RESUMO
We describe the administration of antenatal corticosteroid therapy (ACT) for liveborn very preterm neonates in a population-based study. A total of 790 very preterm neonates (between 24 and 31 full weeks of gestation) were included in this regionally defined population of very preterm neonates in France. The main outcome measure was non-access to ACT. Data were analysed using logistic and polytomous models to control for neonatal and sociodemographic characteristics, mechanisms of very preterm birth and neonatal network organisation. As compared with level III, births in levels I-II maternity units were closely related to non-access to ACT (60.1% vs. 8.8%), but not to pregnancy follow-up (19.7% vs. 17.8%). Only 6.3% of very preterm neonates that benefited from antepartum referral did nor receive ACT. Births associated with rupture of membranes and gestational hypertension were significantly more often transferred to level-III units (73.8% and 68.3% respectively) than those due to maternal bleeding and spontaneous labour (57.0% and 50.7% respectively), and the neonates had a lower probability of not receiving ACT (8.5%, 11.5%, 23.0%, 31.2% respectively). Very preterm neonates referred in utero to a level-III unit came from a more favourable socio-economic environment. Non-access to ACT was more often observed in neonates born to 14- to 24-year-old mothers, smokers, of low socio-economic status, and preterm birth resulting from maternal bleeding or spontaneous labour. These data from a French regional study show that access to ACT is not only explained by practitioners' support of recommendations. In our population-based study, ACT access was related to socio-economic factors and to the mechanisms of very preterm birth. Improving the rate of access to ACT should take these organisational, medical and socio-economic dimensions into account.
Assuntos
Corticosteroides/uso terapêutico , Acessibilidade aos Serviços de Saúde , Doenças do Recém-Nascido/prevenção & controle , Recém-Nascido Prematuro , Adolescente , Corticosteroides/provisão & distribuição , Adulto , Fatores Etários , Estudos de Coortes , Feminino , França , Humanos , Recém-Nascido , Modelos Logísticos , Serviços de Saúde Materna/normas , Pessoa de Meia-Idade , Gravidez , Fatores de Risco , Fumar , Fatores Socioeconômicos , Adulto JovemRESUMO
INTRODUCTION AND HYPOTHESIS: The aim was to assess the efficacy of three-compartment pelvic organ prolapse (POP) vaginal repair using the InteXen biocompatible porcine dermal graft as compared to traditional colporrhaphy with sacrospinous ligament suspension. METHODS: Preoperative, operative, postoperative and follow-up data were collected retrospectively. Objective recurrence was defined as POP quantification >or= stage II and subjective recurrence as a symptomatic bulge. RESULTS: Each group consisted of 63 patients. Surgery time was longer using InteXen (72 +/- 24.5 vs 55 +/- 23.5 min, p = 0.0002). Length of hospital stay (4.6 +/- 1.6 vs 4.9 +/- 2.1 days, p = 0.34) as well as duration of follow-up (37.1 vs 35.7 months, p = 0.45) were equivalent between the two groups. No case of mesh erosion or infection was noted. The objective (17% vs 8%, p = 0.12) and subjective recurrence rates (13% vs 5%, p = 0.12) between the two groups were not statistically different. CONCLUSIONS: InteXen was well tolerated but had similar efficacy to traditional colporrhaphy and sacrospinous ligament suspension.
Assuntos
Bioprótese , Derme/transplante , Procedimentos Cirúrgicos em Ginecologia/métodos , Prolapso de Órgão Pélvico/cirurgia , Vagina/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Desenho de Prótese , Recidiva , Resultado do TratamentoRESUMO
OBJECTIVE: The aim was to study the predictive value and feasibility of fetal scalp lactate microsampling in the management of non-reassuring fetal status during labor. METHODS: A prospective observational study was conducted on cord blood gas samplings from 7,617 singleton and cephalic deliveries at > or =37 weeks of gestation. In this population, 450 fetal scalp blood samples (FBS) were performed for abnormal fetal heart rate (FHR) patterns. Microvolume scalp lactate measurements were compared to scalp pH, neonatal cord blood gas parameters (pH, lactate, base deficit) and the Apgar score. RESULTS: Scalp lactate correlated significantly with scalp pH (r = -0.56, p = 0.001), umbilical artery pH (r = -0.39, p = 0.03), umbilical artery lactate (r = 0.48, p = 0.01) and umbilical artery base deficit (r = 0.51, p = 0.01), but not with Apgar scores. Using receiver operating characteristic curves, a scalp lactate cutoff value of 5 mmol/l was the most predictive for neonatal acidosis. Sampling failure with scalp lactate was inferior to scalp pH (1.3 vs. 14%, p < 0.001). CONCLUSION: Lactate microsampling in fetal scalp blood was found to be an attractive alternative to pH analysis and a useful 2nd-line tool for monitoring fetal asphyxia during labor.
