Laparoscopic Essure® Device Removal by En Bloc Salpingectomy-Cornuectomy with Intraoperative X-Ray Checking: A Retrospective Cohort Study.

STUDY OBJECTIVE: To evaluate the feasibility, efficacy, and morbidity of Essure® device removal via laparoscopic en bloc salpingectomy-cornuectomy resection (LSC) and the utility of confirmation of complete removal with an intraoperative X-ray of the removed specimen (IX-S). DESIGN: Retrospective observational cohort study. SETTING: Academic hospitals of La Conception, Marseille, and Arnaud-de-Villeneuve, Montpellier, France. PATIENTS: Women who were not seeking future fertility seeking Essure® device removal by salpingectomy, between February 2017 and August 2018. INTERVENTIONS: All women underwent LSC. An IX-S was performed to confirm complete Essure® device removal. In the case of an unsatisfactory IX-S, an intraoperative pelvic X-ray control of the patient (IX-P) was performed. If IX-P diagnosed residual Essure® fragments, an additional resection was performed, and the removed tissue was checked by IX-S. MEASUREMENTS AND MAIN RESULTS: We included 72 women, and a total of 140 Essure® devices were removed. The IX-S confirmed complete Essure® device removal in 131 of 140 cases (93.6%) in 63 of 72 women (87.5%). Out of the 9 women with unsatisfactory IX-S, 6 had no residual Essure® fragments at IX-P, and Essure® device removal was considered complete. Three women had a persistent Essure® fragment at IX-P: an additional resection allowed complete removal in 2 cases and resulted in failure in 1 of 140 case (0.7%). There were 2 of 72 women (2.8%) intraoperative complications and 4 of 72 women (5.6%) postoperative grade 1 complications according to the Clavien-Dindo classification. CONCLUSION: Essure® device removal by LSC appears to be an effective and safe procedure. IX-S is a useful method to evaluate whether the removal of Essure® device is complete during an LSC procedure.

Development of an evidence-based training program for laparoscopic hysterectomy on a virtual reality simulator.

BACKGROUND: Substantial evidence in the scientific literature supports the use of simulation for surgical education. However, curricula lack for complex laparoscopic procedures in gynecology. The objective was to evaluate the validity of a program that reproduces key specific components of a laparoscopic hysterectomy (LH) procedure until colpotomy on a virtual reality (VR) simulator and to develop an evidence-based and stepwise training curriculum. METHODS: This prospective cohort study was conducted in a Marseille teaching hospital. Forty participants were enrolled and were divided into experienced (senior surgeons who had performed more than 100 LH; n = 8), intermediate (surgical trainees who had performed 2-10 LH; n = 8) and inexperienced (n = 24) groups. Baselines were assessed on a validated basic task. Participants were tested for the LH procedure on a high-fidelity VR simulator. Validity evidence was proposed as the ability to differentiate between the three levels of experience. Inexperienced subjects performed ten repetitions for learning curve analysis. Proficiency measures were based on experienced surgeons' performances. Outcome measures were simulator-derived metrics and Objective Structured Assessment of Technical Skills (OSATS) scores. RESULTS: Quantitative analysis found significant inter-group differences between experienced intermediate and inexperienced groups for time (1369, 2385 and 3370 s; p < 0.001), number of movements (2033, 3195 and 4056; p = 0.001), path length (3390, 4526 and 5749 cm; p = 0.002), idle time (357, 654 and 747 s; p = 0.001), respect for tissue (24, 40 and 84; p = 0.01) and number of bladder injuries (0.13, 0 and 4.27; p < 0.001). Learning curves plateaued at the 2nd to 6th repetition. Further qualitative analysis found significant inter-group OSATS score differences at first repetition (22, 15 and 8, respectively; p < 0.001) and second repetition (25.5, 19.5 and 14; p < 0.001). CONCLUSIONS: The VR program for LH accrued validity evidence and allowed the development of a training curriculum using a structured scientific methodology.

Factors associated with a poor prognosis for the IVF-ICSI live birth rate in women with rAFS stage III and IV endometriosis.

