Pub Date : 2025-12-08DOI: 10.1016/j.gofs.2025.12.002
Nicolas Sananès, Jeanne Sibiude, Tiphaine Barjat, Vincent Dochez, Cyril Huissoud, Agnès Mailloux, Paul Maurice, Charles Garabedian, Véronique Debarge
Objective: The objective is to determine the circumstances in which feto-maternal hemorrhage (FMH) should be investigated, and how to assess its volume and whether it is acute or chronic, in order to build guidelines for appropriate management.
Methods: The French College of Obstetricians and Gynecologists (CNGOF) conducted a formalized expert consensus method.
Results: Feto-maternal hemorrhage (FMH) is defined as the passage of fetal blood into the maternal circulation through a breach in the feto-placental barrier during pregnancy or childbirth. For the diagnosis of FMH, it is recommended that a Kleihauer-Betke (KB) test be performed as a first-line test, with a positivity threshold of 5 fetal red blood cells per 10,000 adult red blood cells. The volume of fetal blood lost in mL is calculated by dividing the TB test result by 2. Flow cytometry can also be used as a supplement in specialized laboratories if the TB test is difficult to interpret. In the context of FMH, to screen for fetal anemia, it is suggested to perform an ultrasound scan with measurement of the peak systolic velocity in the middle cerebral artery and, depending on the gestational age, to monitor the fetal heart rate. Normal results from these tests do not rule out the presence of fetal anemia. It is suggested that a KB test be performed in cases of decreased fetal movement with abnormal initial assessment, ultrasound signs of fetal anemia, sinusoidal fetal heart rate, or fetal death, in order to detect FMH. It is suggested that a KB test not be performed routinely in cases of ovular sampling, external version or bleeding during pregnancy. In cases of abdominal trauma, it is suggested that a KB test be performed, depending on the characteristics of the shock (high intensity, direct abdominal trauma). In cases of FMH, it is suggested that the severity be assessed based on the estimated volume transfused, the presence or absence of ultrasound signs of fetal anemia, and the presence or absence of fetal heart rate abnormalities. To estimate the volume of transfused blood, it is suggested to use the KB test, the result of which will be related to the estimated fetal weight based on ultrasound measurements. The medical care and follow-up will then depend on the level of risk. In cases where there is a history of FMH in a previous pregnancy, it is suggested to reassure the patient about the risk of FMH recurrence and not to perform any specific monitoring during a subsequent pregnancy.
{"title":"[Feto-Maternal Hemorrhage: Guidelines of the French College of Obstetricians and Gynecologists. Expert consensus from a Delphi method.]","authors":"Nicolas Sananès, Jeanne Sibiude, Tiphaine Barjat, Vincent Dochez, Cyril Huissoud, Agnès Mailloux, Paul Maurice, Charles Garabedian, Véronique Debarge","doi":"10.1016/j.gofs.2025.12.002","DOIUrl":"https://doi.org/10.1016/j.gofs.2025.12.002","url":null,"abstract":"<p><strong>Objective: </strong>The objective is to determine the circumstances in which feto-maternal hemorrhage (FMH) should be investigated, and how to assess its volume and whether it is acute or chronic, in order to build guidelines for appropriate management.</p><p><strong>Methods: </strong>The French College of Obstetricians and Gynecologists (CNGOF) conducted a formalized expert consensus method.</p><p><strong>Results: </strong>Feto-maternal hemorrhage (FMH) is defined as the passage of fetal blood into the maternal circulation through a breach in the feto-placental barrier during pregnancy or childbirth. For the diagnosis of FMH, it is recommended that a Kleihauer-Betke (KB) test be performed as a first-line test, with a positivity threshold of 5 fetal red blood cells per 10,000 adult red blood cells. The volume of fetal blood lost in mL is calculated by dividing the TB test result by 2. Flow cytometry can also be used as a supplement in specialized laboratories if the TB test is difficult to interpret. In the context of FMH, to screen for fetal anemia, it is suggested to perform an ultrasound scan with measurement of the peak systolic velocity in the middle cerebral artery and, depending on the gestational age, to monitor the fetal heart rate. Normal results from these tests do not rule out the presence of fetal anemia. It is suggested that a KB test be performed in cases of decreased fetal movement with abnormal initial assessment, ultrasound signs of fetal anemia, sinusoidal fetal heart rate, or fetal death, in order to detect