Qualité de vie, symptômes et satisfaction à moyen terme après promontofixation laparoscopique. Facteurs prédictifs de satisfaction post opératoire

Objectives: the Pelvic Organ Prolapse (POP) is a common condition that can lead to pelvic disorders, with an impact on the quality of life. Laparoscopic Sacrocolpopexy (LSCP) is currently considered the reference technique for repair of POP. Published results are focused on anatomical results or short time functional results. The main objective of our study was to evaluate the medium term effect of the LSCP on symptoms with valid self-questionnaires. Our second objective is to determine if some pre and intra-operative factors are associated with post-operative women’s satisfaction. Methods: this retrospective single center trial included women suffering from grade 2 and above POP, who underwent LSCP between October 2004 and January 2011. Included patients had completed a preoperative questionnaire and received a similar postoperative one with specific and valid self-questionnaires. Our study has received a favorable opinion from the French Ethics Committee. Results: 152 patients, average aged of 57.9 (±8.9) were included and 92 returned the completed questionnaire (60.5%). The mean follow up was of 50.5 months (4.2 years). The quality of life of patients were significantly improved after LSCP (p<0.001) and the patients were satisfied (PGI-I score = 1.80 (±1.1)). The mean postoperative PFDI20, PFIQ 7, ICIQ, and PISQ12 score were respectively 52.8 (±47.0), 15.44 (±32.17), 6.1 (±20.8) et de 34.8 (±7.57). The post-operative constipation and the recurrence of POP are associated with a poorer satisfaction. A grade =3 seems to predict a better post-operative satisfaction. Conclusions: at a mean follow up of 4.2 years, the patients’ satisfaction remains high after LSCP. The efficiency of LSCP persists with a permanent improvement of pelvic symptoms and quality of life.Introduction : le prolapsus génito urinaire (PGU) est une pathologie fréquente responsable de symptômes pelviens associés à une altération de la qualité de vie. La promontofixation laparoscopique (PFL) est reconnue comme la technique chirurgicale de référence, selon les données de la littérature, qui s’appuient sur des résultats anatomiques ou des résultats fonctionnels à court terme. L’objectif de cette étude est d’évaluer les symptômes et la qualité de vie des patientes à moyen terme après une PFL. L’objectif secondaire est d’identifier des facteurs prédictifs de satisfaction post opératoire. Matériel et méthode : cette étude rétrospective, monocentrique a inclus les patientes opérées entre 2004 et 2011 par PFL pour un PGU symptomatique de stade = 2, qui avaient rempli un questionnaire pré opératoire. Un questionnaire post opératoire similaire a été envoyé à ces patientes contenant des auto-questionnaires validés et spécifiques au PGU. Cette étude a reçu un avis favorable du comité de protection des personnes. Résultats : 152 patientes ont été incluses et 92 (60,5%), âgées de 57,9 (±8.9) ans, ont rempli le questionnaire post opératoire. La durée de suivi moyen était de 50,5 mois (4,2 ans). La qualité de vie des patientes était significativement améliorée en post opératoire (p<0.001) et les patientes satisfaites (PGI-I = 1.80 (±1.1). Les scores moyens du PFDI20, du PFIQ 7, de l’ICIQ et du PISQ-12 étaient respectivement de 52.8 (±47.0), 15.44 (±32.17), 6.1 (±20.8) et de 34.8 (±7.57). La constipation post opératoire et la récidive du PGU sont associées à une moins bonne satisfaction. Un stade de PGU = 3 semble prédictif d’une meilleure satisfaction post opératoire. Conclusion : cette étude a permis de démontrer la nette satisfaction des patientes à moyen terme après PFL avec une efficacité à moyen terme confirmée par l’amélioration persistante des symptômes et de la qualité de vie des patientes

Drug use for gastrointestinal symptoms during pregnancy: A French nationwide study 2010-2018.

