Le port du masque pendant les efforts expulsifs : quel impact réel sur les modalités d’accouchement ?

International audienc

Republication de : Risque périnéal et mesures de protection obstétricale : enquête auprès des professionnels de la naissance

International audienceObjectivesThe main objective was to evaluate the practices declared by birth professionals in the Lorraine region about perineal obstetric protection (any perineal tear combined). The secondary objective was to evaluate prevention measures performed in practice by birth professionals according to the perineal risk subjectively estimated for each obstetric situation.MethodsThis is a practice survey conducted through an anonymous questionnaire distributed to birth professionals (gynecologists, interns, midwife and midwife student) in October 2016. Topics covered concerned maternal, obstetric and fetal risk factors associated with perineal (1st to 4th degrees) lesions and the associated protective measures. A descriptive analysis of the data collected was conducted.ResultsOne hundred and five professionals answered the questionnaire. The identified risk factors were consistent with those highlighted in the literature. Other factors, not known as associated with perineal risk, were cited by professionals (smoking, phototype). If the professional perceived a significant perineal risk, they more frequently practiced an episiotomy (15% vs. 0%, P < 0.001) or considered that the delivery should be performed by an obstetrician (34% vs 8%, P < 0.001).ConclusionThis evaluation shows that birth professionals know the main risk factors for perineal injury. On the other hand, they easily use perineal protection maneuvers (episiotomy for example) without real demonstrated effectiveness.ObjectifsL’objectif de notre étude était de réaliser une évaluation des pratiques déclarées par les professionnels de la naissance de la région Lorraine à propos de la protection périnéale obstétricale (toute déchirure périnéale confondue). L’objectif secondaire était d’évaluer les mesures de prévention réalisées en pratique par les professionnels de la naissance en fonction du risque périnéal subjectivement estimé pour chaque situation obstétricale.MéthodesIl s’agit d’une enquête de pratique réalisée grâce à un questionnaire anonyme distribué aux professionnels de la naissance (gynécologues-obstétriciens, internes de spécialité, sage-femme, étudiants sage-femme) en octobre 2016. Les thèmes abordés concernaient les facteurs de risque maternels, obstétricaux et fœtaux associés aux lésions périnéales (du 1er au 4e degrés) et les mesures de protection associées. Il a été réalisé une analyse descriptive des données recueillies.RésultatsCent cinq professionnels ont répondu au questionnaire. Les facteurs de risque identifiés étaient en accord avec ceux mis en évidence dans la littérature. D’autres facteurs, non connus comme associés à un risque périnéal, étaient cités par les professionnels (tabagisme, phototype). En cas de perception, subjective, par le professionnel d’un risque périnéal important, ils pratiquaient plus fréquemment une épisiotomie (15 % vs 0 %, p < 0,001) ou considéraient que l’accouchement devaient être réalisé par un obstétricien (34 % vs 8 %, p < 0,001).ConclusionCette évaluation montre que les professionnels de la naissance connaissent les principaux facteurs de risque de lésion périnéale. En revanche, ils utilisent facilement des manœuvres de protection périnéale (épisiotomie par exemple) sans réelle efficacité démontrée

Risque périnéal et mesures de protection obstétricale : enquête auprès des professionnels de la naissance

International audienc

Place de l’antibiothérapie en première intention en cas de bartholinite aiguë : à propos d’une série de 33 cas

International audienc

Liquide amniotique teinté ou méconial : doivent-ils modifier notre prise en charge obstétricale ?

International audienc

Évaluation des compétences pour la pratique de la biométrie échographique fœtale : validation prospective du score OSAUS METHOD

