Gynecologie Obstetrique Fertilite & Senologie最新文献

英文中文

[What do French professionals think of the current limits of assisted reproduction technologies in France, should the bioethics law evolve?] [法国专业人士如何看待目前法国辅助生殖技术的局限性？］

IF 0.6 4区医学 Q4 OBSTETRICS & GYNECOLOGY

Gynecologie Obstetrique Fertilite & Senologie

Pub Date : 2024-11-05 DOI: 10.1016/j.gofs.2024.11.001

Joelle Belaisch Allart

引用次数: 0

Sommaire 目录

IF 0.6 4区医学 Q4 OBSTETRICS & GYNECOLOGY

Gynecologie Obstetrique Fertilite & Senologie

Pub Date : 2024-11-01 DOI: 10.1016/S2468-7189(24)00312-X

引用次数: 0

Utilité de la mesure échographique du segment utérin inférieur avant accouchement parmi les femmes ayant un antécédent de césarienne : revue de la littérature [剖宫产产妇分娩前子宫下段超声测量的实用性：文献综述]。

IF 0.6 4区医学 Q4 OBSTETRICS & GYNECOLOGY

Gynecologie Obstetrique Fertilite & Senologie

Pub Date : 2024-11-01 DOI: 10.1016/j.gofs.2024.03.007

Identifying women with a history of cesarean delivery and at real risk for uterine rupture is an important aim in obstetric care. It is with this objective that different authors have evaluated the interest of ultrasound for predicting the risk of a cesarean scar defect by measuring the thickness of the lower uterine segment. The literature is sparse and subject to numerous biases because they are mainly prospective cohort studies with small numbers. However, the results are concordant: Ultrasound measurements of lower uterine segment thickness are strongly correlated with the operative findings observed during cesarean delivery. Moreover, the thinner the lower uterine segment on ultrasound, the higher the likelihood of a uterine defect. Two randomized trials have recently been published. The PRISMA cluster randomized controlled trial evaluated a multifaceted intervention including an ultrasound estimation of the risk of uterine rupture by ultrasound measurement of the lower uterine segment thickness and aimed at helping women in their choice of mode of delivery after a previous cesarean delivery. This multifaceted intervention resulted in a significant reduction in the rates of major perinatal and maternal morbidity, without any increase in the rate of cesarean delivery or uterine rupture. However, due to its design, it is impossible to specifically specify the benefit of lower uterine segment measurement in reducing major maternal and perinatal morbidity since the trial combined several interventions. The LUSTrial randomized controlled trial evaluated the impact on maternal-fetal morbidity and mortality of proposing a mode of delivery based on ultrasound measurement of the lower uterine segment thickness compared to usual care among women with a history of cesarean delivery. Ultrasound measurement of lower uterine segment thickness was not associated with a statistically significant reduction in maternal-fetal morbidity and mortality compared to usual care. In this literature review, we will mainly detail and analyze the results of this trial.

产科护理的一个重要目标是识别有剖宫产史且确实存在子宫破裂风险的妇女。正是基于这一目标，不同的学者通过测量子宫下段的厚度，评估了超声波在预测剖宫产瘢痕缺损风险方面的作用。由于这些文献主要是前瞻性队列研究，研究人数较少，因此文献数量稀少且存在许多偏差。不过，研究结果是一致的：子宫下段厚度的超声测量结果与剖宫产手术中观察到的结果密切相关。此外，超声显示子宫下段越薄，子宫缺损的可能性就越大。最近发表了两项随机试验。PRISMA群组随机对照试验评估了一种多方面的干预措施，包括通过超声测量子宫下段厚度来估计子宫破裂的风险，旨在帮助剖宫产后的产妇选择分娩方式。这种多方面的干预措施显著降低了围产期和孕产妇的主要发病率，而剖宫产率和子宫破裂率却没有增加。然而，由于试验设计的原因，无法具体说明子宫下段测量对降低产妇和围产期主要发病率的益处，因为该试验结合了多种干预措施。LUSTrial 随机对照试验评估了在有剖宫产史的产妇中，根据子宫下段厚度的超声测量提出分娩方式与常规护理相比，对母婴发病率和死亡率的影响。与常规护理相比，超声测量子宫下段厚度与母胎发病率和死亡率的降低没有统计学意义。在这篇文献综述中，我们将主要详细介绍和分析这项试验的结果。

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引用次数: 0

Enquête nationale sur la stratégie de prise en charge du placenta accreta en France [法国胎盘早剥管理策略调查]。

IF 0.6 4区医学 Q4 OBSTETRICS & GYNECOLOGY

Gynecologie Obstetrique Fertilite & Senologie

Pub Date : 2024-11-01 DOI: 10.1016/j.gofs.2024.03.008

Objective

Placenta accreta belongs to placenta accreta spectrum and is defined by an adhesion or even invasion of the placental villi in the myometrium. The main risk factor is a history of cesarean section. Its incidence is increasing following an increase in the cesarean section rate in recent years and the cause of severe maternal morbidity (hemorrhage, transfusions, hysterectomy). Treatment can be radical by cesarean section-hysterectomy or conservative with an attempt at uterine preservation. American, English, Canadian and international recommendations have been established but there are no French recommendations to date. The objective of this study was to investigate management strategy for placenta accreta in type III maternity hospitals in France.

