Pub Date : 2024-11-15DOI: 10.1016/j.jogoh.2024.102882
Amandine Mawa, Gabriel Bizet, Morgane Stichelbout, Louise Devisme, Myrtille Pauchet, Solène Gobert, Anastasia Chudzinski, Véronique Houfflin-Debarge, Damien Subtil
Introduction: Chronic Histiocytic Intervillositis (CHI) appears to be among the most severe placental diseases. Its rarity has limited our knowledge of the women in whom it occurs.
Objective: To search for maternal characteristics linked to the existence of CHI, by first studying the current pregnancy included in the study, then their previous pregnancies.
Material and methods: We conducted a monocentric case-control study between 2000 and 2020. CHI cases were diagnosed by microscopic examination of the placenta. "Low-risk" controls gave birth just before each case, whatever the outcome. "High-risk" controls benefited from placental microscopy immediately after the case examinations.
Results: 151 women were included in each group. CHI cases had twice as many previous pregnancies as both controls, but no more living children at home. Regarding obstetric history, fetal losses were significantly higher in CHI cases: compared to "low-risk" controls, there were more early miscarriages (20.0%, OR 2.6 [1.5;4.8]), late miscarriages (4.8%, OR 8.8 [1.1;187]) and in utero deaths (5.4%, OR 5.6 [1.7;19.8]). The risk of fetal loss does not appear to be increased in first pregnancies of CHI cases. However, differences appeared between cases and both "low-risk" and "high-risk" controls with a history of two previous miscarriages (21.7% vs 11.2%, p=0.009 or vs 9.6%, p=0.005) and the outcome of the second pregnancy (number of living children 59.7% vs 78.0%, p=0.033 or vs 63.0%, p=0.71), respectively.
Conclusion: Women with CHI have a more frequent history of pregnancy failure than other women. This excess fetal loss seems to occur only after the second pregnancy or after two previous miscarriages.
{"title":"Caracteristics of women presenting with Chronic Histiocytic Intervillositis during pregnancy: a case-control study.","authors":"Amandine Mawa, Gabriel Bizet, Morgane Stichelbout, Louise Devisme, Myrtille Pauchet, Solène Gobert, Anastasia Chudzinski, Véronique Houfflin-Debarge, Damien Subtil","doi":"10.1016/j.jogoh.2024.102882","DOIUrl":"https://doi.org/10.1016/j.jogoh.2024.102882","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic Histiocytic Intervillositis (CHI) appears to be among the most severe placental diseases. Its rarity has limited our knowledge of the women in whom it occurs.</p><p><strong>Objective: </strong>To search for maternal characteristics linked to the existence of CHI, by first studying the current pregnancy included in the study, then their previous pregnancies.</p><p><strong>Material and methods: </strong>We conducted a monocentric case-control study between 2000 and 2020. CHI cases were diagnosed by microscopic examination of the placenta. \"Low-risk\" controls gave birth just before each case, whatever the outcome. \"High-risk\" controls benefited from placental microscopy immediately after the case examinations.</p><p><strong>Results: </strong>151 women were included in each group. CHI cases had twice as many previous pregnancies as both controls, but no more living children at home. Regarding obstetric history, fetal losses were significantly higher in CHI cases: compared to \"low-risk\" controls, there were more early miscarriages (20.0%, OR 2.6 [1.5;4.8]), late miscarriages (4.8%, OR 8.8 [1.1;187]) and in utero deaths (5.4%, OR 5.6 [1.7;19.8]). The risk of fetal loss does not appear to be increased in first pregnancies of CHI cases. However, differences appeared between cases and both \"low-risk\" and \"high-risk\" controls with a history of two previous miscarriages (21.7% vs 11.2%, p=0.009 or vs 9.6%, p=0.005) and the outcome of the second pregnancy (number of living children 59.7% vs 78.0%, p=0.033 or vs 63.0%, p=0.71), respectively.</p><p><strong>Conclusion: </strong>Women with CHI have a more frequent history of pregnancy failure than other women. This excess fetal loss seems to occur only after the second pregnancy or after two previous miscarriages.</p>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anti-N-methyl-D-aspartate receptor (NMDA-R) encephalitis is an immune-mediated encephalitis that primarily affects young women. Due to the psychiatric and neurological symptoms, the diagnosis can be challenging, especially during pregnancy. During pregnancy, treatments must take into account the fetal and neonatal risk and the risk of premature delivery. We report a case of anti-NMDA encephalitis in a 31-years-old, 30 weeks pregnant women characterized by predominantly psychiatric symptoms, associated with ovarian teratoma. First-line treatments have led to an improvement in symptoms, allowing the pregnancy to be carried to term and a vaginal delivery.
