Development of a comprehensive database for research on foetal acidosis.

OBJECTIVE: To develop a research database for mother-and-child clinical and laboratory data and digital foetal heart rate (FHR) recordings. METHODS: The Base Bien Naître (BBN) database was derived from a single-centre health data warehouse. It contains exhaustive data on all parturients with a singleton pregnancy, a vaginal or caesarean delivery in labour with a cephalic presentation after at least 37 weeks of amenorrhea, and a live birth between February 1st, 2011, and December 31st, 2018. On arrival in the delivery room, the FHR was recorded digitally for at least 30 min. A cord blood sample was always taken in order to obtain arterial pH (pHa). More than 6,000 recordings were analyzed visually for the risk of foetal acidosis and classified into five groups (according to the French College of Gynaecologists and Obstetricians (CNGOF) classification) or three groups (according to the International Federation of Gynaecology and Obstetrics (FIGO) classification). RESULTS: Of the 16,089 files in the health data warehouse, 11,026 were complete and met the BBN's inclusion criteria. The FHR digital recordings were of good quality, with low signal loss (median [interquartile range]: 7.0% [4.3;10.9]) and a median recording time of 304 min [190;438]). In 3.7% of the children, the pHa was below 7.10. We selected a subset of 6115 records with good-quality FHR recordings over 120 min and reliable cord blood gas data: 692 (11.3%) had at least a significant risk of acidosis (according to the CNGOF classification), and 1638 (26.8%) were at least suspicious (according to the FIGO classification). CONCLUSION: The BBN database has been designed as a searchable tool with data reuse. It currently contains over 11,000 records with comprehensive data.

[Accuracy of ultrasound estimated fetal weight performed by OB-Gyn residents at due date]. / Performance de l'estimation échographique du poids foetal réalisée par les internes de spécialité le jour du terme.

OBJECTIVES: The aim of this study was to evaluate the accuracy of ultrasound fetal weight prediction at due date and to find parameters that may affect this prediction. PATIENTS AND METHODS: We retrospectively studied 201 patients at due date in a university hospital in 2006, the fetal weight estimation being performed by Obstetric-gynecology (OB-Gyn). Estimated fetal weight was calculated with the Hadlock's formula, including biparietal diameter, cephalic circumference, abdominal perimeter and femoral length and was compared with birth weight. RESULTS: The mean birth weight was 3561+/-415 g. The mean absolute weight difference was 261+/-190 g (absolute range: 0 to 1183 g, actual range: -935 to 1183 g). Body mass index>30 kg/m(2) was associated with greater fetal weight inaccuracy (p=0,013). Fetal weight estimation was not influenced by fetal macrosomia, oligoanamnios or maternal weight gain during pregnancy. DISCUSSION AND CONCLUSION: The sonographic estimated fetal weight and birth weight are correlated with a mean absolute percentage error of 7%. However, clinicians should be aware of the risk of inaccuracy in obese women.

Use of automated fetal heart rate analysis to identify risk factors for umbilical cord acidosis at birth.

OBJECTIVE: To identify clinical parameters and intrapartum fetal heart rate parameters associated with a risk of umbilical cord acidosis at birth, using an automated analysis method based on empirical mode decomposition. METHODS: Our single-center study included 381 cases (arterial cord blood pH at birth pHa ≤7.15) and 1860 controls (pHa ≥7.25) extracted from a database comprising 8,383 full datasets for over-18 mothers after vaginal or caesarean non-twin, non-breech deliveries at term (>37 weeks of amenorrhea). The analysis of a 120-min period of the FHR recording (before maternal pushing or the decision to perform a caesarean section during labor) led to the extraction of morphological, frequency-related, and long- and short-term heart rate variability variables. After univariate analyses, sparse partial least square selection and logistic regression were applied. RESULTS: Several clinical factors were predictive of fetal acidosis in a multivariate analysis: nulliparity (odds ratio (OR) 95% confidence interval (CI)]: 1.769 [1.362-2.300]), a male fetus (1.408 [1.097-1.811]), and the term of the pregnancy (1.333 [1.189-1.497]). The risk of acidosis increased with the time interval between the end of the FHR recording and the delivery (OR [95%CI] for a 1-min increment: 1.022 [1.012-1.031]). The risk factors related to the FHR signal were mainly the difference between the mean baseline and the mean FHR (OR [95%CI]: 1.292 [1.174-1.424]), the baseline range (1.027 [1.014-1.040]), fetal bradycardia (1.038 [1.003-1.075]) and the late deceleration area (1.002 [1.000-1.005]). The area under the curve for the multivariate model was 0.79 [0.76; 0.81]. CONCLUSION: In addition to clinical predictors, the automated FHR analysis highlighted other significant predictors, such as the baseline range, the instability of the FHR signal and the late deceleration area. This study further extends the routine application of automated FHR analysis during labor and, ultimately, contributes to the development of predictive scores for fetal acidosis.