PurposeTo describe drug prescription for gastrointestinal symptoms during pregnancy.MethodsUsing the French national health database, we identified pregnancies ending with a birth between April 2010 and December 2018, in France. We studied prescription of antacids, antispasmodics, antinauseants, laxatives and antidiarrheals during pregnancy, between two trimesters before and two trimesters after delivery. We also assessed hospitalization for gastrointestinal symptoms during pregnancy.ResultsAmong 6,365,471 pregnancies, 4,452,779 (74.0%) received at least one gastrointestinal drug during pregnancy; 2,228,275 (37.0%) received an antacid, 3,096,858 (51.5%) an antispasmodic, 1,861,731 (31.0%) an antinauseant, 919,116 (15.3%) a laxative and 617,808 (10.3%) an antidiarrheal. Prescription of proton pump inhibitors doubled from 12.2% in 2010 to 26.0% in 2018, while domperidone use decreased from 18.3% in 2010 to 2.2% in 2018. In addition, prescription of antacids increased from 7.0% during the trimester before pregnancy to 11.8% during the 1st trimester, 17.0% during the 2nd trimester and 23.4% during the 3rd trimester. Antispasmodic use was 10.6% during the trimester before pregnancy, 23.1% during the 1st trimester, 25.2% during the 2nd trimester and 24.0% during the 3rd trimester. Prescription of antinauseant drugs increased from 5.0% during the trimester before pregnancy to 25.7% during the 1st trimester, then decreased to 6.4% during the 2nd trimester and 3.2% during the 3rd trimester. Nausea/vomiting was the most common cause of hospitalization for gastrointestinal symptoms or diseases during pregnancy, although it accounted for only 1.0% of pregnancies.ConclusionsApproximately three-quarters of women use drugs for gastrointestinal symptoms during pregnancy in France. Prescription of gastrointestinal drugs during pregnancy should be the subject of more detailed risk-benefit assessment and recommendations

Medium-term outcomes of laparoscopic sacropexy on symptoms and quality of life. Predictive factors for postoperative dissatisfaction

International audienceIntroduction and hypothesis: We aimed to evaluate the medium-term results of laparoscopic sacropexy (LSP) with validated self-administered questionnaires of symptoms and quality of life and to identify pre-, intra-, and postoperative predictors of postoperative dissatisfaction. Methods: The study included 152 women who had LSP for stage 2 or higher pelvic organ prolapse (POP). The study population comprised women who had completed the preoperative symptom questionnaire (including the PFDI-20 and ICIQ-SF). Postoperative questionnaires included those questionnaires as well as the PFIQ-7 and EQ-5D questionnaires, PISQ-12 sexual function questionnaire, and PGI-I questionnaire (to assess patient satisfaction). Results: In all, 92 women (60.5%) responded in the postoperative period; 75 (81.5%) had anterior and posterior mesh and 17 (18.5%) anterior mesh alone. Moreover, 14 women (15.2%) had a concomitant suburethral sling and 18 (19.6%) a concomitant subtotal hysterectomy. The mean follow-up time was 50.5 (± 20.3) months (4.2 years). PFDI-20 scores had improved significantly at 4 years (median: 47.4 before surgery vs. 34.4 afterwards, p = 0.002), and patient satisfaction was quite clear (PGI-I score = 1.8 ± 1.1). Nine women (9.8%) described recurring vaginal bulge symptoms, and 12 patients were reoperated during follow-up. Recurrence [odds ratio (OR) 8.11, 95% confidence interval (95% CI) 2.28–28.9] and postoperative constipation (OR = 3.47, 95% CI 1.02–11.8) were strongly associated with poorer postoperative satisfaction, as was concomitant UI surgery (OR = 12.5, 95% CI 2.32–67.0). Conclusions: LSP improved women’s symptoms and quality of life. Postoperative constipation, sensation of prolapse recurrence, and concomitant UI surgery were strongly associated with postoperative dissatisfaction

