Gynecologie Obstetrique Fertilite & Senologie最新文献

Objective: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age. Despite its gynecological, metabolic, and psychological consequences, diagnosis remains frequently delayed and heterogeneous. General practitioners play a key role in the early identification and orientation of affected patients. This article aims to assess the knowledge of general practitioners in Loire-Atlantique regarding the diagnosis, management, and follow-up of PCOS, and to identify major gaps.

Methods: We conducted a cross-sectional descriptive study between May and September 2025 using an online questionnaire developed according to the 2023 international guidelines. Knowledge was evaluated using a standardized 10-point score.

Results: A total of 66 questionnaires were included. Most physicians rated their knowledge as average (3.1/5). The mean final score was 3.4/10. The main gaps concerned key Rotterdam diagnostic criteria - short cycles, updated ultrasound thresholds, and biochemical hyperandrogenism - as well as long-term complications, particularly endometrial cancer. Obstetric complications were better recognized, especially gestational diabetes. Lifestyle measures were widely recommended, but preconception counseling was systematically proposed by only 56.1% of respondents. No specific training was associated with higher knowledge scores.

Conclusion: This study highlights substantial gaps in general practitioners' knowledge of PCOS, consistent with international findings. Strengthening undergraduate and continuing medical education, alongside developing tools adapted to primary care, appears essential to harmonize diagnosis and management.

Objective: Transgender individuals face unique reproductive challenges related to medical, social, and institutional obstacles that limit access to fertility preservation. Conventional strategies for fertility preservation, adapted for cisgender populations, often poorly meet the physiological and psychosocial needs of transgender people. However, the rapid evolution of reproductive technologies is opening new perspectives for inclusive and gender-affirming fertility care. This narrative review critically examines innovative fertility preservation methods for transgender people, highlighting their clinical feasibility, ethical implications, and potential to redefine reproductive autonomy.

Method: A comprehensive literature review was conducted to identify reproductive technologies likely to benefit transgender populations.

Results: Traditional fertility preservation techniques, such as gamete or embryo cryopreservation, remain effective but are limited by hormonal incompatibilities and the discomfort of the procedures. New approaches, including gamete retrieval without interrupting hormone therapy, in vitro maturation of gametes from cryopreserved tissues, and the generation of artificial gametes from somatic cells, are emerging as promising alternatives. Uterine transplantation and tissue biotechnologies could also expand the conceptual frontiers of reproductive medicine. However, these innovations remain largely experimental and raise complex ethical issues.

Conclusion: Ensuring equitable access, rigorous ethical oversight, and gender-sensitive implementation will be essential as science evolves toward more inclusive models of human reproduction.

Objective: To estimate the prevalence of pregnant women using cannabis during pregnancy in Marseille, and to determine their socio-demographic characteristics and general knowledge on the subject.

Materials and methods: We conducted a cross-sectional descriptive epidemiological investigation in the maternity wards of Hôpital Nord and Hôpital de la Conception. We distributed a questionnaire to eligible patients hospitalized after delivery, designed to gather socio-demographic and gynecological information, as well as information on cannabis, tobacco, alcohol and other drug use habits, and knowledge of the consequences of such use.

Results: We distributed the questionnaires over a 6-month period between April and September 2023. Among responses, 503 were analyzed. The proportion of patients who had used cannabis during pregnancy was 2.7% [1.3-4.1]. Cannabis was overwhelmingly consumed in the form of a smoked joint. There was no difference in socio-demographic characteristics between the groups of patients who used cannabis and those who did not. The majority of women surveyed (79%) felt that cannabis use was harmful to both mother and fetus.

Conclusion: Although cannabis use during pregnancy may seem marginal, it remains the most widely used illicit substance. Even if estimating this consumption is difficult, it remains a topical concern.

Introduction: The increase in infant mortality in France, driven by the rise in neonatal mortality, raises concerns about the quality of perinatal care. While better organization is identified as a key improvement strategy, data are sparse on the organizational characteristics of maternity units in France.

Methods: This study describes the organization of perinatal care in mainland France in 2016 and 2021, at both national and regional levels, based on data from the National Perinatal Surveys and Annual Hospital Statistics. Six indicators were analysed: maternity unit volume (annual number of births), authorization type, triple on-call coverage (continuous presence of an obstetrician, anaesthesiologist, and paediatrician), understaffed obstetric teams (fewer than 7 full-time equivalents), midwives' workload (ratio of midwives-to-births), and use of temporary staff.

Results: Between 2016 and 2021, the number of maternity units decreased by 8%, and the number of births by 9%. In 2021, 42.5% of maternity units performed fewer than 1000 deliveries per year, 55.4% did not provide triple on-call coverage, 65.9% of obstetric teams were understaffed, 21.1% of midwifery teams had a very high workload, and 68.0% of units used temporary staff at least once a month. These issues varied significantly depending on the region and the unit's level of care.

Conclusion: A large part of the maternity care system was affected by organizational challenges. Their impact on perinatal health needs to be assessed to propose effective solutions for the upcoming revision of the 1998 perinatal care regulations. Significant regional disparities also call for responses tailored to local specificities.

Objectives: In France, each year, approximately 150 women request a medical termination of pregnancy due to psychosocial distress. There are no recommendations regarding their assessment process. Subjectivity can play an even greater role than in the case of a somatic pathology, and differing opinions can sometimes cause tension within teams. The primary objective was to describe these patients' access to care and the stages of their care pathway. The secondary objective was to identify decision-making factors.

Methods: Online questionnaire survey of the 48 CPDPNs in France.

Results: Of the 48 CPDPNs, 44 (91.7%) responded, 23 (52.3%) reported receiving fewer than 5 requests per year, and 10 (22.7%) reported receiving more than 10. Among the centers that responded to this question, 38/43 (88%) reported receiving patients systematically and 5 centers under certain conditions: gestational age, context of the request, or only upon referral from a psychiatrist. Fifteen centers (34%) have an evaluation protocol. After evaluation, 57% of centers report accepting the majority of requests. The most frequently cited factors in favor of acceptance were pregnancy resulting from rape, severe psychological distress, a history of violence, and the young age of the patient. The factors in favor of refusal were perceived ambivalence, lack of evident distress, and non-compliance with the assessment process.

Conclusion: It seems that not all CPDPNs in France systematically receive women who request a termination of pregnancy due to psychosocial distress. Regardless of the final decision concerning the continuation of the pregnancy, medical, social, and psychological support should be offered. A relevant multidisciplinary protocol could enable equitable treatment of patients.