Preconception Care in International Settings

Objectives: This literature review briefly describes international programs, policies, and activities related to preconception care and resulting pregnancy outcomes. Methods: Electronic databases were searched and findings supplemented with secondary references cited in the original articles as well as textbook chapters, declarations, reports, and recommendations. Results: Forty-two articles, book chapters, declarations, and other published materials were reviewed. Policies, programs, and recommendations related to preconceptional health promotion exist worldwide and comprise a readily identifiable component of historic and modern initiatives pertaining to women's health, reproductive freedom, and child survival. Conclusions: The integration of preconception care services within a larger maternal and child health continuum of care is well aligned with a prevention-based approach to enhancing global health

Rapport II(1).4. Problèmes hydrauliques dans les échangeurs à sodium et répercussion sur la thermique

In sodium heat exchanger design, hydraulic problems mainly arise in the local areas comprising the tube cluster inlet and outlet on the casing side. Tests and calculations are described which were carried out with the object of determining head losses and flow patterns in these areas and of assessing their effect on heat exchanger thermal efficiency and stresses.Les problèmes hydrauliques dans les échangeurs à sodium se posent principalement dans les zones singulières que sont l’entrée et la sortie du faisceau tubulaire, côté enveloppe. On décrit les essais et les calculs ayant pour but de déterminer les pertes de charge et la forme de l’écoulement dans ces parties et d’estimer leur incidence sur l’efficacité thermique de l’échangeur ainsi que sur les contraintes.Kayser G., Boulot François. Rapport II(1).4. Problèmes hydrauliques dans les échangeurs à sodium et répercussion sur la thermique. In: Hydrotechnique des liquides industriels. Compte rendu des douzièmes journées de l'hydraulique. Paris, 6-8 juin 1972. Tome 1, 1973

Place de l’accompagnement psychologique dans les CPDPN de France : état des lieux

International audienceAIM:Create a record of the role given to members of the psychological professions in CPDPN Centers (multidisciplinary prenatal diagnosis). After more than 10 years in operation, describe the work methods of the different centers and their members, evaluate the possible diversity of practices and clarify the scope of interventions used by psychologists with patients and members of the CPDPN.METHOD:A descriptive survey consisting of 71 questions sent to psychologists, paediatricians and psychiatrists involved with the 48 CPDPN Centers in France. The main parameters studied are the means used by the CPDPN and their organization in the field of psychology, pre-medical counseling for the termination of pregnancy (IMG), conditions of hospitalization and post-IMG counseling.RESULTS:The survey revealed a high-level of homogeneous practices in the French CPDPN Centers between members of the medical and psychological professions, through joint consultations, ethical committees or specific case meetings for complex fetal pathologies.CONCLUSIONS AND PERSPECTIVES:This study has established a working relationship between members of the psychological professions working in the French CPDPN Centers and has led to the creation of a listing/directory, which facilitates the exchange of information. Video-conferencing is currently being considered in order to share respective practices

Rupture of membranes in case of internal podalic version: a risk for cesarean section on the second twin

Objectives To evaluate if internal version with ruptured membranes is a risk factor of cesarean section for the second twin. Patients and methods Two hundred and fifty-nine twins vaginal deliveries after 33 weeks of gestation from 1997 to 2009 in a level 3 maternity. A retrospective case-control study comparing two groups: cases of cesarean section on second twin and five twins vaginal deliveries following the case. Active management of the second twin delivery was performed with a short intertwin delivery. Results Eleven cesarean sections on the second twin were performed (4.2%). The main indication was failure of internal version. The risk of cesarean section was significantly greater when the internal version was performed with ruptured membranes (OR: 25.4 IC 95% [2.3-275.7] P \u3c 0.003) and when intertwin time delivery interval was increased (8.1 ± 5.1 vs 16.7 ± 6.3, P \u3c 0.001). Discussion and conclusion The rupture of amniotic membranes before or during the internal podalic version is associated with a risk of failure and cesarean for the second twin. We recommend to perform the internal podalic version with unruptured membranes according to the French recommendations

Lésions périnéales sév\u27res liées á une extraction foetale par spatules. Quels facteurs de risques ?

