Clinical profiles of placenta accreta spectrum: the PACCRETA population-based study.

OBJECTIVE: To describe and compare the characteristics of women with placenta accreta spectrum (PAS) and their pregnancy outcomes according to the presence of placenta praevia and a prior caesarean section. DESIGN: Prospective population-based study. SETTING: All 176 maternity hospitals of eight French regions. POPULATION: Two hundred and forty-nine women with PAS, from a source population of 520 114 deliveries. METHODS: Women with PAS were classified into two risk-profile groups, with or without the high-risk combination of placenta praevia (or an anterior low-lying placenta) and at least one prior caesarean. These two groups were described and compared. MAIN OUTCOME MEASURES: Population-based incidence of PAS, characteristics of women, pregnancies, deliveries and pregnancy outcomes. RESULTS: The PAS population-based incidence was 4.8/10 000 (95% CI 4.2-5.4/10 000). After exclusion of women lost to follow up from the analysis, the group with placenta praevia and a prior caesarean included 115 (48%) women and the group without this combination included 127 (52%). In the group with both factors, PAS was more often suspected antenatally (77% versus 17%; P < 0.001) and more often percreta (38% versus 5%; P < 0.001). This group also had more hysterectomies (53% versus 21%, P < 0.001) and higher rates of blood product transfusions, maternal complications, preterm births and neonatal intensive care unit admissions. Sensitivity analysis showed similar results after exclusion of women who delivered vaginally. CONCLUSION: More than half the cases of PAS occurred in women without the combination of placenta praevia and a prior caesarean delivery, and these women had better maternal and neonatal outcomes. We cannot completely rule out that some of the women who delivered vaginally had placental retention rather than PAS; however, we found similar results among women who delivered by caesarean. TWEETABLE ABSTRACT: Half the women with PAS do not have both placenta praevia and a prior caesarean delivery, and they have better maternal outcomes.

Pubo-femoral distance: an easy sonographic screening test to avoid late diagnosis of developmental dysplasia of the hip.

OBJECTIVES: To propose an easy and reproducible sonographic screening test able to avoid late presentation of developmental dysplasia of the hip (DDH). METHODS: The pubo-femoral distance (PFD) cut-off point was determined on 980 infants who underwent ultrasonography of the hips in comparison with the final diagnosis, based on clinical, ultrasound data and follow-up. PFD reproducibility was tested on 52 hips by both an experienced and an inexperienced radiologist. After teaching this screening method to general radiologists, its impact was evaluated by analysing the rate of late diagnosis in an entire administrative area. RESULTS: An abnormal PFD threshold above 6 mm gave a sensitivity of 97.4 % for the diagnosis of DDH (271 hips) and a specificity of 84 %. Sensitivity increased to 100 % when taking into consideration children of 1 month or older. The PFD measurement stayed reproducible even in inexperienced hands (k = 0.795). For 3 years, following the extension of screening to all female infants, there was no late diagnosis of DDH in girls in amongst a catchment area of 1 million inhabitants. CONCLUSIONS: PFD measurement with a threshold for abnormality of 6 mm at the age of 1 month, without asymmetry above 1.5 mm, could eradicate DDH late diagnosis.

Antenatal phosphodiesterase 4 inhibition restores postnatal growth and pulmonary development in a model of chorioamnionitis in rabbits.

Chorioamnionitis is implicated in the pathophysiology of bronchopulmonary disease, and the associated inflammatory response is responsible for adverse effects on alveolar development. The aim of this work was to analyze the effects of a phosphodiesterase 4 (PDE4)-selective inhibitor, rolipram (a modulator of the inflammatory response), in an experimental model of chorioamnionitis on pulmonary development and on the processes of infection and inflammation. Rabbit mothers were assigned to four groups: 1) saline serum inoculation (controls); 2) Escherichia coli intrauterine inoculation (C+); 3) rolipram infusion (R+); and 4) E. coli inoculation + rolipram infusion (C+R+). High rates of morbility and mortality were noticed in mothers and pups (5 of 13 pregnant rabbits in groups with rolipram). Alveolar development, inflammation, and infection were analyzed in pups at day 0 and day 5. At day 0, in the context of chorioamnionitis, rolipram significantly decreased birth weight (p < 0.01) relative to that of controls (p < 0.05). At day 5, weight normalized in group C+R+ but not in group C+ relative to controls (p < 0.001); moreover, alveolar airspace volume was preserved in group C+R+ but not in group C+ (p < 0.05). Interstitial volume decreased in group C+ versus controls (p < 0.05) but was preserved in group C+R+. Specific alveolar area was not significantly modified by rolipram. No significant difference was found concerning bronchoalveolar lavage cellularity, and all blood cultures remained sterile. In this model of impaired alveologenesis, rolipram significantly preserved specific alveolar density. However, PDE4 inhibition induced antenatal fetal demise and growth retardation.