PURPOSE: To assess the factors associated with a poor prognosis for a cumulative IVF live birth rate (LBR) in women with stage III and IV endometriosis according to the revised classification of the American Fertility Society (rAFS). METHODS: A retrospective cohort study was conducted between January 1, 2010, and December 31, 2014, in our Reproductive Medicine Center. We analyzed different factors associated with a poor prognosis for a cumulative IVF LBR in women with rAFS stage III and IV endometriosis. A total of 101 patients were included, representing 232 IVF-ICSI cycles and 212 embryo transfers. The primary endpoint was the cumulative LBR per cycle and per patient. RESULTS: The cumulative LBR per cycle was 14.7% (n = 34) and that per patient was 31.7% (n = 32). The cumulative LBR was significantly decreased by active smoking [adjOR = 3.4, 95% CI (1.12-10.60), p = 0.031], poor ovarian response (POR) according to the Bologna criteria [adjOR = 11.5, 95% CI (1.37-96.83), p = 0.024], and rAFS stage IV [adjOR = 3.2, 95% CI (1.13-8.95), p = 0.024]. The cumulative LBR per women was 59.4% without factors associated with a poor prognosis and 25.6% in the case of one factor, and it decreased to 7.7% in the case of two or three factors (p < 0.001). CONCLUSION: Active smoking, POR according to the Bologna criteria, and rAFS stage IV endometriosis had a negative impact on the IVF-ICSI cumulative LBR for women with rAFS stage III and IV endometriosis. Because smoking dramatically decreases the LBR with endometriosis, stopping smoking before IVF-ICSI should be strongly advised.

IVF oocyte retrieval: prospective evaluation of the type of anesthesia on live birth rate, pain, and patient satisfaction.

PURPOSE: Does the type of anesthesia (paracervical block (PCB) or general anesthesia (GA)) impact live birth rate, pain, and patient satisfaction? METHODS: A non-randomized prospective cohort study was conducted in women treated for IVF. Two groups of patients were prospectively included: the PCB group (n = 234) and the GA group (n = 247). The type of anesthesia was determined by the patients. The primary endpoint was cumulative live birth rate by OR. Secondary endpoints were self-assessment of the patients' peri-operative abdominal and vaginal pain vs the doctors' evaluations during PCB, post-operative abdominal and vaginal pain level, and patient satisfaction in both groups. Pain levels were assessed with a numerical rating scale (NRS). RESULTS: The live birth rate was similar in both groups (19.8% in the GA group vs 20.9% in the PCB group, P = 0.764). During oocyte retrieval in the PCB group, the physicians significantly under-estimated the vaginal pain experienced by the patients (3.04 ± 0.173 for patients vs 2.59 ± 0.113 for surgeons, P = 0.014). Post-operative vaginal and abdominal pain were significantly greater in the PCB group compared to the GA group (2.26 ± 0.159 vs 1.66 ± 0.123, respectively, P = 0.005, and 3.80 ± 0.165 vs 3.00 ± 0.148, respectively, P < 0.001). Patients were more significantly satisfied with GA than with PBC (P < 0.001). CONCLUSION: Because the LBR was similar in both groups and patient satisfaction was high, the choice of anesthesia should be decided by the patients.

Epidemiological, clinical, virological features of hepatitis B newly diagnosed in 2011 in Marseille University hospitals, southeastern France.

Hepatitis B virus (HBV) infection is a public health problem. In France, 0.68% of adults are chronically infected. We aimed to describe the epidemiological, virological and clinical characteristics of HBV infections newly diagnosed in 2011 in University hospitals of Marseille, the second largest French city. HBV serology was performed for 18,130 sera from 15,744 patients. A total of 167 patients were newly-diagnosed with HBV based upon the detection of hepatitis B surface antigen and anti-hepatitis B core antibodies. Clinico-epidemiological features were analyzed for 78 patients. Patients included a majority of men (59%), women being significantly younger with a mean age of 36 ± 17 versus 43.5 ± 16.2 years (P = 0.009). Country of birth was available for 52 patients and 35% of them originated from sub-Saharan Africa. Levels of the liver biological parameters were significantly lower in women compared to men, in whom mean alanine aminotransferase and gammaglutamyl transferase levels were 24 ± 39 versus 37 ± 36 IU/l (P = 0.0001) and 20 ± 20 versus 51 ± 53 IU/l (P = 0.0001), respectively. Co-infections with hepatitis C and human immunodeficiency viruses were found in 5% and 6% of the patients, respectively. HBV DNA was detectable in 90% of the HBeAg-negative patients. In addition, there was a positive correlation between the HBsAg titer and the HBV DNA level (P = 0.001). Genotype D was the most common HBV genotype and was found in 53% of the patients tested, followed by genotype E (21%). HBV remains a major concern with a slightly greater number of new diagnoses than in 2004. HBV genetic diversity was substantial in the present cohort.