Materials and methods

An anonymous questionnaire was sent by email to the obstetrics referents of the university hospital centers in France with type III maternity.

Results

Forty-eight centers were approached, with a participation rate of 77%.

Conclusion

The management of placenta accreta spectrum in France is relatively heterogeneous on several points such as multidisciplinary management, evaluation by placental MRI, preoperative urological evaluation, treatment adopted as first-line, cesarean section-hysterectomy or conservative treatment, therapeutic strategy according to the placental invasion. However, the literature is currently poor, which may explain divergent treatment.

目的：胎盘早剥属于胎盘早剥的一种，是指胎盘绒毛在子宫肌层粘连甚至侵入子宫肌层。主要风险因素是剖宫产史。近年来，随着剖宫产率的增加，其发病率也在不断上升，并导致产妇严重发病（大出血、输血、子宫切除）。治疗方法可以是剖宫产-子宫切除的根治性治疗，也可以是试图保留子宫的保守性治疗。美国、英国、加拿大和国际上都制定了相关建议，但迄今为止还没有法国的建议。本研究的目的是调查法国三类妇产医院对胎盘早剥的处理策略：通过电子邮件向法国拥有 III 类产科的大学医院中心的产科推荐人发送匿名问卷：结果：共联系了 48 家中心，参与率为 77%：法国的胎盘早剥管理在多个方面存在差异，如多学科管理、胎盘磁共振成像评估、术前泌尿系统评估、一线治疗、剖宫产-子宫切除术或保守治疗、根据胎盘侵犯情况采取的治疗策略等。然而，目前的文献较少，这可能是治疗方法存在差异的原因。

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引用次数: 0

Cancer du sein : peut-on l’envisager comme une maladie professionnelle ? [乳腺癌：我们能否将其视为职业暴露疾病？］

IF 0.6 4区医学 Q4 OBSTETRICS & GYNECOLOGY

Gynecologie Obstetrique Fertilite & Senologie

Pub Date : 2024-11-01 DOI: 10.1016/j.gofs.2024.07.001

Objective

Breast cancer is the leading cancer in women in terms of incidence and mortality. The literature currently identifies several risk factors, some modifiable and others not. Because of its multifactorial nature, the combination of factors either increases or reduces the risk of cancer. Since 2004, the first commission's rapport of the French National Environmental Health Plan has recognized the significant impact of occupational exposure on the development of breast cancer. However, neither primary nor secondary preventive measures have yet been implemented in work environment.

Method

Based on available literature, we reviewed current knowledge of breast cancer risk factors associated with occupational exposure.

Results

The risk factors identified were ionizing radiation, magnetic fields, certain endocrine disruptors, ethylene oxide and night shift work.

Conclusion

Recognition of breast cancer as an occupational disease is complicated. In some cases, however, it may be possible, particularly in cases of multifactorial exposure. This work should help to raise awareness among employers and reinforce preventive measures in the workplace.

目的：乳腺癌是女性发病率和死亡率最高的癌症。目前的文献指出了几种风险因素，其中有些可以改变，有些则不能。由于乳腺癌具有多因素性，各种因素的综合作用会增加或减少患癌风险。自 2004 年以来，法国国家环境健康计划第一委员会的报告已认识到职业暴露对乳腺癌发病的重大影响。然而，无论是一级还是二级预防措施都尚未在工作环境中实施：方法：根据现有文献，我们回顾了与职业暴露相关的乳腺癌风险因素的现有知识：结果：确定的风险因素包括电离辐射、磁场、某些内分泌干扰物、环氧乙烷和夜班工作：结论：将乳腺癌认定为职业病非常复杂。然而，在某些情况下，特别是在接触多种因素的情况下，将乳腺癌认定为职业病是可能的。这项工作应有助于提高雇主的认识，加强工作场所的预防措施。

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引用次数: 0

L’allaitement maternel chez les femmes vivant avec le VIH : un défi multidisciplinaire 感染艾滋病毒妇女的母乳喂养：多学科挑战

