[Uterine rupture during medical termination of pregnancy or intrauterine death: A risk management study]. / Rupture utérine sur interruption médicale de grossesse ou mort fœtale in utero : une étude de gestion du risque.

OBJECTIVE: To describe and analyze a series of uterine ruptures (UR) that occurred in the context of medical termination of pregnancy (MTP) or intrauterine death (IUD) from a risk management perspective. METHODS: French retrospective descriptive observational study of all cases of UR occurring during induction for IUD or MTP, reported between 2011 and 2021 by Gynerisq. Cases were recorded on a basis of voluntary reports using targeted questionnaires. RESULTS: Between November 27, 2011, and August 22, 2021, 12 cases of UR occurring during an induction for IUD or MTP were recorded. 50 % of the patients had never given birth by cesarean section. The term of delivery varied from 17+3 days to 41+2 days. The clinical signs found were pain (n=6), ascending fetal presentation (n=5) and bleeding (n=4). All patients were managed by laparotomy, 5 were transfused. One vascular ligation and one hysterectomy were required. CONCLUSION: Knowledge of surgical history is involved in the prevention of UR. The signs of detection are pain, ascending presentation and bleeding. The speed of management and good teamwork allow a reduction of maternal complications. The findings of the morbidity and mortality reviews show that prevention and mitigation barriers can be established.

Continued existence of significant disparities in the technical practices of sperm morphology assessment and the clinical implications: results of a French questionnaire.

OBJECTIVE: To investigate current practices for sperm morphology assessment. DESIGN: E-mail survey questionnaire. SETTING: Diagnostic and clinical institutions/laboratories. PATIENT(S): French biologists and clinicians (n = 225). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Answers to 24 questions. RESULT(S): The survey shows that even now in France there is great inconsistency in the use of sperm morphology assessments. For example, the survey revealed that no fewer than six different staining techniques were in use. Automatic reading is hardly used (used by 2.5% of the biologists replying to the survey). More than 33.6% of biologists use a threshold of normal forms unsuited to their classification, and 20% do not perform any internal quality control in this area. Prescribing doctors seldom trust the tests, likely due to their lack of analytic reliability. Among the biologists surveyed 26% said the percentage of normal forms is either unreliable or not very reliable in analytic terms, and 24% of clinicians stated that it has little clinical relevance. CONCLUSION(S): The survey reveals a marked lack of uniformity in French laboratories for performing sperm morphology assessment and in the use of the results by physicians. Regular quality control procedures and well-trained personnel, up to date with their training and conversant with the latest techniques as well as harmonized practices, are clearly indispensable. It is time for a consensus on the practice and interpretation of this particular test.