Which fetal growth charts should be used in France? Position of the French College of Obstetricians and Gynecologists (CNGOF)

Objective: To assess which fetal growth charts best describe intrauterine growth in France defined as the ability to classify 10% of fetuses below the 10th percentile (small for gestational age [SGA]) and above the 90th percentile (large for gestational age [LGA]) in the second and third trimesters. Methods: We analyzed five studies on fetal ultrasound measurements using three French data sources. Two studies used second and third trimester ultrasound data from a nationwide birth cohort in 2011 (the ELFE study, N = 13 197 and N = 7747); one study used third trimester ultrasound data from on a nationwide cross-sectional study (the 2016 French National Perinatal Survey, N = 9940); and the last two studies were from the “Flash study” 2014 which prospectively collected ultrasound data from routine visits in the second and third trimesters (N = 4858 and N = 3522). For each study, we reported the percentage of measurements below the 10th percentile or above the 90th percentile, using French, Hadlock's, WHO and Intergrowth (IG) charts. Results: WHO classified 4.7% and 16.3% of fetuses as having an estimated fetal weight (EFW) 90th percentiles in the second trimester compared to 3.3% and 34.7% with IG. The percentage of fetuses in the third trimester with an EFW 90th percentiles, ranged from 9.1% to 9.4% and from 8.0% to 11.1%, respectively, for WHO, and from 3.9% to 4.1% and from 17.3% to 21.6%, respectively, for IG. The WHO and IG charts for head circumference were very similar and performed well. Compared to the WHO charts, the French and Hadlock's charts deviated more frequently from the target percentiles values for EFW and biometric measures. Conclusion: It is recommended to use the WHO charts for the assessment of EFW and ultrasound biometric measurements in France (strong recommendation; low quality of evidence)

Factors associated with early menarche: results from the French Health Behaviour in School-aged Children (HBSC) study

<p>Abstract</p> <p>Background</p> <p>Puberty is a transition period making physiological development a challenge adolescents have to face. Early pubertal development could be associated with higher risks of poor health. Our objective was to examine risk behaviours, physical and psychological determinants associated with early menarche (<11 years).</p> <p>Methods</p> <p>Early menarche was assessed in the Health Behaviour in School-aged Children French cross-sectional survey. Data were collected in 2006 by anonymous self-reported standardized questionnaire from a nationally representative sample of 1072 15 years old girls in school classrooms. Family environment, school experience, physical and psychological factors, risk behaviours (substance use and sexual initiation) were recorded. Logistic regression models were applied (analysing for crude and adjusted relationships between early menarche and risk behaviours controlled for family context).</p> <p>Results</p> <p>Median age at menarche was 13.0 years; 57 girls (5.3%) were early-matured. Controlled for familial environment, early menarche was associated with having had more than two life-drunkenness episodes (adjusted OR = 2.5 [1.3-4.6]), early sexual initiation (adjusted OR = 2.8 [1.3-6.0]) and overweight (adjusted OR = 7.3 [3.6-14.9]).</p> <p>Conclusion</p> <p>Early-maturing girls may affiliate with older adolescents, hence engage in risk behaviours linked to their appearance rather than their maturity level. Factors associated with early menarche highlight the need to focus attention on early-matured girls to prevent further health problems linked to risk behaviours.</p

Analyse descriptive des pratiques pour le diagniostic prénatal de la trisomie 21 avant et après la mise en application de l'arrêté du 23 juin 2009 (étude rétrospective au sein de la population de la grande agglomération toulousaine en 2008 et 2011)

TOULOUSE3-BU Santé-Centrale (315552105) / SudocSudocFranceF

Etude de la variabilité entre obstétriciens dans l'évaluation du bien être foetal au cours du travail (intêret de l'utilisation de l'électrocardiogramme foetal couple au rythme cardiaque foetal)

STRASBOURG-Medecine (674822101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

L association du STAN au rythme cardiaque fœtal, en cas d anomalie, permet-elle d améliorer la prise en charge des patientes en salle de travail ?

