[Elective single embryo transfer - the Scandinavian experiment]. / Transfert électif d'un embryon - le modèle scandinave.

Limiting the number of embryos transferred from three to two does not reduce the high risk of twin pregnancy (between 21 and 40%). Scandinavian centers have proposed in the 2000s the elective single embryo transfer (eSET) as the only means to reduce maternal, neonatal and psychological consequences related to multiple births. Pooled results from prospective randomized controlled trials and prospective cohort studies comparing eSET and transfer of two embryos (DET) in a selected population have confirmed the almost complete disappearance of twins when eSET was effective but the compromising effect of eSET upon live birth rates was discussed. Optimizing the eSET overall pregnancy rate need to associate a freezing policy and to define risk factors for increased chance of multiple birth (patient age, diagnosis, number of top-embryos or unsuccessful attempts). The extension of eSET practice to an unselected population irrespective of embryo quality is still controversial. The choice between offering one cycle of SET or DET in an unselected patient population depends on the society's willingness to optimize the in vitro fertilization results according to a defined health care policy: the first one is the twins disappearance with reduced overall pregnancy rate and the second one is a reduced twin birth rate with maintain of the total pregnancy percentage. The real question is to define what percentage of twin pregnancy could be considered as acceptable.

[Comparative efficacy of vaginal insert and dinoprostone gel for cervical ripening at term in current practice]. / Comparaison de l'efficacité entre dispositif intravaginal et gel vaginal de dinoprostone dans la maturation cervicale à terme en pratique quotidienne.

OBJECTIVE: To compare efficiency for slow release vaginal insert and vaginal gel in current practice. METHODS: This retrospective historical study included 171 women: 85 with vaginal insert (Propess, Ferring) and 86 with vaginal gel (Prostine 2mg, Pharmacia). Inclusion criterion were Bishop score 5, singleton pregnancy, vertex presentation, unruptured membranes, and patients with only one prior cesarean delivery were not excluded. Indications for cervical ripening were post-term pregnancy, maternal or fetal pathologies, convenience. The outcomes were vaginal delivery within 12 and 24 hours, cesarean section rate, mean time to delivery, uterine hyperstimulation rate and cost. The statistical analysis was done with Pearson chi2, Student test exact Fisher and U Mann-Whitney tests. RESULTS: Comparing vaginal insert to vaginal gel, no significant differences appeared for vaginal delivery by 24 hours (53% versus 58%), cesarean section (17.6% versus 19.7%) and mean time to delivery (23.8h versus 22.4h). Labor induction rate within the primipara subgroup was significantly reduced with vaginal gel (39% versus 63.6%; p=0.03) but the rate and time of vaginal delivery were similar. In the same population, the rate of uterine hyperstimulation was higher (9.8% versus 0%; p=0.05) with vaginal gel. Cost of treatment was lowered with vaginal insert. CONCLUSION: The dinoprostone vaginal insert for cervical ripening seems to have the same efficiency as vaginal 2mg gel. The cost of treatment appears to be lower, probably because only a single dose is necessary. Use of prostaglandine gel after vaginal insert is not accepted as a gold standard for cervical ripening though our conclusions only concern this retrospective study.