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}
Pub Date : 2025-12-01DOI: 10.1016/j.gofs.2025.10.008
Véronique Pierrat , Jennifer Zeitlin , Pierre-Yves Ancel
This study presents a summary of the results from two cohorts of children born very preterm, EPIPAGE-2 (Epidemiological Study of Small Gestational Ages) in France, and EPICE-SHIPS (“Effective Perinatal Intensive Care in Europe”) in Europe. In 2011, these two cohorts collected data on very preterm infants and their families between birth and age 10. The survival of very preterm infants has improved over the past 25 years, but with significant differences between countries, particularly for extreme prematurity. At preschool age in France, 28% of children born at 24–26 weeks, 19% of those born at 27–31 weeks, and 12% of children born at 32–34 weeks had moderate to severe impairments, compared with 5% of children born at term. 52% of children born at 24–26 weeks of gestation received specialized care, compared to 33% at 27–31 weeks, 26% at 32–34 weeks, and 25% at term. Among children with moderate to severe disabilities, 30–40% did not receive any specialized care. In Europe, the percentage of children receiving such care varied from 28% to 50% depending on the European region. These cohorts provided original data on the prognosis of children born very preterm, its evolution over time, and the care offered. They helped to redefine certain practices, healthcare organization methods and public health policies. Despite the progress made, these children, who represent only 1% of births, account for 50% of perinatal deaths and 50% of disabilities associated with the perinatal period. Nearly 15 years after EPIPAGE-2 and EPICE, the question arises of re-evaluating the care and prognosis for these children.
{"title":"Devenir des enfants nés prématurément en France et en Europe : cohortes EPIPAGE-2, EPICE, et SHIPS","authors":"Véronique Pierrat , Jennifer Zeitlin , Pierre-Yves Ancel","doi":"10.1016/j.gofs.2025.10.008","DOIUrl":"10.1016/j.gofs.2025.10.008","url":null,"abstract":"<div><div>This study presents a summary of the results from two cohorts of children born very preterm, EPIPAGE-2 (Epidemiological Study of Small Gestational Ages) in France, and EPICE-SHIPS (“Effective Perinatal Intensive Care in Europe”) in Europe. In 2011, these two cohorts collected data on very preterm infants and their families between birth and age 10. The survival of very preterm infants has improved over the past 25 years, but with significant differences between countries, particularly for extreme prematurity. At preschool age in France, 28% of children born at 24–26 weeks, 19% of those born at 27–31 weeks, and 12% of children born at 32–34 weeks had moderate to severe impairments, compared with 5% of children born at term. 52% of children born at 24–26 weeks of gestation received specialized care, compared to 33% at 27–31 weeks, 26% at 32–34 weeks, and 25% at term. Among children with moderate to severe disabilities, 30–40% did not receive any specialized care. In Europe, the percentage of children receiving such care varied from 28% to 50% depending on the European region. These cohorts provided original data on the prognosis of children born very preterm, its evolution over time, and the care offered. They helped to redefine certain practices, healthcare organization methods and public health policies. Despite the progress made, these children, who represent only 1% of births, account for 50% of perinatal deaths and 50% of disabilities associated with the perinatal period. Nearly 15 years after EPIPAGE-2 and EPICE, the question arises of re-evaluating the care and prognosis for these children.</div></div>","PeriodicalId":56056,"journal":{"name":"Gynecologie Obstetrique Fertilite & Senologie","volume":"53 12","pages":"Pages 710-717"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276649","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.2025.10.019
Gilles Kayem
{"title":"La prévention, le dépistage, la prise en charge du prématuré : un domaine en évolution constante","authors":"Gilles Kayem","doi":"10.1016/j.gofs.2025.10.019","DOIUrl":"10.1016/j.gofs.2025.10.019","url":null,"abstract":"","PeriodicalId":56056,"journal":{"name":"Gynecologie Obstetrique Fertilite & Senologie","volume":"53 12","pages":"Page 655"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145356824","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.2025.10.012
Thomas Schmitz
Retrospective foreign studies conducted using data from medical-administrative registers have all reported an increase in neonatal mortality and morbidity associated with vaginal delivery, mainly for the second twin. However, these studies suffer from major methodological flaws: lack of comparison according to the planned route of delivery, difficulty in distinguishing extreme prematurity from moderate or late prematurity, lack of adjustment for the most important confounding factors, so that their results do not allow any conclusion regarding a protective effect of cesarean section. Conversely, 3 high-quality French studies, including 2 prospective studies, report no benefit associated with cesarean section in women with preterm labor or premature rupture of membranes. In these 3 studies, even if the differences are not significant, severe neonatal morbidity is lower or survival without severe neonatal morbidity is higher in the planned vaginal delivery group compared to the planned cesarean group. In conclusion, there is no scientific evidence to support any protective effect of elective caesarean section in cases of spontaneous prematurity before 32 weeks of gestation. Therefore, planned vaginal delivery should be the preferred option in France.
{"title":"Voie d’accouchement pour les jumeaux grands prématurés","authors":"Thomas Schmitz","doi":"10.1016/j.gofs.2025.10.012","DOIUrl":"10.1016/j.gofs.2025.10.012","url":null,"abstract":"<div><div>Retrospective foreign studies conducted using data from medical-administrative registers have all reported an increase in neonatal mortality and morbidity associated with vaginal delivery, mainly for the second twin. However, these studies suffer from major methodological flaws: lack of comparison according to the planned route of delivery, difficulty in distinguishing extreme prematurity from moderate or late prematurity, lack of adjustment for the most important confounding factors, so that their results do not allow any conclusion regarding a protective effect of cesarean section. Conversely, 3 high-quality French studies, including 2 prospective studies, report no benefit associated with cesarean section in women with preterm labor or premature rupture of membranes. In these 3 studies, even if the differences are not significant, severe neonatal morbidity is lower or survival without severe neonatal morbidity is higher in the planned vaginal delivery group compared to the planned cesarean group. In conclusion, there is no scientific evidence to support any protective effect of elective caesarean section in cases of spontaneous prematurity before 32 weeks of gestation. Therefore, planned vaginal delivery should be the preferred option in France.</div></div>","PeriodicalId":56056,"journal":{"name":"Gynecologie Obstetrique Fertilite & Senologie","volume":"53 12","pages":"Pages 707-709"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276601","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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