Gynecologie Obstetrique Fertilite & Senologie最新文献

Objectives: Total pregnancy denial is a phenomenon where the woman does not recognize her pregnancy until a late stage, sometimes just before childbirth. These complex situations raise many questions about the support of the mother-child dyad. This qualitative study aims to describe the experiences and strategies of midwives when dealing with cases of total pregnancy denial, as well as the relational dynamics within these particular dyads, in order to identify avenues for appropriate care.

Methodology: Eight semi-structured interviews were conducted with midwives practicing in Île-de-France (hospital, private practice, home hospitalization, and maternal and child protection services). The data were analyzed using grounded theory with the help of the Quirkos software.

Results: The midwives' experiences show that the mother-child relationship evolves favorably in most cases, even in anonymous childbirth situations. The results are organized into several themes: the description of the mother-child relationship, the proposed care approaches, and the midwives' experiences. For the first theme, five sub-themes emerged: maternal investment, psychological ambivalence, childbirth circumstances, the influence of the social environment, and maternal guilt. The second theme highlights the importance of multidisciplinary and personalized support, respecting the pace of the dyad.

Conclusion: This study emphasizes the importance of not stigmatizing women in total pregnancy denial when establishing the mother-child bond. A personalized and gradual care approach, based on empathetic, non-judgmental, and multidisciplinary support, fosters the mother-child bond.

Certain obstetric situations, such as abnormalities in placental invasion, present a major hemorrhagic risk often requiring massive transfusion. To reduce complications associated with massive transfusions and minimize the use of the labile blood product stock, perioperative blood salvage techniques, such as the Cell-saver, have been developed, including in obstetrics. The aim of this article is to provide an update on the use of the Cell-saver in obstetrics, particularly during high hemorrhagic risk obstetric surgeries (such as surgeries for placenta accreta). Firstly, we will review the indications for using the Cell-saver in obstetrics and the technical modalities described in the literature and at our expert center. Secondly, in light of the literature data, we will list the benefits associated with the use of the Cell-saver in obstetrics as well as its risks, complications, and contraindications.

Objectives: The new bioethics law of August 2, 2021 allows French women to self-preserve.

Methods: National observational survey over 2 years based on an online questionnaire conducted under the aegis of GEDO (Groupe d'études pour le don d'ovocytes).

Results: The average age of the 282 women who answered the questionnaire, 34.5 years, is consistent with the benefit/risk balance described in the literature. The most educated women, also very vulnerable, remain the most affected. They are single and childless, but most of them see themselves as a couple and want to become mothers in the future. Their main motivation is to have the choice to postpone a pregnancy without fear of infertility until they have found a suitable partner. Careerist or selfish motivations are anecdotal. The projected fate of unused vitrified oocytes is above all donation to others.

Conclusion: This study shows that oocyte self-preservation is undeniably experienced as a societal victory and is perceived as a step towards gender equality. While oocyte self-preservation is not an absolute guarantee of having a future child, it is part of a primary preventive strategy for age-related fertility decline. Public authorities and health professionals will have to widely disseminate accurate and complete information to allow everyone to have access to an informed reproductive choice.

Objective: The new bioethics law, enacted on August 2, 2021, has expanded access to medically assisted reproduction (MAR) with sperm donation to unmarried women and female couples. The implementation of this law led to a significant influx of sperm donation requests at French sperm banks. This major development in the field of ART in France, and in French society as a whole, prompted us to focus specifically on the requests from female couples.

Method: A retrospective, single-center study was conducted at a gamete donation center in Paris. The data of women in same-sex couples who attended a first consultation with a biologist between October 1, 2021, and October 31, 2022, were analyzed and compared to those of women in heterosexual couples who also requested MAR with sperm donation during the same period. The ART attempts and their outcomes were analyzed up until May 31, 2024.

Results: A total of 117 women in same-sex couples and 75 women in heterosexual couples were included in the study. The profiles in terms of age, ovarian reserve, and history of gynecological conditions did not differ between the two groups. The only observed differences were related to lifestyle, particularly alcohol consumption, which was slightly higher among women in same-sex couples. Additionally, women in same-sex couples appeared to belong more frequently to the category of intermediate professions, but no differences were observed concerning other occupational categories. Regarding the outcomes of ART attempts, cumulative rates of early and ongoing pregnancies were not different between the two groups.