Treatment failure following excision therapy of CIN: the impact of direct colposcopic vision during procedure.

PURPOSE: To assess whether the use of direct colposcopic vision during excision therapy of cervical intraepithelial neoplasia (CIN) has an impact on the risk of treatment failure. METHODS: Data from 285 patients who had had excision therapy with proven CIN at specimen histological analysis were reviewed. Primary endpoint was the occurrence of post-treatment failure defined by the histological diagnosis of CIN 2-3 during follow-up. Data were analysed according to the use of colposcopy at the time of initial therapy of CIN. RESULTS: The use of direct colposcopic vision (DCV) resulted in a significant reduction in the mean height (p = 0.008) and diameter (p < 0.001) of the excised specimen. Patients' median follow-up was 28.4 (±1.3) months. A total of 43 (15.2 %) patients were diagnosed with treatment failure. Compared to excisions performed without any use of colposcopy, DCV was not found to have any significant impact on the risk of treatment failure (HR: 0.58; 95 % CI 0.16-2.13, p = 0.412), neither when compared to excisions performed immediately after colposcopy (HR: 0.91; 95 % CI 0.47-1.79; p = 0.794). The only factors found to have a significant impact on the risk of treatment failure was the identification of clear margins (HR: 0.36; 95 %CI 0.19-0.69; p = 0.002) and the diameter of the surgical specimen (HR: 0.94; 95 %CI 0.89-0.99; p = 0.040). CONCLUSIONS: Although the use of DCV during excision therapy of CIN was associated with a significant reduction in the dimensions of the excised cervical specimen, it did not result in a significant change in the risk of treatment failure.

Intra- and interobserver agreement among obstetric experts in court regarding the review of abnormal fetal heart rate tracings and obstetrical management.

OBJECTIVE: The objective of the study was to evaluate the intra- and interobserver agreement among obstetric experts in court regarding the retrospective review of abnormal fetal heart rate tracings and obstetrical management of patients with abnormal fetal heart rate during labor. STUDY DESIGN: A total of 22 French obstetric experts in court reviewed 30 cases of term deliveries of singleton pregnancies diagnosed with at least 1 hour of abnormal fetal heart rate, including 10 cases with adverse neonatal outcome. The experts reviewed all cases twice within a 3-month interval, with the first review being blinded to neonatal outcome. For each case reviewed, the experts were provided with the obstetric data and copies of the complete fetal heart rate recording and the partogram. The experts were asked to classify the abnormal fetal heart rate tracing and to express whether they agreed with the obstetrical management performed. When they disagreed, the experts were asked whether they concluded that an error had been made and whether they considered the obstetrical management as the cause of cerebral palsy in children if any. RESULTS: Compared with blinded review, the experts were significantly more likely to agree with the obstetric management performed (P < .001) and with the mode of delivery (P < .001) when informed about the neonatal outcome and were less likely to conclude that an error had been made (P < .001) or to establish a link with potential cerebral palsy (P = .003). The experts' intraobserver agreement for the review of abnormal fetal heart rate tracing and obstetrical management were both mediocre (kappa = 0.46-0.51 and kappa = 0.48-0.53, respectively). The interobserver agreement for the review of abnormal fetal heart rate tracing was low and was not improved by knowledge of the neonatal outcome (kappa = 0.11-0.18). The interobserver agreement for the interpretation of obstetrical management was also low (kappa = 0.08-0.19) but appeared to be improved by knowledge of the neonatal outcome (kappa = 0.15-0.32). CONCLUSION: The intra- and interobserver agreement among obstetric experts in court for the review of abnormal fetal heart rate tracing and the appropriateness of obstetrical care is poor, suggesting a lack of objectivity of obstetrical expertise as currently performed in court.

Medical students as sexual health peer educators: who benefits more?

