Republication de : Risque périnéal et mesures de protection obstétricale : enquête auprès des professionnels de la naissance

International audienceObjectivesThe main objective was to evaluate the practices declared by birth professionals in the Lorraine region about perineal obstetric protection (any perineal tear combined). The secondary objective was to evaluate prevention measures performed in practice by birth professionals according to the perineal risk subjectively estimated for each obstetric situation.MethodsThis is a practice survey conducted through an anonymous questionnaire distributed to birth professionals (gynecologists, interns, midwife and midwife student) in October 2016. Topics covered concerned maternal, obstetric and fetal risk factors associated with perineal (1st to 4th degrees) lesions and the associated protective measures. A descriptive analysis of the data collected was conducted.ResultsOne hundred and five professionals answered the questionnaire. The identified risk factors were consistent with those highlighted in the literature. Other factors, not known as associated with perineal risk, were cited by professionals (smoking, phototype). If the professional perceived a significant perineal risk, they more frequently practiced an episiotomy (15% vs. 0%, P < 0.001) or considered that the delivery should be performed by an obstetrician (34% vs 8%, P < 0.001).ConclusionThis evaluation shows that birth professionals know the main risk factors for perineal injury. On the other hand, they easily use perineal protection maneuvers (episiotomy for example) without real demonstrated effectiveness.ObjectifsL’objectif de notre étude était de réaliser une évaluation des pratiques déclarées par les professionnels de la naissance de la région Lorraine à propos de la protection périnéale obstétricale (toute déchirure périnéale confondue). L’objectif secondaire était d’évaluer les mesures de prévention réalisées en pratique par les professionnels de la naissance en fonction du risque périnéal subjectivement estimé pour chaque situation obstétricale.MéthodesIl s’agit d’une enquête de pratique réalisée grâce à un questionnaire anonyme distribué aux professionnels de la naissance (gynécologues-obstétriciens, internes de spécialité, sage-femme, étudiants sage-femme) en octobre 2016. Les thèmes abordés concernaient les facteurs de risque maternels, obstétricaux et fœtaux associés aux lésions périnéales (du 1er au 4e degrés) et les mesures de protection associées. Il a été réalisé une analyse descriptive des données recueillies.RésultatsCent cinq professionnels ont répondu au questionnaire. Les facteurs de risque identifiés étaient en accord avec ceux mis en évidence dans la littérature. D’autres facteurs, non connus comme associés à un risque périnéal, étaient cités par les professionnels (tabagisme, phototype). En cas de perception, subjective, par le professionnel d’un risque périnéal important, ils pratiquaient plus fréquemment une épisiotomie (15 % vs 0 %, p < 0,001) ou considéraient que l’accouchement devaient être réalisé par un obstétricien (34 % vs 8 %, p < 0,001).ConclusionCette évaluation montre que les professionnels de la naissance connaissent les principaux facteurs de risque de lésion périnéale. En revanche, ils utilisent facilement des manœuvres de protection périnéale (épisiotomie par exemple) sans réelle efficacité démontrée

Risque périnéal et mesures de protection obstétricale : enquête auprès des professionnels de la naissance

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Les complications respiratoires de la drépanocytose chez les enfants: le syndrome thoracique aigu.

The acute chest syndrome (ACS) is one of the most frequent complications of sickle cell disease. It affects mostly young children and counts for one quarter of mortality in the young sickle cell disease (SCD) population. This retrospective study evaluates the impact of ACS among hospitalizations for other complications of SCD in patients at the University Childrens' Hospital Reine Fabiola (Brussels, Belgium) in order to isolate clinical conditions associated with a high risk of ACS development. The medical records of all SCD patients aged up to 18 years admitted for all SCD related acute complications over a period of 13 month have been reviewed. Two patient groups have been formed based on the presence of an ACS within the study period. Epidemiologic data, medical history, the clinical presentation at admission but also blood counts in steady state, at admission and along the hospital stay were compared for a total of 96 hospital stays. There is no difference for age or hemoglobin phenotype between the two major patient groups. Male sex and having had a previous ACS episode in the past were significantly more important in the group of patients hospitalized for ACS. Thoracic pain in an SCD patient who doesn't show typical ACS symptoms should be interpreted as a risk factor for ACS. In conclusion, male sex, medical history of at least one ACS and thoracic pain at hospital admission are associated with high risk of developing ACS.English AbstractJournal ArticleSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Fetal biometry in ultrasound: A new approach to assess the long-term impact of simulation on learning patterns