{"title":"Anti N-Methyl-D-Aspartate receptor encephalitis during pregnancy: a case report.","authors":"Leïa Kennel, Dominique Luton, Florence Gressier, Chloé Daffos, Emmanuelle Corruble, Laure Julé, Jean-Baptiste Brunet de Courssou, Claire Szmulewicz","doi":"10.1016/j.jogoh.2024.102876","DOIUrl":"https://doi.org/10.1016/j.jogoh.2024.102876","url":null,"abstract":"<p><p>Anti-N-methyl-D-aspartate receptor (NMDA-R) encephalitis is an immune-mediated encephalitis that primarily affects young women. Due to the psychiatric and neurological symptoms, the diagnosis can be challenging, especially during pregnancy. During pregnancy, treatments must take into account the fetal and neonatal risk and the risk of premature delivery. We report a case of anti-NMDA encephalitis in a 31-years-old, 30 weeks pregnant women characterized by predominantly psychiatric symptoms, associated with ovarian teratoma. First-line treatments have led to an improvement in symptoms, allowing the pregnancy to be carried to term and a vaginal delivery.</p>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ST analysis during labour requires the classification of CTG traces in order to help clinical decisions. The usual STAN classification is based on the FIGO 1987 classification, modified in 2007. New STAN guidelines adapted to physiology-based interpretation have been proposed in 2022. This study compares the interobserver agreement of CTG classification and clinical decisions making, and the ease of use following the 2022 and 2007 STAN guidelines.
Material and Methods
Thirty CTG traces from STAN monitors were selected from a local French database and analysed (CTG classification, clinical decision making) by six observers with different levels of experience in two sessions three months apart. Observers followed the STAN2007 and the STAN2022 guidelines in the first and in the second sessions respectively. Weighted kappa (primary outcome), proportion of complete agreement within the 6 observers, and percent agreement (secondary outcomes) were estimated. At the end of the second session observers rated their satisfaction, ease of use and which guidelines they preferred.
Results
The interobserver agreement for CTG classification were comparable when following STAN2007 and STAN2022 guidelines (weighted kappa 0.57 versus 0.58, P = 0.91, moderate agreement), but a higher proportion of complete agreement within the 6 observers and a higher percent agreement were obtained when following STAN2022 compared to STAN2007 guidelines (complete agreement 50 % versus 20 % respectively, P = 0.01; percentage of agreement 72 % vs 55 %, P = 0.006). Interobserver agreement for clinical decisions did not differ when following STAN2007 or STAN2022 guidelines. Satisfaction scores were higher with STAN2022 guidelines, but not significantly (P = 0.052). All 6 observers stated that they preferred to use the STAN2022 guidelines.
Conclusion
Interobserver agreement is comparable between STAN2022 and STAN2007 for CTG classification in labour and clinical decision making. However, complete agreement and percent agreement are in favour of STAN 2022 for CTG classification.
{"title":"Interobserver agreement in CTG classification and clinical decision during labour: a comparison between STAN2007 and STAN2022 classifications","authors":"Delphine Duchanois , Lola Loussert , Anais Provendier , Carole Brouet , Maeva Chavin , Louise Paret , Paul Guerby , Virginie Ehlinger , Christophe Vayssière","doi":"10.1016/j.jogoh.2024.102874","DOIUrl":"10.1016/j.jogoh.2024.102874","url":null,"abstract":"<div><div>ST analysis during labour requires the classification of CTG traces in order to help clinical decisions. The usual STAN classification is based on the FIGO 1987 classification, modified in 2007. New STAN guidelines adapted to physiology-based interpretation have been proposed in 2022. This study compares the interobserver agreement of CTG classification and clinical decisions making, and the ease of use following the 2022 and 2007 STAN guidelines.</div></div><div><h3>Material and Methods</h3><div>Thirty CTG traces from STAN monitors were selected from a local French database and analysed (CTG classification, clinical decision making) by six observers with different levels of experience in two sessions three months apart. Observers followed the STAN2007 and the STAN2022 guidelines in the first and in the second sessions respectively. Weighted kappa (primary outcome), proportion of complete agreement within the 6 observers, and percent agreement (secondary outcomes) were estimated. At the end of the second session observers rated their satisfaction, ease of use and which guidelines they preferred.</div></div><div><h3>Results</h3><div>The interobserver agreement for CTG classification were comparable when following STAN2007 and STAN2022 guidelines (weighted kappa 0.57 versus 0.58, <em>P</em> = 0.91, moderate agreement), but a higher proportion of complete agreement within the 6 observers and a higher percent agreement were obtained when following STAN2022 compared to STAN2007 guidelines (complete agreement 50 % versus 20 % respectively, <em>P</em> = 0.01; percentage of agreement 72 % vs 55 %, <em>P</em> = 0.006). Interobserver agreement for clinical decisions did not differ when following STAN2007 or STAN2022 guidelines. Satisfaction scores were higher with STAN2022 guidelines, but not significantly (<em>P</em> = 0.052). All 6 observers stated that they preferred to use the STAN2022 guidelines.</div></div><div><h3>Conclusion</h3><div>Interobserver agreement is comparable between STAN2022 and STAN2007 for CTG classification in labour and clinical decision making. However, complete agreement and percent agreement are in favour of STAN 2022 for CTG classification.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-03DOI: 10.1016/j.jogoh.2024.102875
Maina Jan , Sonia Guérin , Marie-Alice Yanni , Antoine Robin , Linda Lassel , Sonia Bhandari Randhawa , Rémi Béranger , Maela Le Lous
Objective
To assess the maternal and fetal benefits of delaying oxytocin perfusion by 24 h following labor induction by amniotomy after 41 weeks of gestation (WG).