BACKGROUND: A prospective study was conducted to evaluate the impact of an educational reproductive health program on medical student peer educators and the secondary school pupils whom they taught. METHODS: The Marseille School of Medicine and ten public secondary schools participated in the study. Medical students were recruited and trained as peer educators to promote sexual health in the secondary schools. The medical students and secondary school pupils were evaluated before and after education program. The main outcome measure was the sexual health knowledge score on a 20-item questionnaire (maximum score 20). RESULTS: A total of 3350 students attended the peer-led course conducted by 107 medical students. The medical students' score increased significantly before and after the course (from 15.2 ± 1.8 to 18.3 ± 0.9; p < 0.001). The knowledge score of the pupils increased (from 7.8 ± 4 to 13.5 ± 4.4; p < 0.001). The girls' score was significantly higher than the boys' score after the course, but not before (14.5 ± 3.3 vs 12.5 ± 4.6; p < 0.001). Prior to the course, the score among the female medical students was significantly higher than that of the males. The overall knowledge increase was not significantly different between medical students and secondary school pupils (mean 3.1 ± 1 and 5.7 ± 4 respectively; p > 0.05). CONCLUSIONS: The program was effective in increasing the knowledge of medical students as well as secondary school pupils. Male sexual health knowledge should be reinforced.

Direct colposcopic vision used with the LLETZ procedure for optimal treatment of CIN: results of joint cohort studies.

PURPOSE: To assess the value of direct colposcopic vision (DCV) for optimizing large loop excision of the transformation zone (LLETZ) for the treatment of cervical intraepithelial neoplasia (CIN). METHODS: Data from 648 patients who underwent excisional procedures for CIN and were included in two previously published cohort studies were retrospectively reviewed. Women who had a LLETZ were included for analysis (n = 436). Margin status, surgical specimen dimensions and volume were analysed according to the use of colposcopy during procedure. RESULTS: Compared to LLETZ guided by previous colposcopy report only, and to LLETZ performed immediately after colposcopy, DCV allowed for a significantly higher rate of clear margins: 33 (52.4 %), 104 (68.0 %) and 142 (84.5 %), respectively (p < 0.001). It also allowed for a significantly higher probability of achieving both negative margins and depth of specimen <10 mm: 10 (15.9 %) cases, 47 (30.7 %) cases and 125 (74.4 %) cases, respectively (p < 0.001). In multivariate analysis, when compared with the use of previous colposcopy report or with colposcopy immediately before the LLETZ, DCV allowed for a significantly higher probability of negative margins (AOR: 4.61; 95 % CI: 2.37-8.99 and AOR: 2.55; 95 % CI: 1.47-4.41), combined negative margins and depth <75th percentile (AOR: 3.67; 95 % CI: 1.97-6.86 and AOR: 3.05; 95 % CI: 1.91-4.87) and combined negative margins and volume <75th percentile (AOR: 12.96; 95 % CI: 5.99-28.05 and AOR: 6.16; 95 % CI: 3.75-10.14), respectively. CONCLUSIONS: When used with the LLETZ procedure, DCV allows for optimal outcomes in terms of negative resection margins, and minimized depth and volume of the excised specimen; and should therefore be recommended.

Validation of an immunohistochemical signature predictive of 8-year outcome for patients with breast carcinoma.

We recently reported that standardized quantitative immunohistochemical (IHC) assays allowed prediction of an adverse outcome among 572 node negative (N-) patients with breast carcinoma (BrCa). To further validate our prior findings, we repeated the IHC stains including a second series of BrCa diagnosed at Yale University. Tissue microarrays (TMAs) of two cohorts of patients with BrCa (418 Marseille University and 303 Yale University) were respectively investigated for IHC expression of 15 markers (HIF-1α, PI3K, pAKT, pmTOR, moesin, P21, 4(E) BP-1, P27, Ker5-6, pMAPKAPK-2, SHARP2, claudin-1, ALDH, AF6 and CD24). Quantitative measurements of immunoprecipitates densitometry assessed with an image analyzer were correlated with 8-year patients' outcome and compared in the two cohorts. The best predictive signature consisted of a combination of five markers that included HIF-1α, PI3K, claudin-1, AF6 and pAKT in N- BrCa. This combination permitted an accurate prediction of outcome in 92.34% (386/418) of N- patients in the first set (Marseille) and 89.8% (158/176) in the second set (Yale). The close results in both cohorts confirmed the validity of this original IHC signature predictive of prognosis in node negative BrCa. This validation suggests that in clinical practice, it would be possible with standardized kits (i) to identify patients with poor prognosis at diagnosis time, particularly in the N- BrCa subset, who would require more aggressive adjuvant therapy and (ii) to avoid useless expensive therapies and their side effects in N- patients with favorable prognosis.

