First case of spontaneous rupture of the left ureter in immediate post-partum

The rupture of the ureter during pregnancy is a rare complication and is most frequently observed in the right ureter. We report below the case of a rupture in the left ureter. A 36-year old woman gave birth vaginally to a 3010-g girl without operative vaginal delivery or episiotomy. The following day, the patient exhibited a sudden pain in the left side spreading to the left iliac fossa. An abdominopelvic CT scan was carried out and revealed a flow of contrast agent at the left ureteral lumbar level and a left urinoma. A ureteral stent was inserted on the left side under X-ray control. Six weeks after delivery the ureteral stent was removed. The Uro CT scan allowed us to confirm the total recovery of the left ureter. We have reported below the first case of left rupture treated in a conservative manner with positive and functional clinical progress

Effect of the use of a video tutorial in addition to simulation in learning the maneuvers for shoulder dystocia

The development of video tutorials is flourishing and may make it possible to maintain knowledge learned during instruction with simulation. The aim of this study was to assess the effect of adding a video tutorial to a lecture and simulation for learning the maneuvers and protocol for the management of shoulder dystocia. Student midwives and medical students attended a lecture class including instruction about maneuvers and a presentation of an algorithm for the management of shoulder dystocia. They were randomized into two groups. The video group was reminded every two weeks to watch a short tutorial. The control group was reminded to consult the slide show. At the end of two months, they were evaluated by graders. The practice, theory, and global scores of the students in the video group were significantly higher than those of the students in the control group (14.8 vs. 10.4; 5.6 vs. 3.4; and 9.3 vs. 7.0, P<0.001). The scores for the video group improved at the second simulation session, compared with the first (14.8 vs. 9.9; 5.6 vs. 2.9; and 9.3 vs. 7, P<0.001). The addition of a video tutorial improved learning compared to a standard lecture and simulation session alone

A mathematical model to predict mean time to delivery following cervical ripening with dinoprostone vaginal insert

The main objective of our study was to analyze the mean time to delivery following cervical ripening with a 10 mg dinoprostone vaginal insert. We performed a retrospective observational study at the level III maternity ward of Angers university hospital. We included all women who had cervical ripening with dinoprostone between January 1, 2015 and September 30, 2016. Overall, 405 patients were included, and 59.3% (240/405) were nulliparous. The mean time to delivery was 20h39 min ± 10h49 min. 21% of deliveries (86/405) occurred between midnight and 6 h a.m., and the cesarean section rate was 33% (132/405). Multiple regression analysis showed that nulliparity, overweight (BMI ≥ 25), a closed cervix on initial examination and the absence of premature rupture of membranes (PRM) all significantly increased the mean time to delivery. We developed a mathematical model integrating the aforementioned factors and their impact to help predict the mean time to delivery following cervical ripening with dinoprostone vaginal insert: Y = 961.188-80.346 × parity + 21.437 × BMI-165.263 × cervical dilation-241.759 × PRM. This equation allows obstetricians to calculate a personalized time to delivery for each patient, allowing a precise scheduling of dinoprostone insert placement, and thus improving the organization in busy maternity wards

Surgery using plasma energy for deep endometriosis: A quality of life assessment

OBJECTIVE: The principal objective of our study was to assess women\u27s quality of life (QoL) after surgery for Deep Endometriosis (DE), according to the surgical technique used. MATERIAL AND METHODS: Qualitative single-center survey in the department of obstetrics and gynecology, Angers University Hospital Center, France. All women who underwent surgery for DE from January 2011 to December 2015 were contacted by phone. The Endometriosis Health Profile-5 score was used to assess QoL before and after the surgery. Fifty-two women (response rate=86%) were included and classified into 3 groups according to the surgical technique used: simple shaving, shaving exclusively or in part by plasma vaporization (plasma), and resection. RESULTS: The 3 groups were comparable for surgical history, preoperative QoL score, and characteristics of endometriotic lesions (size and site). All DE symptoms and QoL scores improved significantly after the surgery, all techniques combined (P<0.01). QoL scores for women who had plasma shaving or complete resection were significantly higher than those for women with simple shaving (respectively, 375 [225-800] and 450 [-50 to 725] vs 275 [-100 to 600]; P=0.04). Self-image significantly improved only in the plasma group (P=0.03). The complete resection group had longer hospitals stays than the other groups (P=0.001), as well as a higher surgical revision rate (23% vs 0%; P=0.02). CONCLUSION: Plasma and complete resection improved QoL similarly for women with DE, both more than shaving alone. The advantage of plasma vaporization lies in the lesser morbidity and better self-image, both better than in women with resection

On population abundance and niche structure

Recent published evidence indicates a negative correlation between density of populations and the distance of their environments to a suitably defined ‘niche centroid’. This empirical observation lacks theoretical grounds. We provide a theoretical underpinning for the empirical relationship between population density and position in niche space, and use this framework to understand the circumstances under which the relationship will fail. We propose a metapopulation model for the area of distribution, as a system of ordinary differential equations coupled with a dispersal kernel. We present an analytical approximation to the solution of the system as well as R code to solve the full model numerically. We use this tool to analyze various scenarios and assumptions. General and realistic demographic assumptions imply a good correlation between position in niche space and population abundance. Factors that modify this correlation are: transitory states, a heterogeneous spatial structure of suitability, and Allee effects. We also explain why the raw output of the niche modeling algorithm MaxEnt is not a good predictor of environmental suitability. Our results elucidate the empirical results for spatial patterns of population size in niche terms, and provide a theoretical basis for a structured theory of the niche

