Gonococcal Chorioamnionitis with Antepartum Fetal Death In Utero

We report the case of a patient who developed gonococcal chorioamnionitis resulting in stillbirth at 28 + 4 weeks of pregancy. As this infection is rare and potentially serious, questions remain regarding occurrence and screening for Neisseria gonorrhoeae infection

Prise en charge de l’infertilité en première intention hors FIV : performances du traitement médical ? Performances de la stimulation ovarienne ? Performances des inséminations ? RPC Endométriose CNGOF-HAS

International audienceUsing the structured methodology of French guidelines (HAS-CNGOF), the aim of this chapter was to formulate good practice points (GPP), in relation to optimal non-ART management of endometriosis related to infertility, based on the best available evidence in the literature

Endométriose et préservation de la fertilité, RPC Endométriose, CNGOF-HAS

International audienceFertility preservation (FP) techniques are progressing rapidly these past few years thanks to the oocyte vitrification. Indication of FP techniques is now extended to non-oncological situation that may induce risk of premature ovarian failure. Ovarian endometriosis can lead to premature ovarian failure and further infertility due to the high risk of ovarian cysts recurrence and surgery. To date, there is no cohort study regarding FP and endometriosis as well as no recommendation. Our purpose is to review the arguments in favor of FP in this specific area and to elaborate strategies according to each clinical form

Prognosis associated with initial care of increased fasting glucose in early pregnancy: A retrospective study

Aim. – To evaluate whether the initial care of women with fasting plasma glucose (FPG) levels at 5.1–6.9 mmol/L before 22 weeks of gestation (WG), termed ‘early fasting hyperglycaemia’, is associated withfewer adverse outcomes than no initial care.Methods. – A total of 523 women with early fasting hyperglycaemia were retrospectively selected in ourdepartment (2012–2016) and separated into two groups: (i) those who received immediate care(n = 255); and (ii) those who did not (n = 268), but had an oral glucose tolerance test (OGTT) at or after22 WG, with subsequent standard care if hyperglycaemia (by WHO criteria) was present. The number ofcases of large-for-gestational age (LGA) infants, shoulder dystocia and preeclampsia with initial care ofearly fasting hyperglycaemia were compared after propensity score modelling and accounting forcovariates.Results. – Of the 268 women with no initial care, 134 had hyperglycaemia after 22 WG and thenreceived care. Women who received initial care vs those who did not were more likely to be insulin-treated during pregnancy (58.0% vs 20.9%, respectively; P < 0.00001), gained less gestational weight(8.6 5.4 kg vs 10.8 6.1 kg, respectively; P < 0.00001), had a lower rate of preeclampsia [1.2% vs 2.6%,respectively; adjusted odds ratio (aOR): 0.247 (0.082–0.759), P = 0.01], and similar rates of LGA infants (12.2%vs 11.9%, respectively) and shoulder dystocia (1.6% vs 1.5%, respectively). When initial FPG levels were5.5 mmol/L (prespecified group, n = 137), there was a lower rate of LGA infants [6.7% vs 16.1%, respectively;aOR: 0.332 (0.122–0.898); P = 0.03].Conclusion. – Treating women with early fasting hyperglycaemia, especially when FPG is 5.5 mmol/L,may improve pregnancy outcomes, although this now needs to be confirmed by randomized clinicaltrials

Endométriose profonde et infertilité, RPC Endométriose CNGOF-HAS

International audienceDeeply infiltrating endometriosis is a severe form of the disease, defined by endometriotic tissue peritoneal infiltration. The disease may involve the rectovaginal septum, uterosacral ligaments, digestive tract or bladder. Deeply infiltrating endometriosis is responsible for disabling pain and infertility. The purpose of these recommendations is to answer the following question: in case of deeply infiltrating endometriosis associated infertility, what is the best therapeutic strategy? First-line surgery and then in vitro fertilization (IVF) in case of persistent infertility or first-line IVF, without surgery? After exhaustive literature analysis, we suggest the following recommendations: studies focusing on spontaneous fertility of infertile patients with deeply infiltrating endometriosis found spontaneous pregnancy rates about 10%. Treatment should be considered in infertile women with deeply infiltrating endometriosis when they wish to conceive. First-line IVF is a good option in case of no operated deeply infiltrating endometriosis associated infertility. Pregnancy rates (spontaneous and following assisted reproductive techniques) after surgery (deep lesions without colorectal involvement) varie from 40 to 85%. After colorectal endometriosis resection, pregnancy rates vary from 47 to 59%. The studies comparing the pregnancy rates after IVF, whether or not preceded by surgery, are contradictory and do not allow, to date, to conclude on the interest of any surgical management of deep lesions before IVF. In case of alteration of ovarian reserve parameters (age, AMH, antral follicle count), there is no argument to recommend first-line surgery or IVF. The study of the literature does not identify any prognostic factors, allowing to chose between surgical management or IVF. The use of IVF in the indication "deep infiltrating endometriosis" allows satisfactory pregnancy rates without significant risk, regarding disease progression or oocyte retrieval procedure morbidity

Stratégies de prise en charge de l’infertilité en assistance médicale à la procréation dans un contexte d’endométriose, RPC Endométriose, CNGOF-HAS

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Predicting the likelihood of a live birth for women with endometriosis-related infertility

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Prise en charge de la prématurité extrême. Réflexions du département hospitalo-universitaire (DHU) « risques et grossesse » [Perinatal care for extremely preterm infants. Considerations of the "risks in pregnancy" department]

Decisions regarding whether to initiate or forgo intensive care for extremely premature infants are often based on gestational age alone. However, other factors also affect the prognosis for these patients and must be taken into account. After a short review of these factors, we present the thoughts and proposals of the Risks and Pregnancy department. The proposals are to limit emergency decisions, to better take into account other factors than gestational age and prenatal predicted fetal weight in assessing the prognosis, to introduce multidisciplinary consultation in the evaluation and proposals that will be discussed with the parents, and to separate prenatal steroid therapy from decision-making regarding whether or not to administer intensive care