Conséquences fonctionnelles ano-rectales du premier accouchement par voie vaginale, impact des spatules de Thierry (étude prospective à propos de 643 patientes)

Contexte : L'incontinence anale du post-partum est un symptôme mal connu malgré des taux importants rapportés par la littérature. Il est donc intéressant d'étudier ce symptôme ainsi que les troubles associés (incontinence urinaire, douleurs périnéales et troubles sexuels) et d'essayer d'en définir les facteurs de risque. Nous avons notamment voulu savoir si les spatules de Thierry étaient un facteur de risque d'incontinence anale. Matériel et méthode : Nous avons mené une étude observationnelle prospective au sein de la maternité Paule de Viguier (type III, CHU Toulouse) entre décembre 2005 et décembre 2006. L'étude a été réalisée à l'aide d'auto-questionnaires anonymes administrés à 2 jours puis 2 et 6 mois post-partum, après avoir relevé les caractéristiques de l'accouchement. Résultats : 643 patientes ont été pré-incluses (primipares accouchant par voie basse d'un singleton en présentation céphaliques spontanément ou par spatules de Thierry). 561 ont signé le formulaire de consentement et notre taux de réponse est de 86% à 2 mois et 81% à 6 mois. La seule différence existant entre les populations accouchant spontanément ou par spatules de Thierry est l'âge plus élevé des femmes dans le deuxième groupe. Le taux d'épisiotomie est significativement plus élevé dans le groupe spatules (97,5% vs 50,3% p= 5) est de 11% à 2 mois et 7,7% à 6 mois. Il existe une association statistique entre l'incontinence anale et l'incontinence urinaire, les douleurs périnéales et les troubles sexuels (délai de reprise des rapports). L'analyse univariée (confirmée par l'analyse multivariée) montre que les facteurs de risque d'incontinence anale à 2 et 6 mois du post-partum sont les déchirures périnéales sévères (OR=4,60 [1,14-31,11]), l'épisiotomie (OR=3,13 [1,31-6,87]), l'âge élevé de la patiente (OR=1,08 [1,008-1,15]). Discussion : Notre étude confirme les taux et les facteurs de risques classiques d'incontinence anale post-partum. Nous montrons un impact négatif important de l'épisiotomie. En revanche, les spatules de Thierry n'apparaissent pas comme un facteur de risque indépendant d'incontinence anale tout en ne montrant pas non plus d'effet délétère sur l'état néonatal. C'est donc un instrument moderne et efficace qui doit continuer à être enseigné mais l'évolution des pratiques doit probablement tendre vers une réduction raisonnée du taux d'épisiotomie. Une étude comparant un usage restrictif et libéral de l'épisiotomie en cas d'extraction par spatule ainsi qu'une étude randomisée prospective comparant les spatules aux autres instruments d'extraction fœtale pourraient valider les données de notre étude.TOULOUSE3-BU Santé-Centrale (315552105) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Apport de l'examen fœtopathologique après interruption médicale de grossesse pour anomalie malformative fœtale (analyse de 273 cas)

TOULOUSE3-BU Santé-Centrale (315552105) / SudocSudocFranceF

Finally an evidence-based indication for injectable phloroglucinol!

International audienceBackground: While phloroglucinol is widely prescribed in European countries for its antispasmodic properties, recent high quality data failed to demonstrate its superiority to placebo in alleviating abdominal pain. Rumors suggest that injectable presentation of phloroglucinol may erase povidone-iodine stains. We thus aimed to evaluate its efficacy in this new indication.Methods: In this double-blind, controlled trial, we randomly assigned 9 squares of fabric obtained from common white coat to receive injectable phloroglucinol (experimental arm), stain remover (active control arm) or water (placebo arm). The primary efficacy endpoint was the change in stain intensity 10 min after the intervention.Results: In placebo and active control arms, povidone-iodine stains remained unchanged 10 min after treatment application. In contrast, the stain disappeared completely in the experimental arm.Conclusion: Injectable phloroglucinol was more effective than usual stain remover and water to remove povidone-iodine stains from white coats

Vaginal Evisceration: An Unexpected Complication of Conization

Background. Large loop excision of the transformation zone (LLETZ) is routinely performed for the management of high grade intracervical neoplasia (CIN). Several uncommon complications have been described, including postoperative peritonitis, pseudoaneurysm of uterine artery, and bowel fistula. We report a unique case of postoperative vaginal evisceration and the subsequent management. Case. A 73-years-old woman underwent LLETZ for high grade CIN. On postoperative day 3, she was admitted for small bowel evisceration through the vagina. Surgical management was based on combined laparoscopic and transvaginal approach and consisted in bowel inspection and reinstatement, peritoneal washing, and dehiscence repair. Conclusions. Vaginal evisceration is a rare but potentially serious complication of pelvic surgery. This case report is to make clinicians aware of such complication following LLETZ and its management

Cross-talk and mutual shaping between the immune system and the microbiota during an oyster's life

