[Quality of life after deep pelvic endometriosis surgery: Evaluation of a French version of the EHP-30]. / Qualité de vie après chirurgie de l'endométriose pelvienne profonde : évaluation d'une version française de l'EHP-30.

OBJECTIVE: To evaluate the changes in the quality of life of patients after deep pelvic endometriosis surgery, with a French version of EHP-30 questionnaire, and the capacity of the EHP-30 to carry out this measurement. MATERIAL AND METHODS: Study prospective monocentric, conducted in the obstetrics and gynecology department of the CHU Dijon during the period of October 2012 from October 2013. A EHP-30 questionnaire was given to patients before surgery. The same questionnaire was sent to their homes, away from surgery (3-6 months) to inform about their postoperative quality of life. The difference in preoperative and postoperative scores was tested using the test Wilcoxon signed ranks. A difference was considered significant if the p-value was less than or equal to 0.05. Sensitivity to change was calculated by the method of effect size (ES). The size of the effect is defined as the difference in mean preoperative and postoperative scores divided by the standard deviation of preoperative scores. A size effet of 0.20 indicates less change scores, of 0.50 a moderate change and of 0.80 a material change. RESULTS: We included 22 patients in total in the prospective analysis. The majority of patients had gynecological symptoms of dysmenorrhea with 69.7%, 75.7% and 75.7% dyspareunia chronic pelvic pain. Nineteen patients (57.6%) had gastro-intestinal symptoms. Urinary symptoms were less frequent. The results of the EHP-30 showed a significant improvement for the items "pain" (P=0.01), "control and powerlessness" (P=0.02), "emotional well-being" (P<0,01) "social relations" (P<0.01), "sexual intercourse" (P=0.03) and "relationship with the medical world" (P=0.05). We observed a non-significant improvement for the items "self-image" (P=0.44), "work" (P=0.48) and "relationships with children" (P=0.50). The size of the effect (ES) was low to high for all dimensions of the questionnaire, ranging from 0.1 to 0.6 for the entire group. A significant sensitivity to change was found for the items "pain" (ES=0.60), "control and powerlessness" (ES=0.62), "social relations" (ES=0.57). A moderate sensitivity to change was found for the items "emotional well-being" (ES=0.29), "relationship with the medical world" (ES=0.26). A low sensitivity to change was found for the items "relationships with children" (ES=0.06), "self-image" (ES=0.16), "work" (ES=0.18), "sexual intercourse" (ES=0.20). A size that is important to moderate effect corresponded to a statistically significant improvement of the score EHP-30. CONCLUSION: This study showed that the EHP-30 is a sensitive tool to change the health status and an appropriate instrument for the assessment of treatment effects in patients with deep pelvic endometriosis.

[Does low-risk delivery exist?]. / L'accouchement à bas risque: existe-t-il ?

OBJECTIVES: The main objective of our study is to evaluate the rate of call of the obstetrician during childbirth supposed in low-risk and compare it to high-risk deliveries in a maternity service level II. The secondary objective is to assess the level of intervention of the obstetrician with the patient in both groups. PATIENTS AND METHODS: This is a prospective study of 490 patients including 259 classified as low risk based on obstetric criteria of Bourgogne Perinatal Network. The criteria considered for the call and/or intervention of the obstetrician were the following: altered fetal heart rate, lactate scalp, instrumental delivery, cesarean section, complete or complicated perineal, serious event during labor (cord prolapse, uterine rupture…), postpartum hemorrhage treated by prostaglandin ocytocic. The high-risk group is taken as reference for the calculation of confidence intervals. RESULTS: The rate of call of the obstetrician in the low versus high risk are: 37% [95% CI: 0.98-2.11] and 29% [95% CI: 1.00] (P=0.0587). The rate of intervention of the obstetrician in the low versus high risk is 21% [95% CI: 1.15-3.07] and 12% [95% CI: 1.00] (P=0.0109). CONCLUSION: The delivery process is unpredictable and potentially risky. Thirty-seven percent of patients classified as low risk at the beginning of labour have required intervention of the obstetrician and 21% of them his intervention.