Ornitho-oekologische Untersuchungen zu Baggerarbeiten in der Unterelbe und zu geplanten Aufspuelungen im Bereich Brammerbank

With 2 mapsTIB: RO 2410 (6) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Hysteroscopic surgery for the treatment of persistent postmenopausal bleeding

OBJECTIVES: Determine the effectiveness of hysteroscopic surgery in persistent postmenopausal bleeding. PATIENTS AND METHODS: Transcervical resection was performed in 176 women between the ages of 46-74 years. A benign cause was noted in 135 cases (polyps in 80 and submucous fibroids in 55); 37 patients had no significant disease and 4 had endometrial atypical hyperplasia missed in the preoperative evaluation. Patients underwent resection of polyp, resection of fibroid or endometrial ablation. Major operative complications were rare and included 3 perforations and one case of fluid overload. Patients were followed for 1-10 years after treatment (mean follow-up 52 months). RESULTS: 167 patients completed the study. Clinical manifestations disappeared in 85.2% of the patients; 15 patients had hysterectomy after the hysteroscopic procedure and 11 had repeat transcervical resection. CONCLUSION: Hysteroscopic treatment can be effective in carefully selected patients with postmenopausal bleeding or abnormal uterine bleeding on hormone replacement therapy. The operative criteria should take the causes of bleeding and not just the age of patient into account

Assessment of shoulder dystocia related knowledge among French obstetrics and gynecology residents

International audienceObjective. - To study the related knowledge of French residents in obstetrics concerning maneuvers for shoulder dystocia (SD). Materials and methods. - Multicenter descriptive transversal study conducted from June to September 2014. Data collection was performed through questionnaires sent by email to French resident in obstetrics. Results. - Among the 1080 questionnaires sent, 366 responses were obtained with a response rate of 33.9%. One hundred and forty-three residents (39.1%) were in the first part of their training (\textless= 5th semester) and 60.9% (n = 223) were in the second part of their training. Theoretical training on the SD was provided to 88.2% of resident (n = 323). In total, 38.8% (n = 142) obtained their French degree in mechanical and technical obstetric and among them 77.5% (n = 110) had the opportunity to train on simulators and dummies. Concerning their practical experiences, 31.5% (n = 45) residents \textless= 5th semester reported having experienced SD during their residency vs 58.3% (n = 130) amongst oldest residents (P \textless 0.001). In the second part of residency, 40% of residents (n = 89) expressed to feel able to manage shoulder dystocia. Only 19.1% (n = 70) were satisfied with their residency training program vs 39.1% (n = 143) who were unsatisfied. Conclusion. - Our study showed that less than one resident out of two (40%) felt able to perform maneuvers for SD in the second part of residency. We think that simulation activities should be mandatory for residency training programs in Obstetrics and Gynecology, which have to develop dependable measures to assess resident competencies to execute practical maneuvers for clinical emergencies in obstetrics. (C) 2015 Elsevier Masson SAS. All rights reserved

Evaluation of adherence to French guidelines concerning the information of the women having a scarred uterus on their mode of delivery

International audienceObjective.-To evaluate adherence of obstetricians from our maternity to French practice guidelines concerning information to give to pregnant patients with a history of scarred uterus. Materials and methods.-Observational retrospective study performed on medical files from June to August 2014 and concerning women with a scarred uterus that gave live-birth after 37 weeks of gestation. Information of patients had to concern the risks of a history of caesarean, the benefits and risks of the various delivery modes. Results.-On 758 deliveries, 77 cases were studied: 48 patients were followed up from the beginning of pregnancy, 23 from the 2nd trimester and 6 were not followed. Among patients followed from the beginning, no data was written on medical file concerning information that should to be given in immediate post-partum, in preconception counseling, and at the beginning of pregnancy about the risks of scarred uterus and the mode of delivery. In the 8th month, information about benefits and risks of the planned delivery mode was noticed in 45% of files. Conclusion.-The information that need in theory to be given to the patients with scarred uterus appeared little or insufficiently noticed on medical files; which can be due either to an inaccurate information, or to a lack of transcription of the information nevertheless given. A check-list in obstetrical file would help to systematize the information to provide in scarred uterus patients. (C) 2015 Elsevier Masson SAS. All rights reserved

Dystocie des épaules : état des lieux de la formation initiale des internes en France