Experiences of parents and caregivers in pediatric intensive care units: A qualitative study.

BACKGROUND: In pediatric intensive care units (PICUs), parents and healthcare professionals attend to children who verbally and non-verbally express their pain and suffering, fears, anxieties, desires, and wishes in complex intensive care situations. What can we learn from these experiences to improve the way we can take care of and support children? OBJECTIVES: The main objective of this clinical ethics study was to focus on the experience stories of parents during their child's hospitalization in a PICU, to analyze their discourse, and to propose an ethical perspective. METHOD: The current research collects the experience reports of parents during their child's hospitalization in a PICU and those of the caregivers who treated them. A total of 17 semi-directive interviews were conducted in the PICU of the Nantes University Hospital from November 2017 to June 2019. Each interview lasted around 1 h. The main results of our study are analyzed and informed by the four ethical principles of T. Beauchamp and J. Childress: autonomy, beneficence, non-maleficence, and justice. RESULTS: The interviews highlighted the difficulties encountered by parents during the hospitalization of their children, such as the distance between their home and the hospital, the technicality of PICU environment, and the difficulty in finding their place as parents. For medical and paramedical teams, their main concerns are undoubtedly to improve the coherence and continuity of their stand toward parents, to promote parental autonomy, and to remain fully aware of the profound existential changes that the child's illness brings about for parents: It is the caregivers' duty to take this into account and to respect the parents' rhythm as much as possible. CONCLUSIONS: The main disagreements between healthcare teams and parents, where they exist, are communication problems that are easily controlled, for the most part, by caregivers.

[Copper-containing intrauterine device (cIUD): Comparison of tolerance and efficacy in nulliparous and parous women over 6 months]. / Dispositif intra-utérin au cuivre (DIUc) : comparaison de la tolérance et de l'efficacité chez des nullipares et des multipares sur 6 mois.

INTRODUCTION: The copper-containing intra-uterine device IUD (cIUD) is a non-hormonal, effective, long-acting method of contraception, which is not widely used in nulliparous patients in France. The objectives of the study are to compare the safety of the cIUD by the rate of continuation at 6 months between nulliparous and parous patients, and to assess the complications and side effects at insertion and during follow-up. Material and method This is a multicenter prospective epidemiological study with follow-up for 6 months. The adult patients were included in Nantes from February 2019 to October 2019 during the insertion of a IUD in different centers: the student health service (SUMPPS) (Nantes), the Clotilde de Vautier center in the Clinic Jules Verne (Nantes) and in the gynecological offices of the city of Nantes. RESULTS: A total of 94 patients were included during the insertion of the cIUD. At 6 months, 77 patients answered the second questionnaire, 49 patients were nulliparous and 28 were parous. The pain on insertion was greater in nulliparous patients with a VAS of 6.5±2.4 (0-10) versus 3.9±2.2 (0-8) for multiparous patients (P<10-4). The 6-month continuation rate for the cIUD was 92.8% for 83.4% for nulliparous patients, and parous patients with no significant difference (P=0.25). Expulsion was the only complication found with 12.2% in nulliparous and 3.5% in parous (P=0.40). Otherwise, 64% of the patients observed heavy bleeding than before without difference with the parity, and 72% of the nulliparous declared to have dysmenorrhea requiring the use of analgesics, against 47% of the parous (P=0.025). The nulliparous were very satisfied or satisfied for 89% in daily life and 96% of them in sex life, without difference compared to parous (97% and 100% respectively). CONCLUSION: There is no difference in the rate of continuation at 6 months between nulliparous and parous. Nulliparous complained more often of dysmenorrhea in comparison to the period before the cIUD. The satisfaction rates were comparable.