Assessment of fetal head engagement with transperineal ultrasound: Searching for the cutoff level.

PURPOSE: Engagement of the fetal head is a determinant element when deciding on operative vaginal delivery. In routine practice, engagement is a clinical diagnosis based on transvaginal digital examination. Transperineal ultrasound might provide complementary information useful for measuring the fetal head-perineum distance (HPD). The purpose of this work was to determine the cutoff HPD distinguishing engagement from non-engagement. MATERIALS AND METHODS: This single-center prospective study approved by the institutional review board was conducted between December 25, 2012 and August 31, 2015 in 411 nulliparous women; 20 did not provide informed consent and were excluded; analysis concerned 391 patients. Clinical diagnosis - engagement or non-engagement depending on results of the transvaginal digital examination (Farabeuf's and Demelin's signs) - was compared with the ultrasound HPD measurement. RESULTS: The clinical diagnosis was non-engagement at complete dilatation in 96 patients (24.6%). The cutoff HPD distinguishing between engagement and non-engagement was 57mm (AUC 83.5% [95%CI 79.3-87.8]), with 75.0% [65.5-82.6] sensitivity, 75.9% [70.7-80.5] specificity, 50.3% [42.2-58.4] positive predictive value, and 90.3% [86.0-93.4] negative predictive value. CONCLUSIONS: In this series, the HPD cutoff distinguishing between engagement and non-engagement was 57mm. Below this cutoff level, the head should be considered engaged, beyond non-engaged. Nevertheless, the pertinence of this cutoff level is hampered by the imprecision of the gold standard used for the clinical diagnosis (transvaginal digital examination). In case of doubt, we recommend, in addition to considering the obstetrical setting, to combine transperineal ultrasound with transvaginal digital examination to avoid deleterious failure of operative vaginal delivery.

Metastasis-free interval in breast cancer patients: Thirty-year trends and time dependency of prognostic factors. A retrospective analysis based on a single institution experience.

INTRODUCTION: Breast cancer remains the leading cause of cancer death in French women in spite of continuously improving management. The objectives of this study were to analyse trends in the metastasis-free interval over the past 30 years and to identify the prognostic factors of survival, while accounting for time dependency. METHODS: A total of 1613 patients diagnosed with invasive non-metastatic breast cancer at Saint Vincent de Paul Hospital, Lille, France between 1977 and 2013, were followed for outcome (metastasis-free interval). Cohort entry time delay, a continuous temporal covariate, was defined to assess improvement of outcome. Data were analysed using the Cox proportional hazards model and presented as hazard ratio (HR). RESULTS: Metastatic disease developed during follow-up in 446 (27.6%) patients. Cohort entry time delay exhibited strong independent prognostic value while accounting for multiple prognostic factors including: tumour size (HR = 1.62, 95 %CI 1.37-1.91); rapid tumour growth (HR = 1.59, 95%CI 1.17-2.16); lymph node ratio (HR = 2.29, 95%CI 1.97-2.66); histological grade (grade 2 was significant only during the first 10 years after diagnosis, grade 3 and progesterone receptor status only during the first 5 years after diagnosis); and oestrogen receptor status (significant only during the first 8 years (HR = 0.75, 95%CI 0.58-0.96)). CONCLUSION: The current study showed an improvement in the prognosis of breast cancer patients over the past 30 years and pointed to the importance of evaluating covariates with time-varying effects.