Significance of HPV 16 and 18 viral load quantitation in women referred for colposcopy.

The clinical utility of HPV 16 and 18 viral loads remains debated. The aim of this study was to assess the clinical significance of HPV 16 and 18 viral load and to determine a cut-off for optimal prediction of grade 2 or higher cervical intraepithelial neoplasia among patients referred to colposcopy. A total of 186 cervico-vaginal specimens harboring HPV 16 and/or 18 obtained at the time of colposcopy from patients without previous cervical neoplasia were tested for HPV 16 and 18 detection and quantitation using quantitative duplex real-time PCR method. Grade 2 or higher cervical intraepithelial neoplasia was diagnosed in 87 (46.8%) cases. Only HPV 16 median viral load increased significantly with the lesion grade: 9.1 × 10(4) in normal cervix or grade 1 cervical intraepithelial lesion versus 4.0 × 10(6) copies per million cells in grade 2 or higher cervical intraepithelial lesion (P < 0.001). The highest predictive value for grade 2 or higher cervical intraepithelial lesion was observed with a HPV 16 viral load cut-off of 3.0 × 10(6) copies per million cells (91% specificity, 58.2% sensitivity). Using this cut-off, the highest predictive value of HPV 16 viral load was observed among those referred for previous low-grade abnormal cervical cytology (96.4% specificity, 88% sensitivity). HPV 18 quantitation showed very poor predictive value. Specific attention should be given when performing colposcopic examination of women with an HPV 16 viral load higher than 3.0 × 10(6) copies per million cells, especially among those referred after a low-grade abnormal cytology.

Two years outcome of women infected with high risk HPV having normal colposcopy following low-grade or equivocal cytological abnormalities: are HPV16 and 18 viral load clinically useful predictive markers?

Management of patients infected with high-risk HPV (hrHPV) despite normal colposcopy following abnormal cytology remains a clinical challenge. The aim of this study was to evaluate if, in that specific population, initial HPV 16 and HPV 18 viral loads are predictive of infection clearance over a 24-month follow-up. A total of 67 women infected with hrHPV having normal colposcopy following equivocal or low-grade cytological abnormalities were recruited and attended regular follow-ups based on repeat colposcopies and HPV testing. HPV16 and HPV18 infection were diagnosed in 36 (53.7%) and 7 (10.4%) cases, respectively. Viral load was quantified using the quantitative duplex real-time PCR method. Although this was not observed for HPV 18, initial HPV 16 viral load was highly associated to HPV 16 infection outcome (receiver operating characteristic curve analysis, area under curve: 0.90). Thus, women who had cleared their HPV 16 infection had significantly lower median initial HPV 16 viral load than those with persistent HPV 16 infection: 1.5 × 10(3) copies per million cells (CPMC) versus 3.8 × 10(6) CPMC, respectively (P = 0.006). The best prediction of HPV 16 clearance was obtained with an initial HPV 16 viral load of <7.5 × 10(4) CPMC: 86.7% specificity and 85.7% sensitivity. Finally, six patients were diagnosed with grade 2 or 3 cervical or vaginal intraepithelial neoplasia. Although all had a persistent hrHPV infection, neither HPV 16 nor 18 viral loads were found to be predictive of the risk of cervical or vaginal intraepithelial neoplasia. HPV16 viral load quantitation could represent a clinically useful marker in that very specific population.

Uterine-sparing surgical management of postpartum hemorrhage: is it always effective?

PURPOSE: To further study the efficacy of uterine-sparing procedures based on triple uterine artery ligation (TUAL) possibly complemented with hemostatic multiple square suturing (HMSS) for the management of post-partum hemorrhage (PPH). METHODS: Cases of PPH occurring during cesarean section and treated, according to our institution guidelines, by TUAL possibly complemented with HMSS between 2000 and 2009 were retrospectively analyzed. RESULTS: Fifty-six patients were included; 13 (23.2%) had TUAL only, while 43 (76.8%) had additional HMSS performed. Surgical conservative management of PPH was effective in 51 (91.1%) cases. PPH due to placenta accreta, either unanticipated or after failure of conservative management, showed an independent and significant impact on the risk of failure of the procedure (AOR 15.07, 95% CI 1.12-201.9, p = 0.041). CONCLUSION: Obstetricians should be aware that a higher risk of failure of the procedure is to be expected in cases of PPH due to placenta accreta. In such situation, to avoid any useless delay in management, our findings suggest that peripartum hysterectomy should be immediately considered.