International audienceSimulation-based education (SBE) has demonstrated its acceptability and effectiveness in improving ultrasound training. Because of the high cost of its implementation (investment in equipment and supervision), a pragmatic assessment of the transfer of skills learned in SBE to clinical practice and the identification of its optimal scheduling conditions have been requested to optimize its input. Objectives: To quantify the long-term impact of simulation-based education (SBE) on the adequate performance of ultrasound fetal biometry measurements (I). The secondary objective was to identify the temporal patterns that enhanced SBE input in learning (II). Methods: Trainees were arbitrarily assigned to a 6-month course in obstetric ultrasound with or without an SBE workshop. In the SBE group, the workshop was implemented 'before' or at an 'early' or a 'late-stage' of the course. Those who did not receive SBE were the control group. The ultrasound skills of all trainees were prospectively collected, evaluated by calculating the delta between OSAUS (Objective Structured Assessment of Ultrasound Skills) scores before and after the course (I). Concomitantly, the accuracy of trainees' measurements was assessed throughout the course by verifying their correlation with the corresponding measurements by their supervisors. The percentage of trainees able to perform five consecutive sets of correct measurements in the control group and in each SBE subgroup were compared (II). Results: The study included 61 trainees (39 SBE and 22 controls). Comparisons between groups showed no significant difference in the quantitative assessment of skill enhancement (difference in the pre-and postinternship OSAUS score: 1.09 § 0.87 in the SBE group and 0.72 § 0.98 in the control group) (I). Conversely, the predefined acceptable skill level was reached by a significantly higher proportion of trainees in the 'early' SBE subgroup (74%, compared with 30% in the control group, P<0.01)(II). Conclusions: The quantitative assessment does not support the existence of long-term benefits from SBE training, although the qualitative assessment confirmed SBE helped to raise the minimal level within a group when embedded in an 'early' stage of a practical course

Association of peripartum management and high maternal blood loss at cesarean delivery for placenta accreta spectrum (PAS): A multinational database study

INTRODUCTION: Placenta accreta spectrum (PAS) carries a high burden of adverse maternal outcomes, especially significant blood loss, which can be life-threatening. Different management strategies have been proposed but the association of clinical risk factors and surgical management options during cesarean delivery with high blood loss is not clear. MATERIAL AND METHODS: In this international multicenter study, 338 women with PAS undergoing cesarean delivery were included. Fourteen European and one non-European center (USA) provided cases treated retrospectively between 2008 and 2014 and prospectively from 2014 to 2019. Peripartum blood loss was estimated visually and/or by weighing and measuring of volume. Participants were grouped based on blood loss above or below the 75th percentile (&gt;3500&#xA0;ml) and the 90th percentile (&gt;5500&#xA0;ml). RESULTS: Placenta percreta was found in 58% of cases. Median blood loss was 2000&#xA0;ml (range: 150-20&#xA0;000&#xA0;ml). Unplanned hysterectomy was associated with an increased risk of blood loss &gt;3500&#xA0;ml when compared with planned hysterectomy (adjusted OR [aOR] 3.7 [1.5-9.4], p&#xA0;=&#xA0;0.01). Focal resection was associated with blood loss comparable to that of planned hysterectomy (crude OR 0.7 [0.2-2.1], p&#xA0;=&#xA0;0.49). Blood loss &gt;3500 ml was less common in patients undergoing successful conservative management (placenta left in situ, aOR 0.1 [0.0-0.6], p&#xA0;=&#xA0;0.02) but was more common in patients who required delayed hysterectomy (aOR 6.5 [1.7-24.4], p&#xA0;=&#xA0;0.001). Arterial occlusion methods (uterine or iliac artery ligation, embolization or intravascular balloons), application of uterotonic medication or tranexamic acid showed no significant effect on blood loss &gt;3500 ml. Patients delivered by surgeons without experience in PAS were more likely to experience blood loss &gt;3500 ml (aOR 3.0 [1.4-6.4], p&#xA0;=&#xA0;0.01). CONCLUSIONS: In pregnant women with PAS, the likelihood of blood loss &gt;3500 ml was reduced in planned vs unplanned cesarean delivery, and when the surgery was performed by a specialist experienced in the management of PAS. This reinforces the necessity of delivery by an expert team. Conservative management was also associated with less blood loss, but only if successful. Therefore, careful patient selection is of great importance. Our study showed no consistent benefit of other adjunct measures such as arterial occlusion techniques, uterotonics or tranexamic acid

A Phg2-Adrm1 Pathway Participates in the Nutrient-controlled Developmental Response in Dictyostelium

Dictyostelium amoebae grow as single cells but upon starvation they initiate multicellular development. Phg2 was characterized previously as a kinase controlling cellular adhesion and the organization of the actin cytoskeleton. Here we report that Phg2 also plays a role during the transition between growth and multicellular development, as evidenced by the fact that phg2 mutant cells can initiate development even in the presence of nutrients. Even at low cell density and in rich medium, phg2 mutant cells express discoidin, one of the earliest predevelopmental markers. Complementation studies indicate that, in addition to the kinase domain, the core region of Phg2 is involved in the initiation of development. In this region, a small domain contiguous with a previously described ras-binding domain was found to interact with the Dictyostelium ortholog of the mammalian adhesion-regulating molecule (ADRM1). In addition, adrm1 knockout cells also exhibit abnormal initiation of development. These results suggest that a Phg2-Adrm1 signaling pathway is involved in the control of the transition from growth to differentiation in Dictyostelium. Phg2 thus plays a dual role in the control of cellular adhesion and initiation of development