International audienceObjectiveTo study the related knowledge of French residents in obstetrics concerning maneuvers for shoulder dystocia (SD).Materials and methodsMulticenter descriptive transversal study conducted from June to September 2014. Data collection was performed through questionnaires sent by email to French resident in obstetrics.ResultsAmong the 1080 questionnaires sent, 366 responses were obtained with a response rate of 33.9%. One hundred and forty-three residents (39.1%) were in the first part of their training (≤ 5th semester) and 60.9% (n = 223) were in the second part of their training. Theoretical training on the SD was provided to 88.2% of resident (n = 323). In total, 38.8% (n = 142) obtained their French degree in mechanical and technical obstetric and among them 77.5% (n = 110) had the opportunity to train on simulators and dummies. Concerning their practical experiences, 31.5% (n = 45) residents ≤ 5th semester reported having experienced SD during their residency vs 58.3% (n = 130) amongst oldest residents (P < 0.001). In the second part of residency, 40% of residents (n = 89) expressed to feel able to manage shoulder dystocia. Only 19.1% (n = 70) were satisfied with their residency training program vs 39.1% (n = 143) who were unsatisfied.ConclusionOur study showed that less than one resident out of two (40%) felt able to perform maneuvers for SD in the second part of residency. We think that simulation activities should be mandatory for residency training programs in Obstetrics and Gynecology, which have to develop dependable measures to assess resident competencies to execute practical maneuvers for clinical emergencies in obstetrics.ObjectifÉtat des lieux de la formation initiale des internes de gynécologie-obstétrique en France aux manœuvres de réduction d’une dystocie des épaules (DDE).Matériels et méthodesEnquête transversale descriptive multicentrique réalisée par auto-questionnaires entre juin et septembre 2014, envoyés par e-mail aux internes de gynécologie-obstétrique adhérents à l’AGOF.RésultatsSur 1080 questionnaires envoyés, 366 réponses ont été obtenues donnant un taux de réponse de 33,9 % : 143 internes (39,1 %) étaient dans leur première moitié de formation (≤ 5e semestre) et 60,9 % (n = 223) étaient dans leur deuxième moitié d’internat. Une formation théorique sur la DDE a été dispensée à 88,2 % des internes (n = 323). Au total, 38,8 % (n = 142) ont passé le Diplôme inter-universitaire (DIU) de mécanique et techniques obstétricales (MTO) et, parmi eux, 77,5 % (n = 110) se sont entraînés sur mannequin dans le cadre de ce DIU. Concernant la pratique, 31,5 % (n = 45) des internes (≤ 5e semestre) ont déclaré avoir été confrontés à une DDE lors de leur stage d’apprentissage vs 58,3 % (n = 130) chez les internes plus anciens (p < 0,001). En deuxième partie d’internat, 40 % des internes (n = 89) se déclaraient capables de réduire une DDE. Seuls 19,1 % (n = 70) étaient satisfaits de leur formation vs 39,1 % (n = 143) d’insatisfaits.ConclusionNotre étude a montré que moins d’un interne sur deux (40 %) se sentait capable de réduire une DDE en deuxième partie d’internat. Il semble nécessaire que les internes puissent bénéficier d’un enseignement sur simulateur avec validation de leur capacité effective à réaliser ce type de manœuvre en urgence

Évaluation du suivi des recommandations concernant l'information des patientes ayant un utérus cicatriciel sur leur mode d'accouchement

International audienceObjectiveTo evaluate adherence of obstetricians from our maternity to French practice guidelines concerning information to give to pregnant patients with a history of scarred uterus.Materials and methodsObservational retrospective study performed on medical files from June to August 2014 and concerning women with a scarred uterus that gave live-birth after 37weeks of gestation. Information of patients had to concern the risks of a history of caesarean, the benefits and risks of the various delivery modes.ResultsOn 758 deliveries, 77 cases were studied: 48 patients were followed up from the beginning of pregnancy, 23 from the 2nd trimester and 6 were not followed. Among patients followed from the beginning, no data was written on medical file concerning information that should to be given in immediate post-partum, in preconception counseling, and at the beginning of pregnancy about the risks of scarred uterus and the mode of delivery. In the 8th month, information about benefits and risks of the planned delivery mode was noticed in 45% of files.ConclusionThe information that need in theory to be given to the patients with scarred uterus appeared little or insufficiently noticed on medical files; which can be due either to an inaccurate information, or to a lack of transcription of the information nevertheless given. A check-list in obstetrical file would help to systematize the information to provide in scarred uterus patients.ButLes recommandations pour la pratique clinique (RPC) concernant l’information des patientes présentant un utérus uni- ou bi-cicatriciel sur leur mode d’accouchement ont été actualisées en France en 2012. L’objectif de notre étude a été d’évaluer le suivi des RPC par les médecins obstétriciens de notre maternité.Patientes et méthodesÉtude observationnelle rétrospective réalisée de juin à août 2014 à partir du dossier médical des patientes porteuses d’un utérus uni- ou bi-cicatriciel ayant accouchés après 37SA à la maternité de la Conception à Marseille. L’information des patientes devait porter sur les risques d’un antécédent de césarienne, les bénéfices et risques des différentes voies d’accouchement.RésultatsSur 758 accouchements, 77 dossiers ont été étudiés : 48 patientes avaient été suivies dès le début de la grossesse, 23 à partir du 2e trimestre et 6 n’ont pas été suivies. Parmi celles suivies dès le début, aucune donnée écrite n’a été trouvée sur les dossiers concernant l’information à donner en post-partum immédiat, en pré-conceptionnel et en début de grossesse sur les risques des utérus cicatriciels et le mode d’accouchement. Au 8e mois, 45 % avaient reçu une information sur les bénéfices et risques du mode d’accouchement prévu.ConclusionL’information à théoriquement donner aux patientes en cas d’utérus cicatriciel apparaissait peu ou insuffisamment sur les dossiers médicaux ; cette observation pouvant être due soit à un défaut d’information, soit à un défaut de transcription de l’information pourtant donnée. La mise en place d’une « check-list » dans le dossier obstétrical permettrait la systématisation de l’information à donner aux patientes