How to optimize excisional procedures for the treatment of CIN? The role of colposcopy.

PURPOSE: To evaluate the value of colposcopy during excisional treatment of cervical intraepithelial neoplasia (CIN). METHODS: Data from 469 women who underwent excisional treatment for CIN in three different hospitals between January 2005 and December 2009 were reviewed. Margins status and surgical specimen dimensions were analyzed according to the use of colposcopy during procedure. RESULTS: The rate of negative margins was not significantly different between women who had excision performed without colposcopic examination, with colposcopy immediately before excision and with direct colposcopic vision (DCV): 74 (62.2%), 186 (72.9%) and 25 (67.6%), respectively (p = 0.107). DCV allowed for significantly higher probability to achieve both negative margins and depth of specimen of less than 10 mm: 22 (18.5%) versus 70 (27.5%) versus 14 (37.8%), respectively (p = 0.039). In multivariate analysis, compared to women who had excision without any use of colposcopy, DCV allowed for significant and independent reduction in both depth (ß: -2.46; 95%CI: -4.45 to -0.47; p = 0.015) and diameter (ß: -4.80; 95%CI: -7.14 to -2.47; p < 0.001) of the surgical specimen. Compared to the use of colposcopy immediately before excision, DCV allowed for a significant and independent reduction in diameter of the surgical specimen (ß: -6.57; 95%CI: -8.78 to -4.35; p < 0.001) without significantly changing its depth (ß: -1.10; 95%CI: -3.01 to -0.80; p = 0.255). CONCLUSIONS: Use of colposcopy, and particularly of DCV during excisional procedures for CIN, allows for smaller surgical specimen without jeopardizing the margins status.

Failed early medical abortion: beware of the uterine scar!--Case report.

OBJECTIVES: To increase awareness of the possible existence of a morbidly adherent placenta in case of failed early medical abortion. CASE: We report a case of placenta increta which caused a massive haemorrhage during surgical aspiration following a failed medical abortion. CONCLUSION: Women with a history of caesarean section, who do not respond to a medical regimen for early termination of pregnancy should undergo an ultrasound examination to establish whether this may be due to a placenta accreta, increta or percreta.

Endometriosis and environmental factors: A critical review.

This review provides an overview of current knowledge on the relationship between various environmental factors and endometriosis. We successively searched for a given exposure factor combined with the word "endometriosis." The literature was comprehensively analyzed and summarized by quoting only the most important and recent studies on each exposition factor. The data focused primarily on endocrine disruptors, such as dioxins and polychlorinated biphenyls, that appear to have the strongest effect. Intriguing data suggest a link with night work, sun exposure and red meat consumption. For the other risk factors studied, particularly those related to lifestyle (tobacco consumption, alcohol, coffee, soy, physical exercise), the data are not sufficient to draw conclusions. In summary, the epidemiological evidence does not support a strong, scientific link between exposure to environmental factors and endometriosis. The complexity of this disease requires advanced study designs and standardized methodology. Future studies should be carefully designed to address these issues to advance our understanding of the impact of the environment and its consequences on endometriosis.

Evaluation of type-specific HPV persistence and high-risk HPV viral load quantitation in HPV positive women under 30 with normal cervical cytology.

The persistence of high-risk HPV (HR-HPV) infection is necessary for the development of cervical intraepithelial neoplasia. The aim of this study was to evaluate if HR-HPV typing and HPV16, 18, 31, and 33 quantitation are predictive for type-specific infection persistence and/or the development of CIN in women under 30 with normal cervical cytology. Young women (under 30) attending a family planning clinic who were HPV positive with normal cervical cytology were included. HPV genotyping was assessed by MY09/MY11 PCR, sequencing, phylogenetic analysis, and cloning when necessary. HR-HPV viral load was quantified using duplex real-time PCR. Study patients were offered for a second smear and HR-HPV detection and quantitation after 12 months. HR-HPV was identified in 43 (21.9%) of the 199 included women. Of these, 39 patients had a second cervical sample taken within a mean interval of 11.7 months (8.8-18.3 months). The mean HR-HPV 16, 18, 31, and 33 initial viral load was 1.9 × 10(6) copies/million cells. The level of viral load did not reveal any significant association with type-specific HR-HPV persistence or the subsequent development of cervical intraepithelial neoplasia. Only HPV16 infection was significantly more likely to persist (91.7% vs. 33.1%, P=0.001) and to develop CIN (33.3% vs. 3.7%, P=0.025). In women under 30 with normal cytology, HR-HPV viral load is common and is not predictive of HPV persistence or the development of cervical intraepithelial neoplasia. HPV16 positive women are significantly more likely to have persistent infection and to develop cervical intraepithelial neoplasia.

