Gynecologie Obstetrique Fertilite & Senologie最新文献

Objectives: To evaluate trends in continued pregnancies following a prenatal diagnosis of severe fetal conditions eligible for termination under French law, as well as the associated perinatal outcome.

Methods: We conducted a time-series analysis from 2008 to 2022 using public data from the French National Institute of Statistics and the Biomedicine Agency. Indicators, expressed per 1000 live births, included the number of severe fetal conditions identified antenatally, authorizations for termination of pregnancy, continued pregnancies, overall neonatal mortality, and pregnancy outcomes in case of continuation.

Results: Between 2008 and 2022, the number of severe fetal conditions identified antenatally increased from 8.70 to 12.09 per 1000 live births. Over the same period, the rate of continued pregnancies rose from 0.60 to 2.69 per 1000 live births. This increase was significantly less pronounced than the overall rise in severe fetal conditions diagnosed antenatally (P<0.001). Among continued pregnancies, the proportion of neonates alive at day 28 increased. Neonatal mortality following pregnancy continuation also increased, but at a slower rate than pregnancy continuation, without a specific contribution to the overall trend in neonatal mortality.

Conclusions: Our findings highlight an evolution in pregnancy outcomes following prenatal diagnosis of severe fetal conditions, raising major clinical, ethical, and organizational challenges, and underscoring the need to strengthen perinatal indicators to better inform public health policies.

Objective: To analyze the clinical and cyto-histological evolution of Genitourinary Syndrome of Menopause (GSM) with the use of fractional carbon dioxide laser.

Methods: We conducted a prospective clinical trial at the Hôpital Nord Franche-Comté, Trévenans, France, over a period of 19 months from 2022 to 2023. The patients enrolled were women over 40 years old, postmenopausal with vaginal symptoms of GSM. The primary outcome was the comparison of the clinical symptom intensity score before and after the three laser sessions. The secondary outcomes were the evolution of GSM with laser treatment through a clinical score, a medical score, the assessment of the sexual quality of life, the study of the cytological and histological effects of the laser, and its side effects.

Results: Among the 75 patients enrolled, 68 have been studied. There was a significant improvement of all the symptoms, the medical score and the sexual quality of life after three laser sessions (P<0.01). In cytology, there was an improvement in the vaginal maturation value with an increase in superficial cells and a decrease in basal cells (P<0.01). Histologically, there was an increase in the thickness of the epithelium (P<0.01), the size of the epithelial cells (P=0.01), and the glycogen (P<0.01), and a decrease in the thickness of the basal layers (P<0.01).

Conclusion: Fractional carbon dioxide laser improves symptoms of GSM, sexual quality of life and restores the characteristics of the vaginal epithelium with effects still present six months after.

Objective: To evaluate the relevance of the "red code" caesarean section indication using the relevance grid developed by the Grenoble team.

Methods: We conducted a retrospective two-phase relevance review in a type 3 maternity hospital. "Red code" caesarean sections were identified via the shared medical record, and their indications were discussed by a pair of practitioners and then with the entire obstetric team. Validation rates were compared before and after team awareness (phase 1 [2022-2023] versus phase 2 [July-December 2024]) using a Fisher's exact test.

Results: In phase 1, 109 caesarean sections were recorded, with 74% validated and 26% reclassified as "orange code". The main reasons for reclassification were excessive interpretation of fetal heart rate abnormalities and instrumental birth failure. In phase 2, of 22 caesarean sections identified, 21 (95.5%) were confirmed as "red code", indicating a significant improvement in the relevance rate (P=0.04).

Conclusion: The relevance review showed a significant improvement in the relevance of "red code" caesarean sections, thereby limiting over-reliance on this practice, a source of general anaesthesia and post-traumatic stress.