Le RCF est utilisé en routine dans la surveillance du travail depuis plus de 30 ans sans avoir été évalué au préalable. Une augmentation du taux de césarienne a été constatée alors que son utilité sur l amélioration du bien-être fœtal est contestée. L imprécision de la signification des anomalies du RCF et la grande variabilité de leur interprétation pourraient en partie expliquer ces mauvaises performances. Dans un large essai suédois l association du STAN au RCF a permis de diminuer les taux d extraction pour anomalie du RCF et d encéphalopathie néonatale modérée ou sévère. Constatant une divergence des pratiques obstétricales nordiques et françaises, nous avons évalué le STAN entre 2002 et 2006. L objectif de cette thèse était de déterminer si l association du STAN permet d améliorer la prise en charge en salle de travail des patientes avec anomalie du RCF. Une étude d observation sur 433 cas a permis de montrer que le STAN avait une sensibilité de 63% pour le diagnostic de l acidose sévère et de 38% pour celui de l acidose modérée. Dans un essai randomisé sur 799 patientes, l utilisation du STAN n a pas entraîné une diminution du taux d extraction pour anomalie du RCF, mais à permis une diminution de 56% du recours au pH au scalp. Nous avons montré, à partir de 30 tracés analysés par 7 obstétriciens, que le STAN permettait d accroître l homogénéité dans les décisions d extraction grâce à la réduction des extractions non justifiées. Le STAN permet d augmenter l homogénéité des décisions d extraction en salle de travail. L incrémentation de la variabilité dans l algorithme décisionnel du STAN est une piste pour augmenter la fiabilité du diagnostic de l acidose.Fetal heart rate (FHR) has been routinely measured by cardiotocography (CTG) to monitor labor for more than 30 years, despite the absence of any formal evaluation. The rate of cesarean delivery has increased over this time, while the usefulness of FHR in improving fetal well-being has been contested. The imprecision in the significance of FHR abnormalities and the great variability in their interpretation may explain this poor performance in part. A large Swedish trial showed that the combination of the STAN (ST segment analysis) with CTG diminished the rate of operative intervention for fetal distress, as well as the rate of moderate or severe neonatal encephalopathy. In view of the divergences between the Nordic countries and France in obstetrical practices, we assessed the STAN in France between 2002 and 2006. The objective of this dissertation was to determine whether combining STAN with CTG improves in labor room management of patients with fetal distress. An observational study of 433 cases showed that STAN had a sensitivity of 63% for a diagnosis of severe acidosis and of 38% for moderate acidosis. In a randomized trial of 799 patients, the use of STAN did not reduce the rate of operative intervention for fetal distress but did lead to a 56% reduction in use of scalp pH tests. In an analysis of 30 tracings by 7 obstetricians, we showed that STAN increased the consistency of decisions for operative intervention by reducing the number of unjustified interventions. STAN increases the consistency of decisions for operative intervention in the labour room. Breaking down the degree of FHR variability into increments in the STAN decision algorithm is one pathway for increasing the reliability of its diagnosis of acidosis.STRASBOURG-Medecine (674822101) / SudocSudocFranceF

Essential thrombocythemia and pregnancy.

International audienceEssential thrombocythaemia (ET) is an acquired myeloproliferative neoplasm, characterised by persistent thrombocytosis and a tendency for either thrombosis or haemorrhage. Among myeloproliferative neoplasms, ET is the most prevalent in young women, which constitute a special group due to their childbearing potential. An increased risk of fetal and maternal complications has been demonstrated in patients with ET. The most common pregnancy-related complication is spontaneous abortion during the first trimester. Recurrent abortion, fetal growth restriction, stillbirth and placental abruption are less frequent. Maternal complications are relatively rare and essentially represented by thromboembolic and bleeding events. Here we summarize the literature describing pregnancy and its outcome in patients with ET and discuss some recommendations for the management of pregnancy

Physiologic and pathologic changes of platelets in pregnancy.

International audiencePlatelets are key players in haemostasis and thrombus formation. Defects affecting platelets during pregnancy can lead to heterogeneous complications, such as thrombosis, first trimester miscarriage and postpartum haemorrhage. The incidence of complications is increased in women who have heritable platelet function disorders. Modifications of platelet count or platelet functions during normal pregnancy and preeclampsia will be summarized and the management of pregnant women with heritable platelet function disorders will be discussed

Motion estimation in ultrasound imaging applied to the diagnostic of pelvic floor disorders

International audienceThe main purpose of this paper is to show the potential of tissue motion estimation in ultrasound imaging for the diagnostic of pelvic floor disorders. We propose to evaluate the tissue motion using a method based on a local deformable model and on image features (local phase and orientation) extracted from the monogenic signal. The proposed method is well adapted to the pelvic organ deformations and estimates motion with subpixel precision without the need for interpolation. The estimated motion is used to visualize the bladder local deformation and to extract quantitative figures such as the deformation parameters and the bladder angle variation. These results could potentially be interesting to characterize the degree of the pelvic organ prolapse

Comparison of the materno-fetal transfer of fifteen structurally related bisphenol analogues using an ex vivo human placental perfusion model

International audienceRegulatory measures and public concerns regarding bisphenol A (BPA) have led to its replacement by a variety of alternatives in consumer products. Due to their structural similarity to BPA, these alternatives are under surveillance, however, for potential endocrine disruption. Understanding the materno-fetal transfer of these BPA-related alternatives across the placenta is therefore crucial to assess prenatal exposure risks. The objective of the study was to assess and compare the placental transfer of a set of 15 selected bisphenols (BPs) (BP 4-4, BPA, BPAF, BPAP, 3-3 BPA, BPB, BPBP, BPC, BPE, BPF, BPFL, BPM, BPP, BPS and BPZ) using the ex vivo human placental perfusion model. The UHPLC–MS/MS method for simultaneous quantification of these BPs in perfusion media, within a concentration range of 0.003–5 μM, was able to measure placenta transfer rates as low as 0.6%–4%. Despite their structural similarities, these BPs differed greatly in placental transport efficiency. The placental transfer rates of BP4-4, BPAP, BPE, BPF, 3-3BPA, BPB, BPA were similar to that of antipyrine, indicating that their main transport mechanism was passive diffusion. By contrast, the placental transfer rates of BPFL and BPS were very limited, and intermediate for BPBP, BPZ, BPC, BPM, BPP and BPAF, suggesting weak diffusional permeability and/or that their passage might involve efflux transport. These placental transfer data will be particularly useful for predicting the fetal exposure of this important class of emerging contaminants