Objective To assess risk factors for anal sphincter injury during operative vaginal delivery using spatulas. Patients and methods A monocentric retrospective study of all assisted vaginal deliveries using Thierry and Teissier\u27s spatulas between January 1st, 2008 and December 31st, 2009 in a teaching level III maternity. We studied risk factors such as primiparity, gestational age, maternal age, previous perineal laceration, level and type of presentation, type of expulsion, unsuccessful extraction and successive use of tools, episiotomy, type of anaesthesia and birth weight. Results There were 346 perineal tears (60.5%); among them, 175 (31%) were type 1, 131 (23%) type 2, 35 (6.1%) type 3 and five (0.9%) type 4. There were 235 episiotomy (41.1%). There was no statistically significant difference between all the supposed risk factors and the severe perineal tears. Conclusion There are no relationship between third and fourth degree perineal lesions during spatula\u27s delivery and supposed risk factors of anal sphincter injury. Only statistical tendances between first vaginal delivery and anal sphincter injury and between occipitosacral delivery and anal sphincter injury were found. We need further randomized studies comparing assisted births using spatulas, forceps and vacuum extractors to better assess perineal tears risk factors

Studies of structure and specificity of some antigen-antibody complexes

International audienceBy using X-ray diffraction and immunochemical techniques, we have exploited the use of monoclonal antibodies raised against hen egg lysozyme (HEL) to study systematically those factors responsible for the high specificity of antigen-antibody interactions. HEL was chosen for our investigations because its three-dimensional structure and immunochemistry have been well characterized and because naturally occurring sequence variants from different avian species are readily available to test the fine specificity of the antibodies. The X-ray crystal structure of a complex formed between HEL and the Fab D1.3 shows a large complementary surface with close interatomic contacts between antigen and antibody. Thus single amino acid sequence changes in heterologous antigens give antigen-antibody association constants that are several orders of magnitude smaller than that of the homologous antigen. For example, a substitution of His for Glu at position 121 in the antigen is sufficient to diminish significantly the binding between D1.3 and the variant lysozyme. The conformation of HEL when complexed to D1.3 shows no significant difference from that seen in the free molecule, and immunobinding studies with other anti-HEL antibodies suggest that this observation may be generally true for the system of monoclonal antibodies that we have studied

Simulation of sow herd dynamics with emphasis on performance and distribution of periodic task events

Currently, the diversity of sow herd management strategies has been described but there are no tools that explore how it promotes sow herd performance nor how it or performance are linked to work organization problems. The goal of the current study was to build a herd dynamic, stochastic object oriented model capable of representing the herd dynamics and performance, and to predict the number of events workers will have to deal with. Each sow is individually represented in the model and the model works as a discrete event simulator with a predefined time step of 1 h. At each time step of simulation, the model searches for an event to be processed. An event may imply change of sow physiological state (e.g. oestrus, far rowing and insemination) and/or request an action from a worker (e.g. oestrous detection and far rowing supervision). This action may result in the planning of a new event (e.g. far rowing after mating) and/or modification of sow state (e.g. from oestrus to pregnant).The occurrences of some technical activities such as weaning are defined in time and frequency according to the management strategy of the farmer. The model is stochastic as sow biology is represented by several normal univariate distributions according to parity or by a threshold (fertility,abortion and mortality rates). When sows return into oestrus after mating they can be moved to another batch or culled depending on batch management strategy and culling policy. Outputs of this model focus on productivity of sows and distribution of tasks over the week. Definitions of the duration of simulation and number of replications to obtain the steady state and the variability of results are presented. The model is able to simulate several batch far rowing systems (BFS) and results of 1-, 3- and 4-week BFS are presented. Several simulations with modified management (no oestrous detection during the weekend and change of the weaning day) or with modified sow biology (increased variability of the weaning-to-oestrus interval and lower fertility rate) are performed. Results indicate that these modifications have specific consequences on performance and task distribution according to the BFS. The model provides useful information concerning the effects of herd management strategies on productivity and distribution of events over time and their sensitivity to biological criteria

Discordant sex in monozygotic XXY/XX twins: a case report

International audienc