Office Hysteroscopy for Infertility: A Series of 557 Consecutive Cases

Objective. To study incidence of abnormal hysteroscopic findings according to age. Methods. We retrospectively studied 557 consecutive office hysteroscopies in patients referred for incapacity to conceive lasting at least 1 year or prior to in vitro fertilization. Rates of abnormal findings were reviewed according to age. Results. In 219 cases, hysteroscopy showed an abnormality and more than a third of our population had abnormal findings that could be related to infertility. Rates of abnormal findings ranged from 30% at 30 years to more than 60% after 42 years. Risk of abnormal finding was multiplied by a factor of 1.5 every 5 years. Conclusion. Our data are an additional argument to propose office hysteroscopy as part of first-line exams in infertile woman, regardless of age

Erratum to: A proposal for the use of uniform diagnostic criteria for gestational diabetes in Europe: an opinion paper by the European Board & College of Obstetrics and Gynaecology (EBCOG)

Screening and diagnostic criteria for gestational diabetes (GDM) are inconsistent across Europe, and the development of a uniform GDM screening strategy is necessary. Such a strategy would create opportunities for more women to receive timely treatment for GDM. Developing a consensus on screening for GDM in Europe is challenging, as populations are diverse and healthcare delivery systems also differ. The European Board & College of Obstetrics and Gynaecology (EBCOG) has responded to this challenge by appointing a steering committee, including members of the EBCOG and the Diabetic Pregnancy Study Group (DPSG) associated with the EASD, to develop a proposal for the use of uniform diagnostic criteria for GDM in Europe. A proposal has been developed and has now been approved by the Council of the EBCOG. The current proposal is to screen for overt diabetes at the first prenatal contact using cut-off values for diabetes outside pregnancy, with particular efforts made to screen high-risk groups. When screening for GDM is performed at 24 weeks' gestation or later, the proposal is now to use the 75 g OGTT with the new WHO diagnostic criteria for GDM. However, more research is necessary to evaluate the best GDM screening strategy for different populations in Europe. Therefore, no clear recommendation has been made on whether a universal one-step, two-step or a risk-factor-based screening approach should be used. The use of the same WHO diagnostic GDM criteria across Europe will be an important step towards uniformity

Evaluation of imaging tools and matching process for fetal head station and position determination in the maternal pelvis during labor

PARIS-BIUSJ-Biologie recherche (751052107) / SudocSudocFranceF

Echographie foetale normale (réalisation d'un DVD pédagogique)

Ce projet a pour objectif d'élaborer une formation théorique d'initiation à l'échographie fœtale grâce à des supports multimédias.Ce projet tente ainsi de regrouper les connaissances indispensables en échographie obstétricale sous forme de films vidéo et de photos accompagnés de commentaires audio, afin de restituer et simplifier les différentes données qui doivent être connues sur ce sujet. En effet, le support vidéo est, sans conteste, un des meilleurs moyens de perfectionner ses connaissances et techniques médicales, tout particulièrement dans le domaine de l'imagerie. Ces cours ne se substituent pas à l'enseignement réalisé dans les Diplômes Inter-Universitaire d'échographie en gynécologie obstétrique et de médecine fœtale, mais constituent une base pour ceux qui débutent ou pour ceux qui souhaiteraient une introduction à l'échographie fœtale. Dans ce DVD, sera abordée l'échographie fœtale normale du premier, deuxième et troisième trimestres en s'appuyant sur la littérature scientifique internationale et le Comité National Technique de l'échographie de dépistage prénatal. L'échographie du col de l'utérus et l'échographie focalisée seront également développées. Pour des raisons évidentes, certaines pathologies indispensables à connaître seront abordées afin de réaliser un examen de base complet. Le document soumis pour ce mémoire n'est pas dans sa forme finale et bien évidemment, pour des raisons techniques, le projet qui vous est présenté est sous forme manuscrite. Lors de la soutenance, le DVD pourra être visionné. Volontairement, pour des soucis de formes, certains chapitres de ce mémoire ne sont pas explicités de façon exhaustive.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Which women uses social Internet networks during pregnancy?