Cardiotocography (CTG) is defined as the simultaneous recording of fetal heart rate and uterine contractions. It is used worldwide during labour to assess foetal well-being and to detect early signs of hypoxia. However, its interpretation relies mainly on visual assessment by clinicians based on standardized guidelines. This subjective evaluation is associated with substantial inter-observer variability, which continues to fuel debate regarding the actual effectiveness of cardiotocographic monitoring during the peripartum period. From the 1980s onward, researchers and clinicians began developing computerized systems to assist professionals in CTG interpretation. However, these decision-support tools have not yet convincingly demonstrated their ability to improve diagnostic performance or, more importantly, perinatal outcomes. Over the past decade, the availability of large clinical databases and the rise of artificial intelligence (AI) have enabled the development of models capable of analysing CTG signals and predicting the risk of foetal hypoxia. These systems have shown promising performance in identifying pathological situations when evaluated on retrospective cohorts. Nevertheless, several important challenges must be addressed before considering their integration into clinical practice. It is essential to develop and share large, multicentric, open databases that allow the training of robust, representative, and generalizable models. Furthermore, these systems must be embedded within a structured care protocol to ensure consistent and operational use in clinical settings.

Objective: The primary objective was to evaluate the effectiveness of antibiotic prophylaxis in preventing intrauterine infections in patients with term prelabor rupture of membranes from 37 weeks of gestation, with a negative group B Streptococcus PCR test.

Methods: This was a retrospective, single-center, before-and-after cohort study conducted in a type 3 French maternity unit. We included women who delivered at ≥37 weeks of gestation with rupture of membranes lasting more than 12 hours and a negative PCR screening for vaginal Group B Streptococcus colonization. Patients (n=830) in the "antibiotic prophylaxis protocol" group received prophylactic PENICILLIN G starting 18 hours after membrane rupture. Patients (n=682) in the "no antibiotic prophylaxis protocol" group received no antibiotics. Intrauterine infection was defined as a temperature >38°C lasting more than 30 minutes or >38.5°C, combined with at least two of the following criteria: fetal tachycardia, meconium-stained amniotic fluid, or pelvic pain under epidural anesthesia.

Results: A total of 1,512 patients were included. The rate of intrauterine infection was significantly lower in the "antibiotic prophylaxis protocol" group compared to the "no prophylaxis protocol" group (1.33% vs. 3.96%, p=0.001). No significant differences were observed between the two groups regarding postpartum endometritis or early-onset neonatal bacterial infection.

Conclusions: Administering antibiotic prophylaxis starting 18 hours after membrane rupture in term patients with term prelabor rupture of membranes and a negative Group B Streptococcus screening appears to reduce the rate of intrauterine infection.

The Obstetrics Committee of the CNGOF, consulted by the CNP GOGM at the request of the ANSM, has reviewed the safety of obstetric vacuum extraction. Instrumental delivery may be performed to shorten the expulsive phase, particularly in cases of fetal heart rate deceleration. The available instruments are the vacuum, forceps, and spatulas, with the choice depending on the clinical situation and the operator. In France, approximately 12% of births involve instrumental assistance, a rate that has remained stable since 2016. The vacuum is used in about two-thirds of these cases - a proportion similar to that observed in most European countries and in Canada, but higher than in the United States. The vacuum works by creating suction on the fetal scalp, allowing controlled and safe traction. Maternal complications (perineal trauma, hemorrhage) and neonatal complications (notably intracranial hemorrhage) are rare and comparable to those observed in cesarean deliveries performed during labor. Epidemiological studies do not show an increased risk of neurological impairment or long-term sequelae in children born by vacuum extraction. Compared with forceps, vacuum extraction is associated with reduced maternal morbidity, particularly a lower risk of anal sphincter injury, with no significant difference in overall neonatal outcomes, except for a slightly higher risk of cephalohematoma or jaundice. No difference has been observed according to operator experience. In conclusion, vacuum-assisted vaginal delivery, which is a technique among the methods recommended by the CNGOF, represents a relevant alternative to cesarean section at full cervical dilation.