International audienceObjectivesTo develop and validate a customized variant for fetal biometry of the generic OSAUS score (Objective Structured Assessment of Ultrasound Skills)MethodsThe 5-points OSAUS METHOD grid was elaborated by defining five target skills specific to fetal biometry for each thematic item of the generic score. The level of skills of 43 trainees was prospectively assessed during an ultrasound examination by using this grid. The results of the “novice” level group (experience < 10 ultrasounds) were compared to those of the “intermediate” level group (experience ≥ 10 ultrasounds) (I). The reached/non-reached skills ratio within the different items composing the score allowed the identification of priority areas of improvement (II). Previously published distribution and actual distribution of ratings according to the generic pass/fail score were compared (III).ResultsMedian scores of “novices” (n = 29) and “intermediates” (n = 14) groups were statistically different, 1.87 (±0.75) and 3.31 (±0.83) (P = 1.85-5), respectively and corresponded to the pre-existing experience (I). A lower ratio of reached skill allowed the identification of “documentation of the examination” item as a priority area of improvement for both groups (II). The relevance of the pass/fail score is consolidated, even if an overlap was observed between novices and intermediates groups (III).ConclusionsThe relevancy and feasibility of using OSAUS scoring method for fetal biometry are supported. In addition, the possibility of comparisons with generic OSAUS remains.ObjectifsDévelopper et évaluer la pertinence clinique d’une version du score générique OSAUS (Objective Structured Assessment of Ultrasound Skills) dédiée à la biométrie fœtale.Matériel et méthodesCinq compétences cibles spécifiques à la biométrie fœtale ont été définies pour chaque item thématique du score générique permettant d’établir une grille d’évaluation OSAUS-METHOD sur 5 points (MEasurements TeacHing in Obstetrics Design). Le niveau de compétence de 43 étudiants a été évalué à l’aide grille OSAUS-METHOD (MEasurements TeacHing in Obstetrics Design) lors d’examens pratiques. Les notes des étudiants débutants (expérience pratique < 10 examens) ont été comparées à celles des étudiants de niveau intermédiaire (expérience pratique ≥ 10 examens) (I). La proportion de compétences validées ou non au sein de chacun des items thématiques du score a permis d’identifier les axes de progression prioritaires (II). La distribution des notes obtenues par rapport au seuil de certification utilisé pour le score générique a été comparée à celle précédemment publiée (III).RésultatsLe score moyen au sein du groupe « débutants » (n = 29) était significativement plus faible que celui au sein du « intermédiaires » (n = 14) (1,87 ± 0,75 et 3,31 ± 0,83 respectivement, p = 1,855) (I). Une proportion plus importante de compétences non validée a permis d’identifier l’item « documentation de l’examen » comme axe de progression prioritaire (II). La pertinence du score seuil pour discriminer les étudiants en fonction du niveau d’expertise est confortée mais un minime chevauchement entre les groupes de niveau est observé (III).ConclusionLa faisabilité et la pertinence de l’utilisation d’un score OSAUS dédié à la biométrie sont confirmées ainsi que la possibilité de comparaisons avec le score OSAUS générique

Assessment of placental perfusion using contrast-enhanced ultrasound: A longitudinal study in pregnant rabbit

International audienc

Artificial intelligence assistance for fetal head biometry: Assessment of automated measurement software

International audienceTo evaluate the feasibility and reproducibility of artificial intelligence software (Smartplanes ®) to automatically identify the transthalamic plane from 3D ultrasound volumes and to measure the biparietal diameter (BPD) and head circumference (HC) in fetus. Material and methods: Thirty fetuses were evaluated at 17-30 weeks' gestation. For each fetus two three-dimensional (3D) volumes of the fetal head along with one conventional two-dimensional (2D) image of the transthalamic plane were prospectively acquired. The Smartplanes ® software identified the transthalamic plane from the 3D volumes and performed BPD and HC measurements automatically (3D auto). Two experienced sonographers also measured BPD and HC from 2D images and from the 3D volumes. Measurements were compared using Bland-Altman plots. Interclass correlation coefficient (ICC) was used to evaluate intraand interobserver reproducibility. Results: For each series of measurements, intra-and interobserver reproducibility rates were high with ICC values > 0.98. The 95% confidence intervals between the BPD measurements were 2 mm (3D versus 2D) and 4 mm (3D auto versus 2D) and the HC measurements were 7.5 mm (3D versus 2D) and 11 mm (3D auto versus 2D). Conclusion: Fetal head measurements obtained automatically by Smartplanes ® software from 3D volumes show good agreement with those obtained by two experienced sonographers from conventional 2D images and 3D volumes. The reproducibility of these measurements is similar to that observed by experienced sonographers

Fetal biometry in ultrasound: A new approach to assess the long-term impact of simulation on learning patterns

International audienceSimulation-based education (SBE) has demonstrated its acceptability and effectiveness in improving ultrasound training. Because of the high cost of its implementation (investment in equipment and supervision), a pragmatic assessment of the transfer of skills learned in SBE to clinical practice and the identification of its optimal scheduling conditions have been requested to optimize its input. Objectives: To quantify the long-term impact of simulation-based education (SBE) on the adequate performance of ultrasound fetal biometry measurements (I). The secondary objective was to identify the temporal patterns that enhanced SBE input in learning (II). Methods: Trainees were arbitrarily assigned to a 6-month course in obstetric ultrasound with or without an SBE workshop. In the SBE group, the workshop was implemented 'before' or at an 'early' or a 'late-stage' of the course. Those who did not receive SBE were the control group. The ultrasound skills of all trainees were prospectively collected, evaluated by calculating the delta between OSAUS (Objective Structured Assessment of Ultrasound Skills) scores before and after the course (I). Concomitantly, the accuracy of trainees' measurements was assessed throughout the course by verifying their correlation with the corresponding measurements by their supervisors. The percentage of trainees able to perform five consecutive sets of correct measurements in the control group and in each SBE subgroup were compared (II). Results: The study included 61 trainees (39 SBE and 22 controls). Comparisons between groups showed no significant difference in the quantitative assessment of skill enhancement (difference in the pre-and postinternship OSAUS score: 1.09 § 0.87 in the SBE group and 0.72 § 0.98 in the control group) (I). Conversely, the predefined acceptable skill level was reached by a significantly higher proportion of trainees in the 'early' SBE subgroup (74%, compared with 30% in the control group, P<0.01)(II). Conclusions: The quantitative assessment does not support the existence of long-term benefits from SBE training, although the qualitative assessment confirmed SBE helped to raise the minimal level within a group when embedded in an 'early' stage of a practical course