FMH. It is suggested that a KB test not be performed routinely in cases of ovular sampling, external version or bleeding during pregnancy. In cases of abdominal trauma, it is suggested that a KB test be performed, depending on the characteristics of the shock (high intensity, direct abdominal trauma). In cases of FMH, it is suggested that the severity be assessed based on the estimated volume transfused, the presence or absence of ultrasound signs of fetal anemia, and the presence or absence of fetal heart rate abnormalities. To estimate the volume of transfused blood, it is suggested to use the KB test, the result of which will be related to the estimated fetal weight based on ultrasound measurements. The medical care and follow-up will then depend on the level of risk. In cases where there is a history of FMH in a previous pregnancy, it is suggested to reassure the patient about the risk of FMH recurrence and not to perform any specific monitoring during a subsequent pregnancy.</p>","PeriodicalId":56056,"journal":{"name":"Gynecologie Obstetrique Fertilite & Senologie","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727349","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}
Pub Date : 2025-12-07DOI: 10.1016/j.gofs.2025.12.001
Charles Garabedian, Marie-Victoire Sénat, Nicolas Sananès, Paul Berveiller, Thierry Brillac, Maela Le Lous, Madleen Lemaître, Delphine Mitanchez, Olivier Morel, Sandrine Paquin, Agnès Rigouzzo, Frédérique Rimareix, Laure Simon, Sopio Tatulashvili, Jeanne Sibiude, Anne Vambergue
<p><p>In France, 0.2% of women who gave birth in 2021 had type 1 diabetes, and 0.3% had type 2 diabetes. Regarding preconception care, it is recommended that women with any type of diabetes achieve an HbA1c level of less than 6.5%. For women using continuous glucose monitoring (CGM), the recommended target range is 0.70-1.80 g/L (3.9-10 mmol/L), and it is recommended to achieve this range at least 70% of the time. The preconception assessment includes: 1) an HbA1c measurement, 2) an assessment of microangiopathic impact, 3) an assessment of macroangiopathic complications, 4) screening for associated cardiovascular risk factors, and 5) a TSH measurement in women with type 1 diabetes (T1D), as well as screening for obstructive sleep apnea syndrome during questioning in cases of type 2 diabetes (T2D) and obesity in women with T1D. To improve preconception glycemic control, implementation of a CGM system is recommended for all women with T1D. Implementation of automated insulin delivery (AID) in anticipation of pregnancy should also be discussed as part of a shared medical decision. For type 2 diabetes, treatment with metformin and/or insulin therapy is recommended if necessary. Other antidiabetic treatments should be discontinued before conception. The following is recommended: 1) Discontinuing statin and potentially teratogenic antihypertensive treatments, replacing them with treatments compatible with pregnancy; 2) systematically providing smoking cessation advice to women who smoke, offering support from a healthcare professional trained in tobacco addiction; and 3) starting folic acid supplementation at 0.4 mg per day before conception. Finally, women of childbearing age should be regularly advised of the importance of planning their pregnancies during follow-up visits. They should also be provided with dietary care to improve glycemic control, and, in some cases, encouraged to lose weight prior to pregnancy. Women should be encouraged to engage in physical activity to improve glycemic control. Regarding care during pregnancy, the following metabolic targets are recommended: Fasting blood glucose should be less than 0.95 g/dL (less than 5.3 mmol/L), and postprandial blood glucose should be less than 1.20 g/dL (less than 6.7 mmol/L) two hours after eating. Time spent in the target range (0.63-1.40 g/dL [3.5-7.8 mmol/L]) should be greater than 70% for type 1 diabetes (T1D) and greater than 90% for type 2 diabetes (T2D). The HbA1c level should be less than 6% during pregnancy, and hypoglycemia should be limited as much as possible. An CGM is recommended for T1D during pregnancy. For women with T2D, an CGM is recommended or they should maintain multiple daily capillary self-monitoring of blood glucose as part of individualized management. For women with type 1 diabetes, treatment with an insulin pump infusion device (IUD) is recommended during pregnancy. For type 2 diabetes, insulin therapy is recommended. The addition or continuation of metformin s
