Binational confidential enquiry of maternal deaths due to postpartum hemorrhage in France and the Netherlands: Lessons learned through the perspective of a different context of care

OBJECTIVE: To learn lessons for maternity care by scrutinizing postpartum hemorrhage management (PPH) in cases of PPH-related maternal deaths in France and the Netherlands. METHODS: In this binational Confidential Enquiry into Maternal Deaths (CEMD), 14 PPH-related maternal deaths were reviewed by six experts from the French and Dutch national maternal death review committees regarding cause and preventability of death, clinical care and healthcare organization. Improvable care factors and lessons learned were identified. CEMD practices and PPH guidelines in France and the Netherlands were compared in the process. RESULTS: For France, new insights were primarily related to organization of healthcare, with lessons learned focusing on medical leadership and implementation of (surgical) checklists. For the Netherlands, insights were mainly related to clinical care, emphasizing hemostatic surgery earlier in the course of PPH and reducing the third stage of labor by prompter manual removal of the placenta. Experts recommended extending PPH guidelines with specific guidance for women refusing blood products and systematic evaluation of risk factors. The quality of CEMD was presumed to benefit from enhanced case finding, also through non-obstetric sources, and electronic reporting of maternal deaths to reduce the administrative burden. CONCLUSION: A binational CEMD revealed opportunities for improvement of care beyond lessons learned at the national level

Medical Therapies for Uterine Fibroids - A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials

BACKGROUND: Uterine fibroids are common, often symptomatic and a third of women need repeated time off work. Consequently 25% to 50% of women with fibroids receive surgical treatment, namely myomectomy or hysterectomy. Hysterectomy is the definitive treatment as fibroids are hormone dependent and frequently recurrent. Medical treatment aims to control symptoms in order to replace or delay surgery. This may improve the outcome of surgery and prevent recurrence. PURPOSE: To determine whether any medical treatment can be recommended in the treatment of women with fibroids about to undergo surgery and in those for whom surgery is not planned based on currently available evidence. STUDY SELECTION: Two authors independently identified randomised controlled trials (RCT) of all pharmacological treatments aimed at the treatment of fibroids from a list of references obtained by formal search of MEDLINE, EMBASE, Cochrane library, Science Citation Index, and ClinicalTrials.gov until December 2013. DATA EXTRACTION: Two authors independently extracted data from identified studies. DATA SYNTHESIS: A Bayesian network meta-analysis was performed following the National Institute for Health and Care Excellence-Decision Support Unit guidelines. Odds ratios, rate ratios, or mean differences with 95% credible intervals (CrI) were calculated. RESULTS AND LIMITATIONS: A total of 75 RCT met the inclusion criteria, 47 of which were included in the network meta-analysis. The overall quality of evidence was very low. The network meta-analysis showed differing results for different outcomes. CONCLUSIONS: There is currently insufficient evidence to recommend any medical treatment in the management of fibroids. Certain treatments have future promise however further, well designed RCTs are needed

Which fetal growth curve reference should be now chosen for our country?

International audienceLe CNGOF souhaite pouvoir répondre à cette question en partenariat avec d’autres sociétés savantes nationales et en élaborant de nouvelles recommandations pour la pratique clinique

État des lieux de l’utilisation du sulfate de magnésium à visée neuroprotectrice au CHU de Rouen

International audienc

E. Verspyck et al. in response to the correspondence by R. Bessis et al. about the editorial by E. Verspyck et al.: Which fetal growth curve reference should be now chosen for our country? Gynécologie Obstétrique Fertilité & Sénologie 2021; 49 (10): S246871892100129X. https://doi.org/10.1016/j.gofs.2021.05.001

International audienceNous tenons tout d’abord à préciser que le CNGOF n’a aucunement l’intention de vouloir s’opposer à d’autres sociétés savantes mais à promouvoir des recommandations sur la pratiqueclinique (RPC) basées sur des preuves scientifiques, afin d’éclairer le clinicien [1]. Nous souhaitons également rapporter aux lecteurs que l’un des rôles essentiels de notre comité de pilotage est de rédiger le texte des recommandations à l’aide d’une revue et d’uneanalyse critique de la littérature issue du travail des experts de ce groupe et ce, sans aucun parti pris ni conflit d’intérêt de notre part

Patient with perinatal brain injury dystonia treated by deep brain stimulation: Management during pregnancy

International audienc