Le travail prématuré spontané (identification précoce par l'électromyogramme utérin et inhibition par le rofecoxib (un inhibiteur de la cyclooxygénase-2) et par les associations de tocolytiques)

L'objectif de ce travail était d'évaluer de nouvelles approches diagnostique et thérapeutique du travail prématuré chez la rate gestante. L'étude de l'électromyogramme utérin a montré que l'analyse spectrale permettait d'identifier précocement le travail prématuré, bien avant l'augmentation de la pression intra-utérine. Au cours du travail prématuré, la cyclooxydenase-2 joue un rôle central dans la synthèse des prostaglandines. Elle est donc une cible thérapeutique privilégiée pour inhiber le travail prématuré. Nous avons montré que le rofecoxib, in inhibiteur spécifique de la cyclooxydenase-2, a un eeffet tocolytique comparable aux inhibiteurs calciques in vitro et in vivo, mais plus puissant que l'indométacine, la ritodrine, et l'atosiban.LYON1-BU.Sciences (692662101) / SudocSudocFranceF

Impact de l'utilisation du STAN pendant le travail (étude avant-après)

LYON1-BU Santé (693882101) / SudocSudocFranceF

Dystocie des épaules (la formation en question)

LYON1-BU Santé (693882101) / SudocSudocFranceF

Impacts of labour first and second stages on Hurst parameter based intrapartum fetal Heart Rate analysis

International audienceIntrapartum fetal heart rate (FHR), routinely monitored in daily obstetrical practice, enables early detection of fetal asphyxia and thus prevention of labour adverse outcomes. FHR variability (FHRV) constitutes an essential characterization of fetal well-being; fetuses with large FHRV are unlikely to be at risk of brain injury. This study investigates the impacts of labour first and second stages on the characterization of FHR temporal dynamics as well as on the discrimination of healthy from acidotic fetuses. FHR temporal dynamics are quantified using Hurst parameter, H, practically estimated within a wavelet framework. Analyses are performed on first and second stages, over a large (3049 records) and well documented database, collected at Hôpital Femme-Mère-Enfant, in Lyon, France. It is observed that Ĥ, for healthy fetuses, remains constant along first stage and then significantly increases during second stage; while, for acidotic fetuses, Ĥ increases to larger values earlier within first stage. This may indicate that the defense mechanism classically at work during second stage as a reaction to excessive stress, is already in use during first stage for acidotic fetuses. Detection performance curves (ROC) also show that second stage Ĥ permits slightly better discrimination of healthy from acidotic fetuses, compared to first stage Ĥ

Impacts of labour first and second stages on Hurst parameter based intrapartum fetal Heart Rate analysis

International audienceIntrapartum fetal heart rate (FHR), routinely monitored in daily obstetrical practice, enables early detection of fetal asphyxia and thus prevention of labour adverse outcomes. FHR variability (FHRV) constitutes an essential characterization of fetal well-being; fetuses with large FHRV are unlikely to be at risk of brain injury. This study investigates the impacts of labour first and second stages on the characterization of FHR temporal dynamics as well as on the discrimination of healthy from acidotic fetuses. FHR temporal dynamics are quantified using Hurst parameter, H, practically estimated within a wavelet framework. Analyses are performed on first and second stages, over a large (3049 records) and well documented database, collected at Hôpital Femme-Mère-Enfant, in Lyon, France. It is observed that Ĥ, for healthy fetuses, remains constant along first stage and then significantly increases during second stage; while, for acidotic fetuses, Ĥ increases to larger values earlier within first stage. This may indicate that the defense mechanism classically at work during second stage as a reaction to excessive stress, is already in use during first stage for acidotic fetuses. Detection performance curves (ROC) also show that second stage Ĥ permits slightly better discrimination of healthy from acidotic fetuses, compared to first stage Ĥ

Fractal Analysis and Hurst Parameter for Intrapartum Fetal Heart Rate Variability Analysis: A Versatile Alternative to Frequency Bands and LF/HF Ratio

International audienceBackgroun

Mutual Information for Intrapartum fetal Heart Rate Analysis

International audienc

Adaptive Multiscale Complexity Analysis of Fetal Heart Rate

International audiencePer partum fetal asphyxia is a major cause of neonatal morbidity and mortality. Fetal heart rate monitoring plays an important role in early detection of acidosis, an indicator for asphyxia. This problem is addressed in this paper by introducing a novel complexity analysis of fetal heart rate data, based on producing a collection of piecewise linear approximations of varying dimensions from which a measure of complexity is extracted. This procedure specifically accounts for the highly nonstationary context of labor by being adaptive and multiscale. Using a reference dataset, made of real per partum fetal heart rate data, collected in situ and carefully constituted by obstetricians, the behavior of the proposed approach is analyzed and illustrated. Its performance is evaluated in terms of the rate of correct acidosis detection versus the rate of false detection, as well as how early the detection is made. Computational cost is also discussed. The results are shown to be extremely promising and further potential uses of the tool are discussed. MATLAB routines implementing the procedure will be made available at the time of publication

Multifractal analysis of fetal heart rate variability in fetuses with and without severe acidosis during labor

International audienceWe performed multifractal analysis of fetal heart rate (FHR) variability in fetuses with and without acidosis during labor. Multifractal analysis was performed on fetal electrocardiograms in 10-minute sliding windows within the last 2 hours before delivery in 45 term fetuses divided in three groups according to umbilical arterial pH and FHR pattern: group A had pH >= 7.30 and normal FHR, group B had pH >= 7.30 and intermediate or abnormal FHR, and group C had acidosis (pH <= 7.05) and intermediate or abnormal FHR. Six multifractal parameters were compared using Wilcoxon rank sum test. Multifractal parameters were significantly different between the three groups in the last 10 minutes before delivery (p < 0.05). Two parameters (h(min), zeta(2)) exhibited a significant difference 70 minutes before delivery, and one parameter (C-2) was different 10 minutes before birth (p < 0.05). Multifractal parameters were significantly different in acidotic and nonacidotic fetuses, independently from FHR pattern