International audienceThe Pacific oyster Crassostrea gigas lives in microbe-rich marine coastal systems subjected to rapid environmental changes. It harbours a diversified and fluctuating microbiota that cohabits with immune cells expressing a diversified immune gene repertoire. In the early stages of oyster development, just after fertilization, the microbiota plays a key role in educating the immune system. Exposure to a rich microbial environment at the larval stage leads to an increase in immune competence throughout the life of the oyster, conferring a better protection against pathogenic infections at later juvenile/adult stages. This beneficial effect, which is intergenerational, is associated with epigenetic remodelling. At juvenile stages, the educated immune system participates in the control of the homeostasis. In particular, the microbiota is fine-tuned by oyster antimicrobial peptides acting through specific and synergistic effects. However, this balance is fragile, as illustrated by the Pacific Oyster Mortality Syndrome, a disease causing mass mortalities in oysters worldwide. In this disease, the weakening of oyster immune defences by OsHV-1 µVar virus induces a dysbiosis leading to fatal sepsis. This review illustrates the continuous interaction between the highly diversified oyster immune system and its dynamic microbiota throughout its life, and the importance of this cross-talk for oyster health. This article is part of the theme issue ‘Sculpting the microbiome: how host factors determine and respond to microbial colonization’

Does changing antiretroviral therapy in the first trimester for pregnancy-related concerns have an impact on viral suppression ?: Changing ART in pregnancy and viral suppression ?

International audienceOBJECTIVE:To determine whether changing antiretroviral therapy (ART) during pregnancy because of concern about fetal risks led to poorer virological outcomes.METHODS:All pregnancies in women with HIV-1 infection enrolled in the national multicenter prospective French Perinatal cohort at 14 week gestation or more were included between January 2005 and December 2015, if the mother was on ART at conception with a plasma viral load <50 copies/mL. The reasons for a change in the ART were analyzed according to treatment guidelines at the time of the pregnancy and defined as for safety concerns in the absence of reported maternal intolerance. Virological and pregnancy outcomes were studied by survival analysis and logistic regression adjusted for a propensity score established for each patient according to baseline characteristics.RESULTS:Of 7079 pregnancies in the overall cohort, 1797 had ART at conception with a viral load <50 copies/mL before 14 week gestation. Of these, 22 changed regimens in the first trimester for intolerance, and 411 of the remaining 1775 (23%) solely for safety concerns. The proportion of change was higher when the initial treatment was not recommended in the national guidelines (OR adjusted: 23.1 [14.0-38.2]), than when it was an alternative option (ORa: 2.2 [1.3-3.7]), as compared to recommended first-line regimens. Treatment changes for safety concerns did not lead to poorer virological control, compared with pregnancies without such changes (19.3% vs. 15.6%, HRa: 1.0 [0.7-1.4]).CONCLUSIONS:Changing ART early in pregnancy to regimens considered safer for pregnancy, and neonatal health did not have a destabilizing effect on viral suppression

Transgenerational response to early microbial exposure in the oyster Crassostrea gigas and positive impact on survival capacities to juvenile mortality syndrome

National audienc

Early life microbial exposures shape the Crassostrea gigas immune system for lifelong and intergenerational disease protection

Background: The interaction of organisms with their surrounding microbial communities influences many biological processes, a notable example of which is the shaping of the immune system in early life. In the Pacific oyster, Crassostrea gigas , the role of the environmental microbial community on immune system maturation – and, importantly, protection from infectious disease – is still an open question. Results: Here, we demonstrate that early life microbial exposure durably improves oyster survival when challenged with the pathogen causing Pacific Oyster Mortality Syndrome (POMS), both in the exposed generation and in the subsequent one. Combining microbiota, transcriptomic, genetic, and epigenetic analyses, we show that the microbial exposure induced changes in epigenetic marks and a reprogramming of immune gene expression leading to long-term and intergenerational immune protection against POMS. Conclusions: We anticipate that this protection likely extends to additional pathogens and may prove to be an important new strategy for safeguarding oyster aquaculture efforts from infectious disease

Early life microbial exposures shape the Crassostrea gigas immune system for lifelong and intergenerational disease protection

Background The interaction of organisms with their surrounding microbial communities influences many biological processes, a notable example of which is the shaping of the immune system in early life. In the Pacific oyster, Crassostrea gigas, the role of the environmental microbial community on immune system maturation – and, importantly, protection from infectious disease – is still an open question. Results Here, we demonstrate that early life microbial exposure durably improves oyster survival when challenged with the pathogen causing Pacific Oyster Mortality Syndrome (POMS), both in the exposed generation and in the subsequent one. Combining microbiota, transcriptomic, genetic, and epigenetic analyses, we show that the microbial exposure induced changes in epigenetic marks and a reprogramming of immune gene expression leading to long-term and intergenerational immune protection against POMS. Conclusions We anticipate that this protection likely extends to additional pathogens and may prove to be an important new strategy for safeguarding oyster aquaculture efforts from infectious disease