{"title":"[Preexisting diabetes: expert consensus from the College of French Gynecologists and Obstetricians].","authors":"Charles Garabedian, Marie-Victoire Sénat, Nicolas Sananès, Paul Berveiller, Thierry Brillac, Maela Le Lous, Madleen Lemaître, Delphine Mitanchez, Olivier Morel, Sandrine Paquin, Agnès Rigouzzo, Frédérique Rimareix, Laure Simon, Sopio Tatulashvili, Jeanne Sibiude, Anne Vambergue","doi":"10.1016/j.gofs.2025.12.001","DOIUrl":"https://doi.org/10.1016/j.gofs.2025.12.001","url":null,"abstract":"<p><p>In France, 0.2% of women who gave birth in 2021 had type 1 diabetes, and 0.3% had type 2 diabetes. Regarding preconception care, it is recommended that women with any type of diabetes achieve an HbA1c level of less than 6.5%. For women using continuous glucose monitoring (CGM), the recommended target range is 0.70-1.80 g/L (3.9-10 mmol/L), and it is recommended to achieve this range at least 70% of the time. The preconception assessment includes: 1) an HbA1c measurement, 2) an assessment of microangiopathic impact, 3) an assessment of macroangiopathic complications, 4) screening for associated cardiovascular risk factors, and 5) a TSH measurement in women with type 1 diabetes (T1D), as well as screening for obstructive sleep apnea syndrome during questioning in cases of type 2 diabetes (T2D) and obesity in women with T1D. To improve preconception glycemic control, implementation of a CGM system is recommended for all women with T1D. Implementation of automated insulin delivery (AID) in anticipation of pregnancy should also be discussed as part of a shared medical decision. For type 2 diabetes, treatment with metformin and/or insulin therapy is recommended if necessary. Other antidiabetic treatments should be discontinued before conception. The following is recommended: 1) Discontinuing statin and potentially teratogenic antihypertensive treatments, replacing them with treatments compatible with pregnancy; 2) systematically providing smoking cessation advice to women who smoke, offering support from a healthcare professional trained in tobacco addiction; and 3) starting folic acid supplementation at 0.4 mg per day before conception. Finally, women of childbearing age should be regularly advised of the importance of planning their pregnancies during follow-up visits. They should also be provided with dietary care to improve glycemic control, and, in some cases, encouraged to lose weight prior to pregnancy. Women should be encouraged to engage in physical activity to improve glycemic control. Regarding care during pregnancy, the following metabolic targets are recommended: Fasting blood glucose should be less than 0.95 g/dL (less than 5.3 mmol/L), and postprandial blood glucose should be less than 1.20 g/dL (less than 6.7 mmol/L) two hours after eating. Time spent in the target range (0.63-1.40 g/dL [3.5-7.8 mmol/L]) should be greater than 70% for type 1 diabetes (T1D) and greater than 90% for type 2 diabetes (T2D). The HbA1c level should be less than 6% during pregnancy, and hypoglycemia should be limited as much as possible. An CGM is recommended for T1D during pregnancy. For women with T2D, an CGM is recommended or they should maintain multiple daily capillary self-monitoring of blood glucose as part of individualized management. For women with type 1 diabetes, treatment with an insulin pump infusion device (IUD) is recommended during pregnancy. For type 2 diabetes, insulin therapy is recommended. The addition or continuation of metformin s","PeriodicalId":56056,"journal":{"name":"Gynecologie Obstetrique Fertilite & Senologie","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716771","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}
Pub Date : 2025-12-01DOI: 10.1016/j.gofs.2025.10.016
Ninon Dupuis , Christophe Vayssière
Vaginal progesterone is currently considered for the prevention of preterm birth (PTB), depending on the patient's risk profile. Among women with a history of PTB but without a short cervix, recent studies are inconsistents and large trials show no benefit. The literature does not support routine prescription, confirming the 2016 French recommendations. Current data are insufficient to determine its use among women with multiple previous spontaneous PTBs or according to the gestational age of the previous PTB. In these cases, women should be offered progesterone prescription in the context of a shared decision-making process. In multiple pregnancies, results are mixed, but no benefit has been shown except when cervical length is < 25 mm. Data on uterine malformations or fibroid uterus are too limited to draw conclusions. In symptomatic patients (threatened preterm labor or late miscarriage), data are heterogeneous but show no benefit of vaginal progesterone on pregnancy prolongation or neonatal outcomes.