Methods
We performed a retrospective review including all women with a vertex presentation fetus who had an indication for labor induction by amniotomy with or without oxytocin after 41 WG between 2015 and 2022. Patients who underwent an IOL by amniotomy followed by oxytocin perfusion within 0 to 4 hours (early oxytocin group: EO group) were compared with patients who underwent an IOL by amniotomy alone or followed by an oxytocin perfusion after an expectant period for up to 24 hours in the absence of a spontaneous onset of labor (delayed oxytocin group: DO group). The primary outcome was the rate of vaginal delivery (natural or operative). The secondary outcomes were maternal and neonatal complications.
Results
We included 363 patients: 103 patients in the EO group and 260 in the DO group. Only 47 of the women in the DO group (18 %) required oxytocin. The proportion of vaginal deliveries was significantly higher in the DO group (248 patients, 95.4 %) than in the EO group (85 patients, 82.55 %) (p<0.01). Maternal morbidity did not differ significantly between groups. Fewer babies displayed severe newborn acidemia or required transfer to the neonatal intensive care unit in the DO group (p<0.05).
Conclusion
Delaying oxytocin administration by 24 hours after amniotomy was associated with a significantly higher rate of vaginal delivery. These results required confirmation in prospective randomized studies.
{"title":"Induction of labor in late-term pregnancy: amniotomy plus early oxytocin perfusion versus amniotomy plus oxytocin perfusion delayed by 24 h","authors":"Maina Jan , Sonia Guérin , Marie-Alice Yanni , Antoine Robin , Linda Lassel , Sonia Bhandari Randhawa , Rémi Béranger , Maela Le Lous","doi":"10.1016/j.jogoh.2024.102875","DOIUrl":"10.1016/j.jogoh.2024.102875","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the maternal and fetal benefits of delaying oxytocin perfusion by 24 h following labor induction by amniotomy after 41 weeks of gestation (WG).</div></div><div><h3>Methods</h3><div>We performed a retrospective review including all women with a vertex presentation fetus who had an indication for labor induction by amniotomy with or without oxytocin after 41 WG between 2015 and 2022. Patients who underwent an IOL by amniotomy followed by oxytocin perfusion within 0 to 4 hours (early oxytocin group: EO group) were compared with patients who underwent an IOL by amniotomy alone or followed by an oxytocin perfusion after an expectant period for up to 24 hours in the absence of a spontaneous onset of labor (delayed oxytocin group: DO group). The primary outcome was the rate of vaginal delivery (natural or operative). The secondary outcomes were maternal and neonatal complications.</div></div><div><h3>Results</h3><div>We included 363 patients: 103 patients in the EO group and 260 in the DO group. Only 47 of the women in the DO group (18 %) required oxytocin. The proportion of vaginal deliveries was significantly higher in the DO group (248 patients, 95.4 %) than in the EO group (85 patients, 82.55 %) (<em>p</em><0.01). Maternal morbidity did not differ significantly between groups. Fewer babies displayed severe newborn acidemia or required transfer to the neonatal intensive care unit in the DO group (<em>p</em><0.05).</div></div><div><h3>Conclusion</h3><div>Delaying oxytocin administration by 24 hours after amniotomy was associated with a significantly higher rate of vaginal delivery. These results required confirmation in prospective randomized studies.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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