Nanoscale deformation of a liquid surface

We study the interaction between a solid particle and a liquid interface. A semianalytical solution of the nonlinear equation that describes the interface deformation points out the existence of a bifurcation behavior for the apex deformation as a function of the distance. We show that the apex curvature obeys a simple power-law dependency on the deformation. Relationships between physical parameters disclose the threshold distance at which the particle can approach the liquid before capillarity provokes a "jump to contact". A prediction of the interface original position before deformation takes place, as well as the attraction force measured by an approaching probe, are produced. The results of our analysis agree with the force curves obtained from atomic force microscopy experiments over a liquid puddle

Mini-bandelette sous-urétrale versus bandelette transobturatrice : efficacité et morbidité

Objectif Comparer l’efficacité d’une mini-bandelette ALTIS® et d’une bandelette sous-urétrale (BSU) classique transobturatrice TVT-ABBREVO® pour le traitement de l’incontinence urinaire d’effort féminine. Méthodes Une étude rétrospective monocentrique incluait toutes les patientes opérées par BSU transobturatrice (TVT-ABBREVO®) ou mini-bandelette (ALTIS®) en 2015, au centre hospitalier universitaire d’Angers. Le taux de succès était défini par l’amélioration de la qualité de vie définie par un score PGI-I (Patient Global Impression of Improvement) compris entre 1 et 3, l’absence de fuite urinaire lors d’un test à la toux à l’examen clinique, et l’absence de fuite urinaire à l’effort rapportée sur le questionnaire USP (Urinary Symptom Profile). La morbidité liée aux bandelettes ainsi que les données peropératoires étaient également répertoriées. Résultats Quatre-vingt-douze patientes étaient incluses (39 dans le groupe ALTIS et 53 dans le groupe ABBREVO). Le suivi moyen était de 13,55 mois. Le taux de succès n’était pas significativement différent dans le groupe ALTIS que ce soit pour le test à la toux négatif (89,7 % vs 94,3 % dans le groupe ABBREVO, p = 0,45), pour l’absence de fuite urinaire rapportée dans le questionnaire USP (87,2 % vs 90,6 % dans le groupe ABBREVO, p = 0,61), ou pour l’amélioration de la qualité de vie avec un score PGI-I entre 1 et 3 (82,1 % vs 86,8 % dans le groupe ABBREVO, p = 0,53). En revanche, plus de patientes étaient pleinement satisfaites avec un score PGI-I à 1 dans le groupe ABBREVO (67,9 % vs 46,2 % dans le groupe ALTIS, p = 0,03). La douleur postopératoire immédiate était significativement moins intense dans le groupe ALTIS que dans le groupe ABBREVO (score EVA moyen à 0,5 vs 1,3, p = 0,01) mais cette différence disparaissait à une semaine de la chirurgie. Les taux des autres complications étaient similaires dans les deux groupes. Conclusion Les résultats fonctionnels des bandelettes ALTIS et TVT-ABBREVO® semblent similaires dans le traitement de l’incontinence urinaire d’effort féminine

Perinatal grief following neonatal comfort care for lethal fetal condition

BACKGROUND: The objective of the study was to assess perinatal grief experienced after continuing pregnancy and comfort care in women diagnosed with lethal fetal condition compared with termination of pregnancy for fetal anomaly (TOPFA). METHODS: This was a retrospective observational study which included women who chose to continue their pregnancy after the diagnosis of lethal fetal condition with comfort care support at birth at the Prenatal Diagnosis Center of Rennes Hospital from January 2007 to January 2017. Women were matched with controls who underwent TOPFA for the same type of fetal anomaly, gestational age at diagnosis and year. Women were evaluated by a questionnaire including the Perinatal Grief Scale. RESULTS: There were 28 patients in the continuing pregnancy group matched with 56 patients in the TOPFA group. Interval between fetal loss and completion of questionnaire was 6±3 years. Perinatal grief score was similar at 61±22 vs 58±18 (p = 0.729) in the continuing pregnancy and TOPFA groups, respectively. Women in the TOPFA group expressed more guilt. The cesarean-section rate in the continuing pregnancy group was 25% . CONCLUSION: Perinatal grief experienced by women opting for continuing pregnancy and comfort care after diagnosis of a potentially lethal fetal anomaly is not more severe than for those choosing TOPFA

Traitement médical de l’endométriose douloureuse sans infertilité, RPC Endométriose CNGOF-HAS

OBJECTIVE: To provide clinical practice guidelines for the management of painful endometriosis in women without infertility. METHODS: Systematic review of the literature literature since 2006, level of evidence rating, external proofreading and grading of the recommendation grade by an expert group according to HAS methodology. RESULTS: Combined hormonal contraceptives (COP) and the levonorgestrel-releasing intra-uterin system (LNG-IUS) are recommended as first-line hormonal therapies for the treatment of painful endometriosis (grade B). Second-line therapy relies on oral desogestrel microprogestative, etonogestrel-releasing implant, GnRH analogs (GnRHa) and dienogest (grade C). It is recommended to use add-back therapy containing estrogen in association with GnRHa (grade B). After endometriosis surgery, hormonal treatment relying on COP or LNG-IUS is recommended to prevent pain recurrence (grade B). COP is recommended to reduce the risk of endometrioma recurrence after surgery (grade B) but the prescription of GnRHa is not recommended (grade C). Continuous COP is recommended in case of dysmenorrhea (grade B). GnRHa is not recommended as first line endometriosis treatment for adolescent girl because of the risk of bone demineralization (grade B). The management of endometriosis-induced chronic pain requires an interdisciplinary evaluation. Physical therapies improving the quality of life such as yoga, relaxation or osteopathy can be proposed (expert agreement). Promising medical alternatives are currently under preclinical and clinical evaluation