{"title":"Quelles indications de la Progestérone dans les populations à risque d’accouchement prématuré en 2025 ?","authors":"Ninon Dupuis , Christophe Vayssière","doi":"10.1016/j.gofs.2025.10.016","DOIUrl":"10.1016/j.gofs.2025.10.016","url":null,"abstract":"<div><div>Vaginal progesterone is currently considered for the prevention of preterm birth (PTB), depending on the patient's risk profile. Among women with a history of PTB but without a short cervix, recent studies are inconsistents and large trials show no benefit. The literature does not support routine prescription, confirming the 2016 French recommendations. Current data are insufficient to determine its use among women with multiple previous spontaneous PTBs or according to the gestational age of the previous PTB. In these cases, women should be offered progesterone prescription in the context of a shared decision-making process. In multiple pregnancies, results are mixed, but no benefit has been shown except when cervical length is<!--> <!--><<!--> <!-->25<!--> <!-->mm. Data on uterine malformations or fibroid uterus are too limited to draw conclusions. In symptomatic patients (threatened preterm labor or late miscarriage), data are heterogeneous but show no benefit of vaginal progesterone on pregnancy prolongation or neonatal outcomes.</div></div>","PeriodicalId":56056,"journal":{"name":"Gynecologie Obstetrique Fertilite & Senologie","volume":"53 12","pages":"Pages 671-675"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276184","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}
Pub Date : 2025-12-01DOI: 10.1016/j.gofs.2025.10.004
Muriel Doret Dion , Aude Fendler
Tocolysis is a tte gold standard in France in preterm labor before 34 WG. Nifedpine and atosiban are recommanded as first line tocolysis since the clinical guidelines published in 2016 by the French College of Obstetrics and Gynecology (CNGOF). Pregnancy prolongation over 48 hours due to tocolysis has been demonstrated in several studies, without impact on prematurity. These 48 hours allow antenatal corticotherapy and in utero transfer. Despite these promising results, no study had been able to demonstrate any improvement in neonatal prognosis or in infants until 5,5 years old due to tocolysis, questioning the current place of tocolysis in preterm labor. Nevertheless, datas are weak due to the lack of power of all studies in the last 20 years to demonstrate any change in neonatal prognosis. Therefore, it is still difficult to identify populations to exclude from tocolysis. Beyond medication, other parameters need to be considered such as national and territorial health organization, specific to each country. A collegial opinion with a revision of the national guidelines including all the parameters is necessary before any change in preterm labor management.
{"title":"La tocolyse en cas de menace d’accouchement prématuré à membranes intactes","authors":"Muriel Doret Dion , Aude Fendler","doi":"10.1016/j.gofs.2025.10.004","DOIUrl":"10.1016/j.gofs.2025.10.004","url":null,"abstract":"<div><div>Tocolysis is a tte gold standard in France in preterm labor before 34 WG. Nifedpine and atosiban are recommanded as first line tocolysis since the clinical guidelines published in 2016 by the French College of Obstetrics and Gynecology (CNGOF). Pregnancy prolongation over 48<!--> <!-->hours due to tocolysis has been demonstrated in several studies, without impact on prematurity. These 48<!--> <!-->hours allow antenatal corticotherapy and <em>in utero</em> transfer. Despite these promising results, no study had been able to demonstrate any improvement in neonatal prognosis or in infants until 5,5 years old due to tocolysis, questioning the current place of tocolysis in preterm labor. Nevertheless, datas are weak due to the lack of power of all studies in the last 20 years to demonstrate any change in neonatal prognosis. Therefore, it is still difficult to identify populations to exclude from tocolysis. Beyond medication, other parameters need to be considered such as national and territorial health organization, specific to each country. A collegial opinion with a revision of the national guidelines including all the parameters is necessary before any change in preterm labor management.</div></div>","PeriodicalId":56056,"journal":{"name":"Gynecologie Obstetrique Fertilite & Senologie","volume":"53 12","pages":"Pages 676-680"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276667","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}
Pub Date : 2025-12-01DOI: 10.1016/j.gofs.2025.10.002
Pierre Delorme , Jeanne Sibiude , Anne Pinton
Spontaneous preterm births, particularly those occurring before 32 weeks of gestation, are a major cause of neonatal morbidity. In women with a prior spontaneous preterm birth, the risk of recurrence is estimated at around 30%. Two main preventive strategies are proposed: prophylactic cerclage, performed before 16 weeks, and cervical ultrasound surveillance with ultrasound-indicated cerclage in case of cervical shortening. In the absence of a standardized clinical definition of cervical insufficiency, comparisons between these strategies are limited by three main factors: indication bias, as women at highest risk are more likely to undergo cervical ultrasound monitoring; the lack of a standardized clinical definition of cervical insufficiency, which leads to the inclusion of lower-risk women and dilutes potential benefits; and the relative rarity of the condition, which reduces the statistical power of available studies. Meta-analyses cannot correct for these limitations. The absence of a demonstrated difference despite indication bias suggests that classical cases of cervical insufficiency may benefit more from prophylactic cerclage. Future research should also consider medico-economic and psychological aspects. In conclusion, for women with an isolated history of spontaneous preterm birth, the choice between prophylactic cerclage and ultrasound surveillance should be individualized, taking into account clinical history, patient preferences, and available resources.