Description of 101 cases of nipple cracks and risk factors via case-control study in eight units of a perinatal network.

Nipple crack are a frequent complication of breastfeeding, causing pain for the mother and feeding difficulties for the baby with the risk of early cessation of breastfeeding. The characteristics of nipple cracks have rarely been described. Treatment varies according to the period of breasfeeding and the maternity ward. Eight maternity wards in a perinatal health network in western France followed up maternal nipple cracks. The cracks were described and their treatment was noted. The variables regarding the mothers, delivery conditions, health of newborns, and their ability to breastfeed were analyzed. Each case patient was matched with a control patient who was in a room adjacent to the case patient. Case-control analysis was univariate, followed by multivariate analysis via logistic regression (SPSS 20.0) with adjusted odds ratios (aOR). In all, 101 cases of women with nipple cracks were studied. The cracks were predominantly located in the upper external quadrants as well as in the central part of the nipple. There were no lateralization effects (right or left). The most frequent treatments after breastfeeding were oils, hydrophilic gel, and maternal milk. Compared with the 101 controls without cracks, the features associated with cracks in multivariate analysis were fair skin (aOR=1.92 [1.01-3.60]; P=0.04), history of nipple cracks (aOR=11.38 [3.69-35.13]; P=0.0001), first breastfeeding (aOR=4.21 [1.27-13.86]; P=0.018), and normal weight or no obesity (aOR=0.33 [0.14-0.75]; P=0.008). Two more specific analyses were performed in primiparous and multiparous women. In conclusion, the practitioners learned to describe nipple cracks and analyze their treatments. Knowledge of the risk factors should enable practitioners to propose active prevention to mothers with fair skin, a history of cracks, or a lack of experience in breastfeeding by helping them to breastfeed during the first days of their infant's life, especially for primiparous and overweight or obese women.

[Fetal version by acupuncture (moxibustion) versus control group]. / Etude comparative de la version foetale par acupuncture (moxibustion) versus groupe témoin.

OBJECTIVE: Breech delivery is known to increase maternal and fetal morbidity. Several methods have been suggested to increase the rate of fetal reverse. The aim of this study was to assess the efficacity of acupuncture or more exactly moxibustion at the 34th AW to increase the rate of fetal reverse. MATERIALS AND METHODS: Clinical trial over 68 major pregnant women, adjusted on parity, whose fetus was in breech presentation at the 8th month. They were randomised to receive or not the treatment. It is the first randomised clinical trial performed on this subject in France, from January 1st 2006 to April 30th 2008. RESULTS: The rate of fetal reverse is not statistically higher with moxibustion for the primipara (7/19 versus 6/19) and for the multipara (9/14 versus 11/19). CONCLUSION: Moxibustion, such as performed in this trial, has not modified the fetal rate reverse either on primipara or on multipara.

Breastfeeding and early childhood caries. Review of the literature, recommendations, and prevention.

CONTEXT: Early childhood caries is a chronic disease that affects a child's general state of health. The question of a link between primary tooth caries and breastfeeding has been addressed for many years, with contradictory results. The concomitant decay of primary teeth, effective establishment, or not, of oral hygiene, and alimentary diversification away from breastfeeding are all confounding factors in this topic. The aim of our study was to analyze the links between breastfeeding and the appearance of caries, as described in the scientific literature and in the recommendations of specialist societies. METHODS: A review of publications written in English and French was carried out, searching for the terms early childhood caries, decay and breastfeeding, focusing on literature reviews and meta-analyses dating from the past 10 years. The PubMed database of the US National Library of Medicine National Institutes of Health (NBCI) was used. Furthermore, a review of specialist dental and pediatric societies was conducted. RESULTS: Breastfeeding until the age of 1 year is not associated with an increased risk of dental caries, and may even provide protection compared with feeding with formula milk. By contrast, infants who are breastfed beyond the age of 12 months demonstrate an increased risk of caries. However, the results derive from heterogeneous studies that do not always take into account contradictory factors such as eating habits of the mother or infant (feeding during the night, number of meals per day, eating sweet foods etc.), dental hygiene, or the sociocultural context. Moreover, the most recent recommendations of pediatric and dental societies advise breastfeeding until the age of 2 years, suggesting that this be accompanied by toothbrushing and better nutrition by reducing the frequency and consumption of sugary foods, aimed at helping parents choose prolonged breastfeeding. CONCLUSION: Extended breastfeeding is a protective factor for childhood caries under 1 year of age. Beyond 1 year, it is difficult to conclude between protection and aggravation of caries because of the multiplicity of confounding factors such as dietary patterns, which vary depending on countries and families, and problems of oral hygiene. In practical terms, when breastfeeding continues beyond 1 year, consultation with a dentist is necessary for examination and preventive advice regarding dietary practices (especially sugar intake), oral hygiene, or supplementary fluoride.

