Is failure of fetal head engagement during previous delivery a contraindication for trial of labor: A French retrospective study.

OBJECTIVE: To study whether history of cesarean delivery for arrest of descent (failure of fetal head engagement or unsuccessful instrumental delivery), is a factor of unsuccessful vaginal birth after cesarean delivery. METHODS: Multicenter prospective study of patients undergoing TOL after previous caesarean delivery between May 2012 and May 2013 in 6 maternities. Univariate statistical analysis was performed depending of previous cesarean delivery indication. Multivariate analysis was used to determine independent association between these factors and TOLAC success. RESULTS: Four hundred and eighty women with previous cesarean delivery were included and separated into two groups: the study group was composed of patients with history of CD for arrest of descent (failure of fetal head engagement or unsuccessful instrumental delivery) (n=31); control group included all other indications for CD (n=449). Overall, of the 480 women included in the study, 71.2 % underwent a TOL for a subsequent delivery (n=342): 68 % in the study group (n=21) vs 71.5 % in the control group (n=321). Vaginal birth after cesarean (VBAC) was obtained in 66.6 % vs 61% in the study and control group respectively (p=0.656). Univariate analysis of factors that may influence the success rate of (VBAC) did not show any difference between the two groups. Multivariate analysis showed that VBAC was only significantly associated with history of vaginal delivery subsequent to prior CD for arrest of descent. CONCLUSION: This study reassures us in our clinical practice allowing TOL in cases of history of CD for fetal head engagement failure or instrumental delivery failure in the second stage of labor.

[Supporting people with Diogenes syndrome]. / Accompagnement des personnes atteintes du syndrome de Diogène.

Diogenes syndrome is a chronic condition often affecting elderly people, especially those living in isolation. It is characterised by self-neglect and compulsive hoarding. Medico-social professionals working with people in their home, have reflected on levers to help improve the complex support of these patients.

Placenta accreta: management with uterine artery embolization in 17 cases.

PURPOSE: To report on the management of placenta accreta with uterine artery embolization (UAE) and to analyze the outcomes. MATERIALS AND METHODS: A retrospective study was performed over a 128-month period of all women with placenta accreta who underwent UAE in a single center. Seventeen patients were included, and they were further divided into two groups: a preventive group (diagnosis was made in the prenatal period, n = 6) and a curative group (diagnosis was made during delivery, n = 11). The mean patient age was 34.6 years +/- 5.5 in the preventive group and 31.4 years +/- 4.3 in the curative group. The mean term of pregnancy was 35 weeks +/- 2 of amenorrhea in the preventive group and 38 weeks +/- 2 in the curative group. RESULTS: The primary success of embolization was 100% in both groups. In the preventive group, massive bleeding occurred in a patient 2 days after unsuccessful manual placenta delivery resulted in an hysterectomy; in a second case, delayed bleeding (2 months after the procedure) was controlled with a second embolization. There were no episodes of repeat bleeding in the curative group. In the preventive group, two patients presented with uterine scarring, with synechiae in one and endometrial atrophy in the other. In the curative group, one patient presented with secondary amenorrhea. The delay before embolization was significantly different in the two groups (23.3 minutes +/- 5.1 in the preventive group vs 73 minutes +/- 44.7 in the curative group, P < .01), and total blood loss was 0.7 L +/- 0.8 in the preventive group and 2.6 L +/- 1.2 in the curative group (P < .01). CONCLUSIONS: Prenatal diagnosis of placenta accreta permits its preventive management, which reduces time to embolization and blood loss.