{"title":"Cerclage prophylactique ou surveillance du col en cas d’antécédent unique de prématurité spontanée : revue critique des données disponibles","authors":"Pierre Delorme , Jeanne Sibiude , Anne Pinton","doi":"10.1016/j.gofs.2025.10.002","DOIUrl":"10.1016/j.gofs.2025.10.002","url":null,"abstract":"<div><div>Spontaneous preterm births, particularly those occurring before 32 weeks of gestation, are a major cause of neonatal morbidity. In women with a prior spontaneous preterm birth, the risk of recurrence is estimated at around 30%. Two main preventive strategies are proposed: prophylactic cerclage, performed before 16 weeks, and cervical ultrasound surveillance with ultrasound-indicated cerclage in case of cervical shortening. In the absence of a standardized clinical definition of cervical insufficiency, comparisons between these strategies are limited by three main factors: indication bias, as women at highest risk are more likely to undergo cervical ultrasound monitoring; the lack of a standardized clinical definition of cervical insufficiency, which leads to the inclusion of lower-risk women and dilutes potential benefits; and the relative rarity of the condition, which reduces the statistical power of available studies. Meta-analyses cannot correct for these limitations. The absence of a demonstrated difference despite indication bias suggests that classical cases of cervical insufficiency may benefit more from prophylactic cerclage. Future research should also consider medico-economic and psychological aspects. In conclusion, for women with an isolated history of spontaneous preterm birth, the choice between prophylactic cerclage and ultrasound surveillance should be individualized, taking into account clinical history, patient preferences, and available resources.</div></div>","PeriodicalId":56056,"journal":{"name":"Gynecologie Obstetrique Fertilite & Senologie","volume":"53 12","pages":"Pages 661-665"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276686","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}
Pub Date : 2025-12-01DOI: 10.1016/j.gofs.2025.10.005
Clément Chollat , Jean-Baptiste Muller , Alexandra Chadie , Marie Brasseur-Daudruy , Eric Verspyck , Stéphane Marret
The up-dated literature, notably the 2024 Cochrane review, and meta-analysis with individual data, as well as the identified socio-economic benefits, confirms that the administration of magnesium sulfate is recommended in women at risk of imminent preterm delivery before 32 weeks of gestation. In preterm infants, this intervention significantly reduces the risk of neonatal intracranial haemorrhage (moderate level of evidence), which is associated with an increased risk of subsequent neurodisabilities, as well as a very significant reduction in the risk of subsequent cerebral palsy in children (strong level of evidence). No effect on fetal, neonatal or infant mortality rates was observed. Given the still high rates of CP in the subgroup of children born between 30 and 32 or even 32-34 SA, and the absence of severe adverse events in both mother and child, it could be proposed to administer MgSO4 up to 34 SA (expert opinion). Magnesium sulfate is currently the only pharmacological molecule with a proven neuroprotective effect in preterm infants. It represents one of the means available to us to modulate the neurodevelopmental trajectory of the child, in particular the development of neuromotor skills. Optimization of administration methods is now a major challenge, with the aim of achieving an antenatal administration rate of over 90% in eligible patients. Further studies are needed to determine the optimal dosage, the timing of administration, the appropriateness and duration of the maintenance dose, the route of administration and, finally, the long-term outcome of children exposed to MgSO4 in the antenatal period.