[Validation of the cervical length education and review program in a population of French residents in obstetrics and gynecology]. / Intérêt d'une formation théorique des internes de gynécologie obstétrique à la mesure échographique du col utérin.

OBJECTIVES: Evaluate an educational program based on "CLEAR" (Cervical Length Education and Review) in the teaching of measuring sonographic cervical length to residents in gynecology and obstetrics. METHODS: This is a prospective cohort study in a tertiary care center between May and November 2017. The residents were asked to collect 5 cervical length images from patients suspected with threatened preterm labor. A theoretical session on cervix measurement image criteria based on "CLEAR" program was taught to all residents. Then, they had to collect 5 new cervical length images. All the images were reviewed by two experienced reviewers, blinded to the resident and whether the image was obtained before or after the theoretical session and based on 8 criteria. RESULTS: Ten residents participated to the study. The mean total score CLEAR was significantly higher post-intervention: 6.6±0.9 vs. 4.3±2.1, positive difference of 2.3±2.3 (P<0.001). Improvement was most significant with the junior residents: 3.6 pre vs. 6.5 post-intervention. CONCLUSION: Educational program based on CLEAR criteria allowed to improve the competence of residents in measuring sonographic cervical length, although this can also be correlated with the progression of residents during the semester. It could be implemented systematically with the aim of CLEAR certification to standardize the teaching of residents in gynecology and obstetrics.

Miss rate for colorectal neoplastic polyps: a prospective multicenter study of back-to-back video colonoscopies.

BACKGROUND AND STUDY AIM: Polyp miss rates during colonoscopy have been calculated in a few tandem or back-to-back colonoscopy studies. Our objective was to assess the adenoma miss rate while limiting technique or operator expertise biases, i. e. by performing a large multicenter study, with same-day back-to-back video colonoscopy, done by two different operators in randomized order and blinded to the other examination. PATIENTS AND METHODS: 294 patients at 11 centers were included. Among the 286 analyzable tandem colonoscopies, miss rates were calculated in both a lesion- and patient-based analysis. Each of these rates was determined for polyps overall, for adenomas, and then for lesions larger than 5 mm, and for advanced adenomas. Univariate and logistic regression analysis were performed to define independent variables associated with missed polyps or adenomas. RESULTS: The miss rates for polyps, adenomas, polyps > or = 5 mm, adenomas > or = 5 mm, and advanced adenomas were, respectively, 28 %, 20 %, 12 %, 9 % and 11 %. None of the masses with a carcinomatous (n = 3) or carcinoid component (n = 1) was missed. The specific lesion miss rates for patients with polyps and adenomas were respectively 36 % and 26 % but the corresponding rates were 23 % and 9.4 % when calculated for all 286 patients. The diameter (1-mm increments) and number of polyps (> or = 3) were independently associated with a lower polyp miss rate, whereas sessile or flat shape and left location were significantly associated with a higher miss rate. Adequacy of cleansing, presence of diverticula, and duration of withdrawal for the first procedure were not associated with adenoma miss rate. CONCLUSIONS: We confirm a significant miss rate for polyps or adenoma during colonoscopy. Detection of flat polyps is an issue that must be focused on to improve the quality of colonoscopy.

[Premature rupture of membranes before 32 weeks of gestation: prenatal prognosis factors]. / Rupture prématurée des membranes avant 32 semaines d'aménorrhée: facteurs pronostiques prénatals.