Detection of complicated ectopic pregnancies in the hospital discharge database: A validation study

International audienceOBJECTIVE: Complicated ectopic pregnancies with severe bleeding (CEPSB) are life-threatening situations and should be considered maternal near-miss cases. Previous studies have found an association between severe maternal morbidity secondary to CEPSB and substandard care. Almost all women with CEPSB are hospitalized, generating administrative and medical records. The objective of this study was to propose a method to measure the validity of the hospital discharge database (HDD) to detect CEPSB among hospital stays in two gynecological units.METHODS: We included all hospital stays of women who were 18-45 years old and hospitalized for acute pelvic pain or/and metrorrhagia in the two hospitals. The HDD was compared to medical data (gold standard). Two algorithms constructed from the International Classification of Disease (ICD-10) and Common Classification of Medical Procedures (CCAM), were applied to the HDD: a "predefined algorithm" according to coding guidelines and a "pragmatic algorithm" based on coding practices. Sensitivity, specificity and positive likelihood-ratios were calculated. False negatives and positives were analyzed to describe coding practices.RESULTS: Among 370 hospital stays included, 52 were classified as CEPSB cases. The "predefined algorithm" gave a sensitivity of 23.1% (95% CI: 11.6-34.5) and a specificity of 99.1% (95% CI: 98.0-100.0) to identify CEPSB. The "pragmatic algorithm" gave a sensitivity of 63.5% (95% CI: 50.4-76.5) and a specificity of 94.7% (95% CI: 92.2-97.5) to identify CEPSB. Coding errors (77.6%) were due to misuse of diagnosis codes and because complications were not coded.CONCLUSION: HDD is not reliable enough to detect CEPSB due to incorrect coding practices. However, it could be an ideal tool to monitor quality of care if a culture in data quality assessment is developed to improve quality of medical information

A snapshot of the Covid-19 pandemic among pregnant women in France

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Rare predicted loss-of-function variants of type I IFN immunity genes are associated with life-threatening COVID-19

BackgroundWe previously reported that impaired type I IFN activity, due to inborn errors of TLR3- and TLR7-dependent type I interferon (IFN) immunity or to autoantibodies against type I IFN, account for 15-20% of cases of life-threatening COVID-19 in unvaccinated patients. Therefore, the determinants of life-threatening COVID-19 remain to be identified in similar to 80% of cases.MethodsWe report here a genome-wide rare variant burden association analysis in 3269 unvaccinated patients with life-threatening COVID-19, and 1373 unvaccinated SARS-CoV-2-infected individuals without pneumonia. Among the 928 patients tested for autoantibodies against type I IFN, a quarter (234) were positive and were excluded.ResultsNo gene reached genome-wide significance. Under a recessive model, the most significant gene with at-risk variants was TLR7, with an OR of 27.68 (95%CI 1.5-528.7, P=1.1x10(-4)) for biochemically loss-of-function (bLOF) variants. We replicated the enrichment in rare predicted LOF (pLOF) variants at 13 influenza susceptibility loci involved in TLR3-dependent type I IFN immunity (OR=3.70[95%CI 1.3-8.2], P=2.1x10(-4)). This enrichment was further strengthened by (1) adding the recently reported TYK2 and TLR7 COVID-19 loci, particularly under a recessive model (OR=19.65[95%CI 2.1-2635.4], P=3.4x10(-3)), and (2) considering as pLOF branchpoint variants with potentially strong impacts on splicing among the 15 loci (OR=4.40[9%CI 2.3-8.4], P=7.7x10(-8)). Finally, the patients with pLOF/bLOF variants at these 15 loci were significantly younger (mean age [SD]=43.3 [20.3] years) than the other patients (56.0 [17.3] years; P=1.68x10(-5)).ConclusionsRare variants of TLR3- and TLR7-dependent type I IFN immunity genes can underlie life-threatening COVID-19, particularly with recessive inheritance, in patients under 60 years old