{"title":"Neuroprotection périnatale : apport du sulfate de magnésium dans la prévention des troubles du neurodéveloppement de l’enfant prématuré","authors":"Clément Chollat , Jean-Baptiste Muller , Alexandra Chadie , Marie Brasseur-Daudruy , Eric Verspyck , Stéphane Marret","doi":"10.1016/j.gofs.2025.10.005","DOIUrl":"10.1016/j.gofs.2025.10.005","url":null,"abstract":"<div><div>The up-dated literature, notably the 2024 Cochrane review, and meta-analysis with individual data, as well as the identified socio-economic benefits, confirms that the administration of magnesium sulfate is recommended in women at risk of imminent preterm delivery before 32 weeks of gestation. In preterm infants, this intervention significantly reduces the risk of neonatal intracranial haemorrhage (moderate level of evidence), which is associated with an increased risk of subsequent neurodisabilities, as well as a very significant reduction in the risk of subsequent cerebral palsy in children (strong level of evidence). No effect on fetal, neonatal or infant mortality rates was observed. Given the still high rates of CP in the subgroup of children born between 30 and 32 or even 32-34 SA, and the absence of severe adverse events in both mother and child, it could be proposed to administer MgSO4 up to 34 SA (expert opinion). Magnesium sulfate is currently the only pharmacological molecule with a proven neuroprotective effect in preterm infants. It represents one of the means available to us to modulate the neurodevelopmental trajectory of the child, in particular the development of neuromotor skills. Optimization of administration methods is now a major challenge, with the aim of achieving an antenatal administration rate of over 90% in eligible patients. Further studies are needed to determine the optimal dosage, the timing of administration, the appropriateness and duration of the maintenance dose, the route of administration and, finally, the long-term outcome of children exposed to MgSO4 in the antenatal period.</div></div>","PeriodicalId":56056,"journal":{"name":"Gynecologie Obstetrique Fertilite & Senologie","volume":"53 12","pages":"Pages 687-693"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276875","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}
Pub Date : 2025-12-01DOI: 10.1016/j.gofs.2025.11.005
Thomas Schmitz
Antenatal administration of a single course of corticosteroids before 34 weeks of gestation is associated in the neonatal period with a significant reduction of respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC) and death, and possibly in childhood with a reduction of cerebral palsy and increased psychomotor development index and intact survival. However, this treatment could be associated with insulin resistance in adulthood and with an increase in mental and behavioural disorders as well as more infections in childhood when birth finally occurs at term. Because of a favourable benefit/risk ratio, antenatal administration of a single course of corticosteroids is recommended for women at risk of preterm delivery before 34 weeks. Repeated antenatal corticosteroid administration is associated in the neonatal period with respiratory benefits but dose-dependent decreased birth weight and, in childhood, with possible neurological impairment. Therefore, this strategy is not recommended. There are two possible strategies for improving the benefit/risk ratio of treatment: reducing the dose or improving the timing of administration. Although it was not possible in a French trial to demonstrate the non-inferiority of a 50% dose reduction on the occurrence of severe RDS, survival without severe neonatal morbidity after half-dose was identical to that after full-dose. The results of further trials and follow-up of these children are therefore required before any conclusions can be drawn about dose reduction. Strategies to improve the timing of treatment have never been evaluated. In conclusion, antenatal corticosteroid administration is recommended to every woman at risk of preterm delivery before 34 weeks of gestation. Strategies aimed at improving the benefit/risk ratio of this treatment are still being evaluated.