OBJECTIVE: Premature preterm rupture of membranes (PPROM) accounts for a significant part of overall perinatal mortality and morbidity. This study aims to define potential prognostic factors for neonatal outcome. PATIENTS AND METHODS: One hundred and thirty-one pregnancies complicated with PPROM at between 26 and 32 weeks were retrospectively reviewed over a three-year period. The influence of chorioamnionitis on perinatal morbidity and mortality was assessed using a composite outcome. RESULTS: On admission, gestational age (GA) at diagnosis, fetal heart rate anomalies and increasing severity of clinical features of chorioamnionitis were significantly related with an adverse outcome. Significant factors associated with a favourable outcome were an administration of steroids for lung maturation, prophylactic antibiotics and tocolytic therapies. Stratifying according to GA at PPROM, the survival rates were 43 and 52% at before 22 weeks and between 22 and 26 weeks respectively. The prognosis dramatically improved after 26 weeks with an 84.6% rate of survival without impairment. Although this rate reached 97.5% after 30 weeks, there was no statistical evidence supporting any benefit to prolong pregnancies beyond this point. The complete expression of chorioamnionitis independently increased the mortality rate by 41% (OR=1.41; 95% CI [0.99-2.01]. Overall, the most relevant factor was GA at delivery, levelling the prognostic value of GA at diagnosis. DISCUSSION AND CONCLUSION: If no consensus rules PPROM at the moment, the most efficient prognosis factor before 34 weeks is mostly determined by GA at delivery.

[Cesarean after labor induction: Risk factors and prediction score]. / Césarienne après déclenchement du travail : facteurs de risque et score de prédiction.

OBJECTIVES: The objective of the study is to determine the risk factors for caesarean section at the time of labor induction, to establish a prediction algorithm, to evaluate its relevance and to compare the results with observation. METHODS: A retrospective study was carried out over a year at Nantes University Hospital with 941 cervical ripening and labor inductions (24.1%) terminated by 167 caesarean sections (17.8%). Within the cohort, a case-control study was conducted with 147 caesarean sections and 148 vaginal deliveries. A multivariate analysis was carried out with a logistic regression allowing the elaboration of an equation of prediction and an ROC curve and the confrontation between the prediction and the reality. RESULTS: In univariate analysis, six variables were significant: nulliparity, small size of the mother, history of scarried uterus, use of prostaglandins as a mode of induction, unfavorable Bishop score<6, variety of posterior release. In multivariate analysis, five variables were significant: nulliparity, maternal size, maternal BMI, scar uterus and Bishop score. The most predictive model corresponded to an area under the curve of 0.86 (0.82-0.90) with a correct prediction percentage ("well classified") of 67.6% for a caesarean section risk of 80%. CONCLUSION: The prediction criteria would make it possible to inform the woman and the couple about the potential risk of Caesarean section in urgency or to favor a planned Caesarean section or a low-lying attempt on more objective, repeatable and transposable arguments in a medical team.

[Comparison of obstetric prognosis of attempts of breech delivery: Spontaneous labor versus induced labor]. / Comparaison du pronostic obstétrical des tentatives d'accouchement par le siège : travail spontané versus déclenchement.

OBJECTIVES: Delivery mode in breech presentation (BP) is often controversial. Spontaneous labor, when vaginal birth seems safe, allows to better estimate uterus contractility, fetus' accommodation to maternal pelvis and optimize monitoring with a partograph. Induced labor in BP was usually contra-indicated. Lack of strong scientific evidence on this matter has permitted a progressive and careful evolution in obstetrical management, with the introduction of induced labor in BP. The aim of our study is to compare vaginal birth rates when labor is induced versus when spontaneous in BP. Maternal and fetal morbidity and mortality parameters were also evaluated. METHODS: In this retrospective study were included 206 patients carrying fetuses in BP, between June 2012 and June 2017. 182 of them had spontaneous labor and 24 experienced induced labor. Inclusion criteria were singleton pregnancy, BP after 34 weeks of gestation and vaginal delivery authorized by a senior obstetrician. Multiple pregnancy, birth before 34 weeks of gestation, uterine scar, planned caesarian section for BP, intra-uterine fetal death and medical termination of pregnancy were excluded. Induction of labor was performed for medical reason on a favorable cervix. RESULTS: There was no significant difference in cesarean section rates between the two "induced" and "spontaneous" labor groups in BP (OR=1.69 [CI95%: 0.71-4.04]). We observed no difference between the two groups in neither perineum trauma nor post-partum hemorrhage. No difference was found between the two groups in rates of Apgar score<7 5minutes after birth, neonatal transfer, fetal trauma and pH at birth. CONCLUSION: Despite our small population, it seems acceptable to propose induced labor for medical reason if cervix is favorable in BP if a protocol is available stating acceptability criteria for vaginal birth. It can avoid unnecessary caesarian section and allow better obstetrical outcome. It would be interesting to study fetal and maternal morbidity and mortality criteria in induced labor versus planned cesarean section when patients could be eligible for induced labor in BP.