Internet has become an important part of our life, including during pregnancy where it is broadly used to find information (84%). The aims of this study were (1) to describe the proportion of women using Internet Social Networks (ISN) concerning their pregnancy, during pre or postpartum hospital stay, (2) to define how ISN users refer to their pregnancy and delivery on these social networks, (3) to compare anxiety level, social sustain level, sociodemographic characteristics of the both population (4) and to determine profiles of the ISN users with multiple correspondence analysis. Methods: 399 questionnaires were distributed in the postpartum wards of two academic hospitals in Paris, and 258 fully filled were retrieved. Tools: Anxiety scale (STAI- A and B), Cutrona Social Provisions Scale, sociodemographic and obstetrical questionnaire. Results: 76% (n = 195) were ISN users. We compared ISN users versus ISN non users women. Demographically, the two populations were comparable. Anxiety scores were similar in both groups, whereas social support scores showed a statistical difference in social integration. In the global population, 84% use Internet for information concerning pregnancy; this rate is higher for ISN users than ISN non users (tendency 0.058). ISN were used in priority for sharing with relatives, and 10% with other pregnant women. Concerning pregnancy, patients posted in priority the birth announcement (28%), the pregnancy announcement (23%), and the newborn’s pictures (12%). 6% posted their fetuses’ ultrasound pictures. Three clusters of ISN users were extracted with statistically different social support scores (p = 0.019) and comparable anxiety scores. The third one, with at risk profile, used ISN as social support. For all women, but specifically for younger and more socially fragile women, Internet gives to professional new perspectives to develop information and prevention tools during the perinatal period

Should we advise women that pre-labor caesarean section prevents pelvic floor dysfunction?

International audienceVaginal delivery is reported as a main risk factor of pelvic floor dysfunction. Nevertheless, data with a high level of evidence are lacking to confirm the hypothetic protective effect of pre-labor caesarean section. In order to promote a preventive strategy for a disease, it is necessary to know perfectly its pathophysiology and to be sure that the strategy is in place before the beginning of the pathological process. In other words, the causality between the exposure factor and the disease must be certain. Due to the maternal and neonatal morbidities associated with caesarean section it is essential to be careful before promoting prophylactic pre-labor caesarean section policies [1,2]. The objective of this scientific review is to provide a systematic analysis of the causality between vaginal delivery and pelvic floor dysfunction using Hill’s criterion for causality in order to devise a policy of advising pre-labor caesarean section to prevent pelvic floor dysfunctio

Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012

International audienceAims/hypothesis: The aim of this study was to assess the risk of adverse perinatal outcomes in gestational diabetes mellitus (GDM) in a large national cohort.Methods: All deliveries taking place after 22 weeks in France in 2012 were included by extracting data from the hospital discharge database and the national health insurance system. The diabetic status of mothers was determined by the use of glucose-lowering agents and by hospital diagnosis. Outcomes were analysed according to the type of diabetes and, in the GDM group, whether or not diabetes was insulin-treated.Results: The cohort of 796,346 deliveries involved 57,629 (7.24%) mothers with GDM. Mother–infant linkage was obtained for 705,198 deliveries. The risks of adverse outcomes were much lower with GDM than with pregestational diabetes. After limiting the analysis to deliveries after 28 weeks to reduce immortal time bias, the risks of preterm birth (OR 1.3 [95% CI 1.3, 1.4]), Caesarean section (OR 1.4 [95% CI 1.4, 1.4]), pre-eclampsia/eclampsia (OR 1.7 [95% CI 1.6, 1.7]), macrosomia (OR 1.8 [95% CI 1.7, 1.8]), respiratory distress (OR 1.1 [95% CI 1.0, 1.3]), birth trauma (OR 1.3 [95% CI 1.1, 1.5]) and cardiac malformations (OR 1.3 [95% CI 1.1, 1.4]) were increased in women with GDM compared with the non-diabetic population. Higher risks were observed in women with insulin-treated GDM than those with diet-treated GDM. After limiting the analysis to term deliveries, an increased risk of perinatal mortality was observed. After excluding women suspected to have undiagnosed pregestational diabetes, the risk remained moderately increased only for those with diet-treated GDM (OR 1.3 [95% CI 1.0, 1.6]).Conclusions/interpretation: GDM is associated with a moderately increased risk of adverse perinatal outcomes, which is higher in insulin-treated GDM than in non-insulin-treated GDM for most outcomes

Change in Birth Rate Before and After Bariatric Surgery in France

International audienc