Gestational diabetes: a strong independent risk factor for severe neonatal respiratory failure after 34 weeks.

PURPOSE: To evaluate if gestational diabetes (GD) exposes neonates delivered after 34 weeks to an increased risk of severe neonatal respiratory failure (NRF). METHODS: Data from 3,237 women who delivered after 34 weeks with systematic screening for GD were analyzed. Diagnosis of severe NRF required the association of clinical and radiological criteria with a minimum of 24 h of ventilation and admission to neonatal intensive care unit. RESULTS: A total of 166 (5.1%) cases of GD were identified. Severe NRF was diagnosed in 7 (4.21%) cases among women with GD as compared to 13 (0.42%) in others (p < 0.001). The rate of severe NRF was also significantly higher in cases of premature delivery (p < 0.001), fetal growth retardation (p < 0.001), and cesarean section (p = 0.005). After adjustment for these variables, GD was identified as an independent risk factor for NRF (AOR 11.55, 95% CI 3.9-33.9, p < 0.001). Two other risk factors were also identified: late preterm delivery (AOR 6.13, 95% CI 1.8-21.2, p = 0.004); and hypotrophy (AOR 9.16, 95% CI 2.7-30.5, p < 0.001). CONCLUSIONS: GD is an independent risk factor for severe NRF after 34 weeks. Neonates from such pregnancies should be monitored carefully.

Objective assessment of obstetrics residents' surgical skills in caesarean: Development and evaluation of a specific rating scale.

OBJECTIVE: To develop a modified version of Objective Structured Assessment of Technical Skill (OSATS) rating scale for evaluation of surgical skills specific to caesarean and to assess its relevance in documenting the residents' learning curve during their training. Secondarily, to verify the scale's stability to caesarean's level of difficulty and comparing self-assessment to hetero-assessment in order to propose a practical application of this rating scale during residency. STUDY DESIGN: We conducted a multicentre observational prospective study, from May 2018 to November 2018. All residents at that time could participate and fill in the rating scale after caesarean. Senior surgeons had to fill in the same rating scale. We analysed correlation between self-assessments and hetero-assessments and sensitivity to change of the rating scale. Analysis of feature's relevance was performed by principal component analysis, factor analysis and reliability analysis. RESULTS: In total, 234 rating scales were completed evaluating 18 residents. Our study demonstrated that our rating scale could be used to evaluate surgical skills of residents during caesarean and distinguish their year of residency (p < 0.001) with a high correlation between self and hetero-assessment (Intraclass Correlation coefficient for global score: 0.78; 95% CI 0.68-0.86). The principal component analysis revealed two dimensions corresponding to the two parts of the rating scale and the factorial analysis allowed us to confirm distribution of features according to these two dimensions. Cronbach's alpha allowed us to highlight the percentage of representation of the scale's features in relation to all potential theoretical features (0.93, 95% CI 0.82-0.95). CONCLUSION: Our rating scale could be used for self-assessment during residency and as a hetero-assessment tool for validating defined stages of the internship.

Qualitative study of self-reported experiences of infertile women with polycystic ovary syndrome through on-line discussion forums.

OBJECTIVES: To highlight the self-reported experiences and disease perceptions of infertile women with polycystic ovary syndrome (PCOS). METHODS: A qualitative study using an inductive method was conducted on infertile women with PCOS who shared their self-reported experiences on French-speaking on-line forums. RESULTS: 785 comments by 211 women on 7 forums were analyzed. Women complained of late diagnosis and lack of information regarding PCOS. PCOS and infertility showed negative psychological impact on daily life. This impact appeared to be alleviated by the sharing of knowledge and experience enabled by these forums. CONCLUSION: The self-reported experience of infertile women with PCOS is interesting for health practitioners. The psychological impact of PCOS and perceptions of illness appear to be improved by sharing experiences between women with PCOS, suggesting a beneficial support role of online discussion forums.