[Longitudinal evaluation of pulmonary function tests in children with newborn screening for cystic fibrosis. Relationships with pulmonary infection. Study of 40 children undergoing 744 pulmonary function tests]. / Evolution des épreuves fonctionnelles respiratoires (EFR) chez des enfants atteints de mucoviscidose et dépistés à la naissance. Lien avec l'infection pulmonaire. Etude sur 40 enfants et 744 EFR.

OBJECTIVES: To report longitudinal assessment of pulmonary function in children with neonatal screening for cystic fibrosis and its relationships with Pseudomonas aeruginosa (PA) chronic infection, nutritional status, sex, age and genotype. POPULATION AND METHODS: Children benefited systematically of 3 visits a year with pulmonary function tests (PFT) and bacteriological examination. Forty children and 744 PFTs were analysed, with 38 children during at least 4 years. RESULTS: We reported a decrease of pulmonary function tests with chronic PA infection and the genotype DeltaF508/DeltaF508. The decline was gradual and not different between not infected and recently infected children. The PFTs of children infected for a long times were very deteriorate, probably due to the fact that they were infected with multiresistant strains of PA. CONCLUSION: We think that it is important to survey pulmonary function before 5 years old in these early infected children. We should determinate if the important decrease of PFT in these early infected children is due to infection by PA mucoid.

[Follow-up network for newborns at risk for handicap in a French region]. / Réseau de suivi des nouveau-nés à risque de développer un handicap. L'expérience du réseau de suivi régional << grandir ensemble en Pays de la Loire >>.

BACKGROUND AND OBJECTIVES: - Follow-up networks for newborns with a handicap risk need to be put into place downstream of the perinatal health networks. Such a network was implemented in the Pays de la Loire region in 2003. Our objective is to evaluate the feasibility and the capacity to detect infants with an incapacitating condition at nine months corrected age and the patents'satisfaction with such a network. MATERIAL AND METHODS: - A common tool based on the Amiel Tison assessment was set up. Infants included since 1(st) March 2003 and who were two years old corrected age on 1(st) September 2006 were taken into consideration. A satisfaction survey was conducted with the parents of infants showing normal development at two years old corrected age or with an abnormal neuromotor examination. RESULTS: - Amongst the 1339 infants included, 1185 (88.4 %) were seen at the age of two years: 7.3 % showed pathological development, 4.5 % infants showed suspect neuromotor examination. Cares were proposed for 11% of the infants followed, permitting cares from nine months old for 65 % of the infants considered as having a pathological development at the age of two years. DISCUSSION/CONCLUSION: - This follow-up network has fulfilled its initial goal: 2.2 % of newborn babies in the region were included, a low rate of lost for follow-up was observed. Moreover, this network has a relative good capacity for detection and early initiation of care. The application of the parents is important and their level of satisfaction appeared to be high. This experiment shows that regional follow-up networks can become reality, but their efficiency still needs to be improved.

[Eleven cases of early neonatal sudden death ou near death of full term and healthy neonates in maternity wards]. / Onze cas de malaises graves de nouveau-nés à terme et présumés sains dans les premières heures de vie.