Assuntos
Asfixia Neonatal/diagnóstico , Ácido Láctico/sangue , Adulto , Feminino , Frequência Cardíaca Fetal , Humanos , Concentração de Íons de Hidrogênio , Recém-Nascido , Trabalho de Parto , Valor Preditivo dos Testes , Gravidez , Estudos Prospectivos , Couro Cabeludo/embriologiaRESUMO
We report a case of abdominal eventration associated with cystic fibrosis, diagnosed by mid-trimester ultrasonography. The defect concerned the abdominal muscles and their aponevrotic sheath, but respected the skin. There was no associated malformation. The outcome was favorable after surgery, and the infant is well at the age of 6 months.
Assuntos
Parede Abdominal/anormalidades , Parede Abdominal/diagnóstico por imagem , Feto/anormalidades , Diagnóstico Pré-Natal/métodos , Adulto , Feminino , Doenças Fetais/diagnóstico , Doenças Fetais/diagnóstico por imagem , Humanos , Recém-Nascido , Gravidez , UltrassonografiaRESUMO
BACKGROUND: An increasing number of patients with early-stage breast cancer is being diagnosed by way of population-wide mammographic screening in women. Because breast-conservation therapy (BCT) is the standard treatment, the aim of our study was to determine factors predisposing patients to re-excision for pT1 tumors. METHODS: A retrospective study was conducted at Besancon University Hospital in France. Patients with pathologic diagnosis of invasive breast carcinoma <20 mm in size (pT1) and undergoing BCT were selected. From these, "no-re-excision" and "re-excision" subgroups were constituted and compared in terms of patient and tumor characteristics. The intent of all surgeries was therapeutic. RESULTS: Of 206 patients who underwent BCT for pT1 tumors, 84 (41%) needed re-excision. After multivariate analysis, factors predicting re-excision were the absence of positive histologic diagnosis before surgery (P <.0001), limited superficial and deep surgical resection (P <.0001), multifocal lesion (P <.0001), and size of the in situ carcinoma (P <.0001). CONCLUSIONS: These predictive factors could be useful in reducing the rate of re-excision as well as in identifying patients with multifocal tumors and/or extensive in situ carcinoma whose disease would be better managed by mastectomy.
Assuntos
Neoplasias da Mama/cirurgia , Mastectomia Segmentar , Idoso , Neoplasias da Mama/patologia , Feminino , Humanos , Pessoa de Meia-Idade , ReoperaçãoRESUMO
The aim of this study was to define the anatomical relationships of the uterosacral ligament complex (USLC) and to analyze histologically its content. Three fetal and four adult cadavers were used. Anatomical dissections were carried out. Eight fresh biopsies (four fetal and four adult) of the USLC were analyzed histologically and immunohistochemically. Specimens were stained with hematoxylin eosin safran coloration, with anti-nervous cell antibodies (PS 100) and with anti-smooth muscle antibodies (to visualize vessel walls). By removing the visceral pelvic fascia, nervous fibers were found within the USLC forming the hypogastric plexus. Histologically, the USLC contained connective tissue, nervous fibers, sympathetic nodes, vessels, and fatty tissue. No structured ligamentous organization was identified. The uterosacral "ligament" is a "complex" integrating connective tissue as well as nervous and vascular elements. Radical excisions and USLC suspension during pelvic floor reconstructive surgery should be performed with caution in order to preserve pelvic innervation.
Assuntos
Vasos Sanguíneos/citologia , Feto/anatomia & histologia , Plexo Hipogástrico/citologia , Ligamentos/citologia , Plexo Lombossacral/citologia , Região Sacrococcígea/anatomia & histologia , Útero/citologia , Idoso , Idoso de 80 Anos ou mais , Biópsia , Vasos Sanguíneos/embriologia , Cadáver , Feminino , Humanos , Plexo Hipogástrico/embriologia , Imuno-Histoquímica , Ligamentos/embriologia , Plexo Lombossacral/embriologia , Gravidez , Útero/irrigação sanguínea , Útero/embriologia , Adulto JovemRESUMO
A case of right chylothorax in a male neonate is reported. A sonographic diagnosis was made during the 35th week of pregnancy. A complete recovery was obtained with appropriate dietetic therapy.