Conclusion: This study thus provides an initial insight into the profile and outcomes for women in same-sex couples who received ART with sperm donation shortly after the enactment of the bioethics law in France. The similarity in profiles and ART outcomes between women in same-sex couples and those in heterosexual couples supports the approach of offering similar medical care, regardless of the couple's configuration.

Objective: Socio-economic conditions are one of the critical factors of the health of pregnant women. However, precariousness remains poorly defined and detected by general practitioners because too few tools adapted to private practice are available. General practitioners, as the first point of contact for these patients and often the future doctors of the children to come, take charge of them or refer them to other practitioners. Their medical and social practices in this context are mostly undocumented. The purpose of this practice survey is to understand the underlying rationale and frame of reference according to which GPs identify precarious pregnant women and the way they take care of them.

Method: This is a qualitative study based on semi-structured interviews. They were thematically analyzed using the inductive method of grounded theorizing. Private general practitioners carrying out pregnancy follow-ups were enrolled via GP networks and then sampled according to the "respondent driven sampling".

Results: Twelve interviews were conducted between September 2020 and April 2021. The analysis led to explore 6 main themes, poverty identification, feelings about it, the care of precarious women and the attitude, resources and training of the GPs.

Conclusion: The definition of precariousness by GPs is directly linked to their own representation of it. They work in formal or informal networks to avoid being isolated in the care that they describe as complex. They feel the need for suitable training and information related to the support of these patients.

Objective: The law of 7 July 2011 adopts the concept of therapeutic abortion (Medical Termination of Pregnancy or MTP) for maternal reasons if the pregnancy poses a "serious threat" to the woman's health, allowing for the introduction of the concept of psycho-social distress.

Materials and methods: This was a retrospective monocentric study involving 33 women seeking IMG for psychosocial reasons between January 2017 and December 2021 at the University Hospital of Tours. The study resulted in 29 approvals and 25 MTP procedures performed.

Results: Eighty-seven per cent of the requests were accepted. Over half of the women were under 25 years old and were primiparous. The procedures were performed at a mean gestational age of 22 weeks. Sixty percent did not use contraception at the time of conception, and 36% did not use it after the MTP. About a third of the women experienced violence and had psychiatric histories. The majority of the women did not have stable economic resources. Fifty-six per cent of the MTP procedures involved feticide. There were 7 immediate complications with no subsequent consequences. The average time to completion was 16.5 days.

Conclusion: This is a delicate and underexplored subject in literature. Although sporadic in France, these procedures have been practiced for many years. The diversity of opinions during multidisciplinary committees ensures the best objectivity. Requests for psychosocial IMG are rare, but responding to them is in accordance with the law. Analyzing the profile and journey of women has contributed to a better understanding of the complex situations that lead them to this decision.

Objective: Virtual reality with Snow World shows a 45% decrease in painful peaks during the care of burn victims. Hypnosis has anxiolytic effect and modulate the response to pain. HypnoVR© is based on many concepts recognized in medicine accessible without specific training. In our practice, 95% of oocyte pick-up are made with local anesthesia and simple premedication, whereas conscious sedation is recommanded in Europe. HypnoVR© is systematically offered during oocyte pick-up. Our study had to compare the pain felt between the 2 group with or without HypnoVR©, also anxiety, tolerance and satisfaction of patients.

Method: It was a prospective comparative, non-randomized, single-center, open-label study. We included all patients who were to benefit from an oocyte pick-up from 18 to 43 years-old. The usual protocol of pick-up was used and it was possible to add HypnoVR©. A questionnaire was distributed to each patient to collect their opinion.

Results: A total of 112 patients were included, 60 without HypnoVR© and 52 with HypnoVR©; 2 were excluded from the main analysis for missing data. There is no statistically significant difference in pain and anxiety between the groups. Patients are satisfied: 90.20% (n=46/52) would like to use it again and 98.04% (n=50/52) would recommend it.

Conclusion: Despite the absence of a statistically significant difference, patients are satisfied with HypnoVR© and tolerance is good. It seems interesting to be able to offer it during oocyte pick-up.