OBJECTIVE: Sécurité naissance-Naître ensemble des Pays-de-la-Loire network organized a survey to evaluate the incidence rate of early neonatal sudden death or near death syndrome for the full term and healthy presume neonates. METHOD: Maternity wards are declared apparent life-threatening events and deaths from 2001 to 2006. Certain cases and probable cases were defined. Incidence rate have been calculated with births in maternity wards during period... RESULTS: Eleven apparent life-threatening events are observed with 7 deaths during five and half years. The incidence rate was one apparent life-threatening events for 26,000 births and one death for 40,000 births, with certain cases for 41,000 births and probable cases for 71,000 births. All kind of maternities were involved. Nothing very special could be noticed about pregnancies and deliveries. Five times on eight well known cases, the newborn was in skin to skin contact with heir mother at the moment of the event, once in her arms and once in the delivery room, far from the mother, at three minutes of life. Twice on four well known cases, newborns were lying on their belly. A baby has been considered as dead at the maternity, ten have been transferred to care unit, and six died in the ward. CONCLUSION: Without systematic survey in France, it's not easy to say if the incidence of this type of event have increased, and if their happening is linked with skin-to-skin practices at the birth. In Sécurité naissance-Naître ensemble des Pays-de-la-Loire from September 2006, prevent measures have been suggested in all maternities in the recommendation on care to normal newborns. A systematic study with a standard questionary has been organized in region area to notice apparent life-threatening events and neonatal sudden deaths, and we could hope a systematic prospective survey in France.

[Epidemiology of anti-D allo-immunization during pregnancy]. / Epidémiologie de l'allo-immunisation anti-D pendant la grossesse.

The number of women exposed to a risk of anti-D allo-immunization who require care depends on the number of pregnancies, the distribution of blood groups in the Rhesus D system, and the number of allo-immunization risk situations as well as the chosen prevention protocol. In 2004, there were 790,000 pregnancies in metropolitan France. The total number of conceptions (adding abortions, voluntary interruptions, ectopic pregnancies and in utero fetal deaths) would be to the order of 1,100,000 to 1,200,000. Since 15% of the French population is RhD-negative, 15% of pregnant women or women who have delivered are RhD-negative, which would correspond to 160,000 to 180,000 women exposed to a risk of anti-D allo-immunization. Two strategies could be evaluated: prevention targeting risk factors and systematic prevention from 28 weeks gestation. Both strategies involve treatment with anti-D anti-globulins to RhD-negative women with an RhD-positive newborn. Targeted prevention would involve 160,000 to 190,000 doses for 130,000 to 150,000 women. The systematic approach would consist in 300,000 to 340,000 doses for 250,000 to 280,000 women. This number could be lowered by reserving treatment for women with a RhD-positive partner (210,000 to 230,000 doses for 260,000 to 290,000 women), but this would require a precise contract between the physician and the woman. Another way to reduce the number of doses would be to determine the Rh group of the fetus either by ovular samples or by genotyping on maternal blood. This would give about 200,000 to 220,000 doses for 240,000 to 270,000 women. In light of the literature, the systematic protocol would probably reduce the number of immunized women, the current estimation being 700 women still immunized in France and the goal being a reduction to a residual 200. The number of infants at risk of in utero maternal allo-immunization (fetal death, anasark, anemia) or after birth (jaundice, severe anemia) is not known in France and could be the cause of a few deaths with involvement of about a hundred children. In light of experience in other countries, the systematic protocol would enable avoiding a certain number of these deaths.

[Accidental exposure to blood by midwives in French maternity units: results of the national surveillance 2003]. / Les accidents d'exposition au sang chez les sages-femmes dans les maternités françaises: résultats de la surveillance nationale en 2003.

OBJECTIVE: Midwives appear to be the health care workers exposed to the highest rates of bloodborne injury. In this paper - based on a national survey - we describe the bloodborne injuries occurring in this profession. MATERIAL AND METHOD: During the year 2003, 241 hospitals took part in a national survey of bloodborne injuries. Employees registered anonymous standardized reports of bloodborne events with the Occupational Medicine Unit. The data were processed by the coordination center for the fight against nosocomial infections (C. CLIN) which is in charge of the national analysis of all the events reported in this database. RESULTS: 169 of the 6973 bloodborne events reported during 2003 (2.4%), were signed by midwives or midwife students. The first three most frequent accidents reported were: ocular projections during childbirth, pricks when repairing episiotomy, pricks or cuts when handling soiled instruments. CONCLUSION: Improving knowledge of risk as well as promotion of protection/prevention measures well adapted to this profession should be helpful in optimizing future attitudes.

