questionnaire focused on the growth curves used, the etiological assessment carried out, the rate and modalities of antenatal surveillance as well as the criteria indicating a birth. RESULTS: The response rate was 76%. The CFEF curves are used for screening in 78.4% of centers and in the event of FGR in 39.2% of them. The etiological assessment includes a referent ultrasound in 62.7% of cases and amniocentesis is offered in 74.5% of hospitals in case of severe and early FGR. All centers use umbilical Doppler for FGR. The fetal heart rate is monitored between once a week to three times a day in the event of cerebro-placental redistribution. In case of reverse flow, birth is induced from 28 weeks on for some teams while others continue the pregnancy until 39 weeks. In case of cessation of fetal growth, the expected terms of birth are between 28 and 38 weeks. CONCLUSION: There is great heterogeneity in the management of FGR, particularly in terms of antenatal surveillance and the term of birth envisaged.

Prospective assessment of reproducibility of three-dimensional ultrasound for fetal biometry.

PURPOSE: To compare fetal ultrasound measurements performed by two observers with different levels of experience and evaluate the potential contribution of the use of three-dimensional (3D) ultrasound on repeatability, reproducibility and agreement of two-dimensional (2D) and 3D-derived measurements. MATERIALS AND METHODS: Two observers (one senior and one junior) measured head circumference (HC), abdominal circumference (AC) and femur length (FL) in 33 fetuses (20 to 40 weeks of gestation). Each observer performed two series of 2D measurements and two series of 3D measurements (i.e., measurements derived from triplane volume processing). Measurements were converted into Z-scores according to gestational age. Variability between the different series of measurements was studied using Bland-Altmann plots and intra-class correlation coefficients (ICC). RESULTS: Agreement with the 2D measurements of the senior observer was higher in 3D than in 2D for the junior observer (systematic differences of -0.4, -0.2 and -0.8 Z-score vs. -0.1, -0.1 and -0.6 for HC, AC and FL on 2D and 3D datasets, respectively). The use of 3D ultrasound improved junior observer repeatability (ICC=0.94, 0.88, 0.90 vs. 0.94, 0.94 and 0.96 for HC, AC and FL in 2D and 3D, respectively). The reproducibility was greater using the junior observer 3D datasets (ICC=0.75, 0.60 and 0.45 vs. 0.79, 0.89 and 0.63 for HC, AC and FL, respectively). CONCLUSION: The use of 3D ultrasound improves the consistency of the measurements performed by a junior observer and increases the overall repeatability and reproducibility of measurements performed by observers with different levels of experience.

[Cystic fibrosis and pregnancy: Outcome, prognostic factors and obstetrical management]. / Mucoviscidose et grossesse : impact, facteurs pronostiques et prise en charge obstétricale.

As a result of improvements in life expectancy and therapies, increasing numbers of patients with cystic fibrosis become pregnant. The first studies were pessimistic and report adverse outcomes on the fetus and the mother. In the recent publications, long-term outcome for women with cystic fibrosis does not appear to be negatively impacted by pregnancy. Furthermore, the number of women successfully completing pregnancy continues to rise. The aim of this review is to assess the outcome of pregnancy in women with cystic fibrosis and the impact of pregnancy on the disease. It is hoped it will improve the counseling for pregnant women with cystic fibrosis and their obstetrical management.

[How to proceed after a failed vacuum delivery]. / Quelle voie d'accouchement choisir après échec d'extraction par ventouse.

OBJECTIVES: Compare maternal and neonatal morbidity in patients delivered by a second instrument versus cesarean section after failed vacuum. METHODS: We performed a retrospective study between January 2006 and December 2014. Case notes of 172 failed vacuum deliveries were studied. The studied parameters were blood loss, perineal tears, pH, Apgar score, neonatal reanimation and length of stay in neonatology. RESULTS: The frequency of vacuum failure was 8.7%. The use of the second instrument (77.9%) was associated with a higher prevalence of third degree perineal tears (13.4% vs. 0%; P=0.017) and more episiotomy (72.2% vs. 0%; P<0.0001). There was no significant difference regarding post partum hemorrhage between cesarean section and second instrument delivery. There was no significant difference regarding neonatal morbidity between cesarean section and second instrument delivery after failed vacuum. When an attempted second instrument delivery failed, the risk of adverse neonatal outcome was increased: newborns had a significantly longer stay in a neonatal unit (2.4 versus 0.6 days; P=0.026), lower pH (P=0.017), lower Apgar scores (7.4 versus 8.8; P=0.0373), needed intubation (P=0.0471) and had seizures (P=0.04) more often. CONCLUSION: Compared to cesarean section, the use of the second instrument increased maternal morbidity but doesn't seem to increase neonatal morbidity. If the second instrument fails, neonatal morbidity is significantly increased.