{"title":"Bénéfices et risques de la corticothérapie anténatale","authors":"Thomas Schmitz","doi":"10.1016/j.gofs.2025.11.005","DOIUrl":"10.1016/j.gofs.2025.11.005","url":null,"abstract":"<div><div>Antenatal administration of a single course of corticosteroids before 34 weeks of gestation is associated in the neonatal period with a significant reduction of respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC) and death, and possibly in childhood with a reduction of cerebral palsy and increased psychomotor development index and intact survival. However, this treatment could be associated with insulin resistance in adulthood and with an increase in mental and behavioural disorders as well as more infections in childhood when birth finally occurs at term. Because of a favourable benefit/risk ratio, antenatal administration of a single course of corticosteroids is recommended for women at risk of preterm delivery before 34 weeks. Repeated antenatal corticosteroid administration is associated in the neonatal period with respiratory benefits but dose-dependent decreased birth weight and, in childhood, with possible neurological impairment. Therefore, this strategy is not recommended. There are two possible strategies for improving the benefit/risk ratio of treatment: reducing the dose or improving the timing of administration. Although it was not possible in a French trial to demonstrate the non-inferiority of a 50% dose reduction on the occurrence of severe RDS, survival without severe neonatal morbidity after half-dose was identical to that after full-dose. The results of further trials and follow-up of these children are therefore required before any conclusions can be drawn about dose reduction. Strategies to improve the timing of treatment have never been evaluated. In conclusion, antenatal corticosteroid administration is recommended to every woman at risk of preterm delivery before 34 weeks of gestation. Strategies aimed at improving the benefit/risk ratio of this treatment are still being evaluated.</div></div>","PeriodicalId":56056,"journal":{"name":"Gynecologie Obstetrique Fertilite & Senologie","volume":"53 12","pages":"Pages 681-686"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145643251","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}
Extremely premature infants (22–26 weeks) are at high risk of neonatal death, severe morbidity, and disability. The survival of these infants is essentially linked to the obstetrical-pediatric team's willingness to provide intensive care. Numerous studies show that this increased survival rate in cases of willingness to actively manage them is not accompanied by an increased risk of morbidity and psychomotor delay in the longer term. The great variability in antenatal practices for the management of extremely premature infants reflects the confusion among medical teams who, in the absence of consensus and formalized decision-making processes, end up making management decisions that are at best based on local habits, and at worst on the individual habits of the attending clinician. This variability in practices across centers poses a problem of equity. Thus, in our country, practices and outcomes vary greatly depending on the child's place of birth. Intensive antenatal care rates for these children vary from 22 to 61% depending on the region. One consequence is a survival rate in France that is much lower than in other countries. Survival in the USA, Great Britain, Japan, Australia, and Sweden is 10 to 50% higher than in France. To improve this situation, new principles have been proposed: administration of corticosteroid therapy independently of treatment, prognostic assessment not based solely on gestational age, and collective decision-making on treatment outside of an emergency setting, and consensus on the information to be provided to parents before informing them and seeking their opinions. This approach requires consistency in care before, during, and after birth and relies on close obstetric-pediatric collaboration. This new organization is being tested in the PREMEX Cluster randomized trial involving 25 perinatal networks in France, the results of which will be available in 2026.
{"title":"Quelle organisation périnatale dans les situations à risque de prématurité avant 28 SA ?","authors":"François Goffinet , Héloïse Torchin , Pierre-Yves Ancel , Pierre-Henri Jarreau","doi":"10.1016/j.gofs.2025.10.007","DOIUrl":"10.1016/j.gofs.2025.10.007","url":null,"abstract":"<div><div>Extremely premature infants (22–26 weeks) are at high risk of neonatal death, severe morbidity, and disability. The survival of these infants is essentially linked to the obstetrical-pediatric team's willingness to provide intensive care. Numerous studies show that this increased survival rate in cases of willingness to actively manage them is not accompanied by an increased risk of morbidity and psychomotor delay in the longer term. The great variability in antenatal practices for the management of extremely premature infants reflects the confusion among medical teams who, in the absence of consensus and formalized decision-making processes, end up making management decisions that are at best based on local habits, and at worst on the individual habits of the attending clinician. This variability in practices across centers poses a problem of equity. Thus, in our country, practices and outcomes vary greatly depending on the child's place of birth. Intensive antenatal care rates for these children vary from 22 to 61% depending on the region. One consequence is a survival rate in France that is much lower than in other countries. Survival in the USA, Great Britain, Japan, Australia, and Sweden is 10 to 50% higher than in France. To improve this situation, new principles have been proposed: administration of corticosteroid therapy independently of treatment, prognostic assessment not based solely on gestational age, and collective decision-making on treatment outside of an emergency setting, and consensus on the information to be provided to parents before informing them and seeking their opinions. This approach requires consistency in care before, during, and after birth and relies on close obstetric-pediatric collaboration. This new organization is being tested in the PREMEX Cluster randomized trial involving 25 perinatal networks in France, the results of which will be available in 2026.</div></div>","PeriodicalId":56056,"journal":{"name":"Gynecologie Obstetrique Fertilite & Senologie","volume":"53 12","pages":"Pages 694-702"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276642","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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