[Central-venous-catheter-related bacteremia in neonatalogy]. / Bactériémies nosocomiales sur cathéters veineux centraux en néonatologie.

OBJECTIVE: The aim of this retrospective study was to identify the risk factors for catheter-associated bloodstream infection (CABSI) in neonates. METHOD AND RESULTS: Fifteen episodes of CABSI occurred in 108 central catheters over a period of one year (2002). The univariate analysis risk factors were birth weight (1.064 vs 1.413 g; P<0.001), gestation age (28 vs 31 weeks; P<0.001), blood transfusion (8/15 vs 3/34; P<0.01), corticosteroids (7/15 vs 3/34; P<0.01), nasal CPAP duration (13.6 vs 2 days; P<0.01). Nasal CPAP duration was the only risk factor independently associated with CASBI (OR=1.2, 95% confidence interval=1.09-1.5) in the multivariate logistic regression analysis. CONCLUSIONS: The risk of infection associated with low birth weight is multifactorial suggesting that host-related factors are important. Prevention remains difficult and a policy of strict aseptic catheter care must be promoted.

[Survey of 319 women satisfaction using abortion in centers of Pays de la Loire in France]. / Enquête de satisfaction de 319 femmes ayant eu recours aux centres d'IVG dans les Pays de la Loire.

CONTEXT: Perinatal network the "Security birth" Pays de la Loire (RSN), in collaboration with the regional network "Sexual health" (RRSS) organized a satisfaction survey in 2014 among women who had an induced abortion in the centers in Pays de la Loire. The objective of the study is to evaluate the satisfaction of women who resort to abortion centers, study the factors and propose actions for improvement. METHODS: A questionnaire, developed with professionals, was offered to women after the end of the abortion act. The scales of satisfaction were based on Likert scales to 4 degrees. They were collected for the period of contact centers, for the abortion itself, and overall. Data were collected on the civil status, the care pathway to get to the abortion center, features centers and professionals met, acts anesthesia and end of abortion, wait times and overall satisfaction of women. The women with rather poor satisfaction were compared with other women by univariate analysis with odds ratios (OR) and multivariate with adjusted odds ratios (ORa). RESULTS: Of the 18 centers, 13 participated and 319 responses were analyzed. The abortions were performed on average 8±SA 2. Among the methods, 40.1 % were drug, and 59.9 % with anesthesia (14.0 % with general anesthesia [AG] and 45.9 % under local anesthesia [AL]). The first contacts on average to 5.7 SA were mostly general practitioners (38 %), then the abortion centers directly (22 %), and planning centers (16 %). The information was considered clear (94 %), the appropriate orientation (97 %), with respect to the application (98 %). The first meeting at the center was done 7 days after the call (6.7 SA), and met women overall. The abortion was performed 16 days after the first call center (8.0 SA) with satisfaction by field 78 % (waiting time) to 98 % (confidentiality, privacy…). The overall satisfaction rate was 89.0 % and 8.2 % were not satisfied. Factors related to the non-satisfaction in multivariate analysis were the least easy access to the center (ORa=0.31 [.11 to 0.86; p=0.02]), pain perceived≥4 (ORa=3 50 [1.32 to 9.28], p=0.02), the lack of explanation (ORa=0.23 [0.05 to 0.97]; p=0.04), and the accompanying inability (ORa=0.27 [0.10 to 0.70], p=0.007). Finally, 12.6 % of women reported for improvement with clear remarks. DISCUSSION: This is the first regional survey on the satisfaction of women resorting to abortion. Delays from the first contact are satisfactory and show no organizational problem. The various dimensions of satisfaction showed a high satisfaction rate in the 13 participating centers. The least satisfactory factors are related to organizational problems (waiting circuits especially trips to the operating room and maternity) and problems related to the care itself (not enough explanations, reduced ability to reassure and support Savory absence, lack of choice of the method of anesthesia, pain experienced). Five areas for improvement have been proposed to the care-givers of the centers.