IF 0.6 4区医学 Q4 OBSTETRICS & GYNECOLOGY

Gynecologie Obstetrique Fertilite & Senologie

Pub Date : 2024-11-01 DOI: 10.1016/j.gofs.2024.10.003

Pr Jeanne Sibiude

引用次数: 0

Fistule vésicovaginale à la suite d’une myolyse transvaginale par micro-ondes, à propos de deux cas [经阴道微波肌溶解后的膀胱阴道瘘：两个病例的报告]。

IF 0.6 4区医学 Q4 OBSTETRICS & GYNECOLOGY

Gynecologie Obstetrique Fertilite & Senologie

Pub Date : 2024-11-01 DOI: 10.1016/j.gofs.2024.06.003

引用次数: 0

Risque d'acidose en cas de déclenchement pour PAG avant 37 SA [严重早产 SGA 胎儿经阴道分娩并引产的机会：一项观察性研究]。

IF 0.6 4区医学 Q4 OBSTETRICS & GYNECOLOGY

Gynecologie Obstetrique Fertilite & Senologie

Pub Date : 2024-11-01 DOI: 10.1016/j.gofs.2024.03.086

Objective

If a small for gestational age (SGA) foetus needs to be delivered because of severity (< 3rd centile) attempting induction of labor theoretically increases the risk of caesarean section and neonatal acidosis, but these risks are poorly understood. This article aims to assess the risk of caesarean section and neonatal acidosis in attempted vaginal birth of a moderately preterm foetus in the setting of severe SGA.

Method

A single-centre hospital-based observational study conducted over a period of 17 consecutive years in mothers with a single foetus in cephalic presentation with severe SGA (< 3rd centile) needing foetal extraction. Neonatal acidosis was considered moderate if pH < 7.10 and severe if pH < 7.0. The degree of severity of SGA was estimated according to the birth weight ratio.

Results

Four hundred and thirty-four foetuses with severe SGA were included during the period, 140 of whom were born after induction (32.3%). In this group, 66.4% of women achieved a vaginal birth (66.4%; 95% CI [58.0-74.2]) and the risk of moderate or severe acidosis was doubled compared with the group of foetuses who had undergone a planned caesarean section (7.9% vs. 3.1%, OR = 2.7 [1.1-6.7]). Neither gestational age nor the degree of growth restriction was significantly related to the risk of caesarean section or to the risk of moderate or severe neonatal acidosis.

Conclusion

In cases of severe SGA before 37 weeks' gestation, induction of labour allows vaginal delivery in two-thirds of cases. It is accompanied by a doubling of the risk of moderate or severe neonatal acidosis.

目标：如果胎龄过小（SGA）的胎儿因严重的 SGA 而需要分娩（方法：对单胎头位、重度 SGA 的母亲进行连续 17 年的单中心医院观察研究：连续 17 年对单胎头位分娩且严重 SGA 的母亲进行单中心医院观察研究（结果：在此期间，共纳入 434 名严重 SGA 胎儿：研究期间共纳入了 434 名重度 SGA 胎儿，其中 140 名是引产后出生的（32.3%）。在这一组中，66.4%的产妇通过阴道分娩（66.4%；95% CI [58.0-74.2]），与计划剖腹产的胎儿相比，中度或重度酸中毒的风险增加了一倍（7.9% 对 3.1%，OR=2.7 [1.1-6.7]）。胎龄和生长受限程度与剖腹产风险或中度或重度新生儿酸中毒风险均无明显关系：结论：对于妊娠 37 周前的重度 SGA 病例，三分之二的病例可以通过引产进行阴道分娩。结论：对于妊娠 37 周前的重度 SGA 病例，三分之二的病例可以通过引产进行阴道分娩，但同时发生中度或重度新生儿酸中毒的风险会增加一倍。

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引用次数: 0

Comment je fais… une mastectomie endoscopique en 10 étapes [我是怎么做的......内窥镜乳房切除术 10 个步骤]。

IF 0.6 4区医学 Q4 OBSTETRICS & GYNECOLOGY

Gynecologie Obstetrique Fertilite & Senologie

Pub Date : 2024-11-01 DOI: 10.1016/j.gofs.2024.05.004

引用次数: 0

Sommes-nous enfin prêts à dépister les cardiopathies congénitales au 1er trimestre de la grossesse en population à bas risque ? 我们终于准备好在妊娠头三个月对低风险人群进行先天性心脏病筛查了吗？

IF 0.6 4区医学 Q4 OBSTETRICS & GYNECOLOGY

Gynecologie Obstetrique Fertilite & Senologie

Pub Date : 2024-11-01 DOI: 10.1016/j.gofs.2024.01.001

引用次数: 0

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