Publications by authors named "Didier Lémery"

54 Publications

A French audit of maternity unit protocols for immediate postpartum hemorrhage: A cross-sectional study (HERA).

J Gynecol Obstet Hum Reprod 2021 Jan 7;50(1):101934. Epub 2020 Oct 7.

Fédération Nationale des Réseaux de Santé en Périnatalité, Nantes, France.

Objectives: The principal objective of this work was to assess how well the written protocols of maternity units used for the prevention and management of postpartum hemorrhage (PPH) corresponded to the 2004 French guidelines on this topic. The second objective was to assess whether or not this correspondence with the national guidelines varied according to hospital level (basic, specialized, and subspecialized) and status (teaching, public, and private).

Methods: This observational multicenter cross-sectional study took place in September 2010 and included French perinatal networks that volunteered to participate. We asked 300 French maternity units belonging to these networks to participate by emailing a copy of their department's protocol for PPH to the study team. This team designed and performed a clinical audit of these protocols, defining 16 criteria that incorporated the 2004 French guidelines for prevention and management of PPH. The main outcome measure was the percentage of units reporting protocols meeting these criteria.

Results: Of the 244 maternity units responding, 97.1 % had a written protocol but only 67.0 % had a local protocol. Protocol correspondence with the 2004 French guidelines was good for the criteria involving quantitative assessment of the quantity of blood loss (83.5 %) and secondary management of PPH (>80 %). Correspondence with the guidelines was poor in terms of defining PPH in the protocol (25.3 %) and of requiring the recording of the time of PPH diagnosis (53.2 %) and of the volume of blood loss (55.7 %). These results differed only slightly according to maternity unit status or level.

Conclusion: In all, 67.0 % (159/237) of maternity units had a local protocol for PPH. The contents of these protocols should be improved to be closer to the national guidelines.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jogoh.2020.101934DOI Listing
January 2021

Temperature Elevation in an Instrumented Phantom Insonated by B-Mode Imaging, Pulse Doppler and Shear Wave Elastography.

Ultrasound Med Biol 2020 Dec 19;46(12):3317-3326. Epub 2020 Sep 19.

Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France; Pôle Femme et Enfant, CHU de Clermont-FerrandClermont-Ferrand, France.

Diagnostic ultrasound is the gold standard for obstetric scanning and one of the most important imaging techniques for perinatal and neonatal monitoring and diagnosis. Ultrasound provides detailed real-time anatomic information, including blood flow measurements and tissue elasticity. The latter is provided through various techniques including shear wave elastography (SWE). SWE is increasingly used in many areas of medicine, especially in detection and diagnosis of breast, thyroid and prostate cancers and liver disease. More recently, SWE has found application in gynaecology and obstetrics. This method mimics manual palpation, revealing the elastic properties of soft biological tissues. Despite its rising potential and expanding clinical interest in its use in obstetrics and gynaecology (such as for assessment of cervical ripening or organ development and structure during pregnancy), its effects on and potential risks to the developing fetus remain unknown. Risks should be evaluated by regulatory bodies before recommendations are made on the use of SWE. Because ultrasound is known to produce thermal and mechanical effects, this study measured the temperature increase caused by B-mode, pulse Doppler (PD) and SWE, using an instrumented phantom with 11 embedded thermocouples. Experiments were performed with an Aixplorer diagnostic ultrasound system (Supersonic Imagine, Aix-en-Provence, France). As expected, the greatest heating was detected by the thermocouple closest to the surface in contact with the transducer (2.9°C for SWE, 1.2°C for PD, 0.7°C for B-mode after 380-s excitation). Both conduction from the transducer face and direct heating owing to ultrasound waves contribute to temperature increase in the phantom with SWE associated with a larger temperature increase than PD and B-mode. This article offers a methodological approach and reference data for future safety studies, as well as initial recommendations about SWE safety in obstetrics and gynaecology.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ultrasmedbio.2020.08.021DOI Listing
December 2020

Response to IA Abdelazim's et al. letter about the article of E. Nohuz et al. [Combined Endoloop® ligation and pessary cerclage devices for delayed interval delivery: A first case report, Taiwan J Obstet Gynecol. 2019; 58:579-580].

Taiwan J Obstet Gynecol 2020 07;59(4):631

Department of Obstetrics and Gynecology, University Hospital, Clermont-Ferrand, France; University Clermont-Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.tjog.2020.05.035DOI Listing
July 2020

Temperature Rise Caused by Shear Wave Elastography, Pulse Doppler and B-Mode in Biological Tissue: An Infrared Thermographic Approach.

Ultrasound Med Biol 2020 Feb 14;46(2):325-335. Epub 2019 Nov 14.

Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France; Pôle Femme et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.

The aim of this study was to determine the interest in and relevance of the use of infrared thermography, which is a non-invasive full-field surface temperature measurement technique, to characterize the heterogeneous heating caused by ultrasound in biological tissue. Thermal effects of shear wave elastography, pulse Doppler and B-mode were evidenced in porcine tissue. Experiments were performed using a high-frequency echography Aixplorer system (Supersonic Imagine, Aix-en-Provence, France). For all three modes, ultrasound was applied continuously for 360 s while the temperature at the sample surface was recorded with a Cedip Jade III-MWIR infrared camera (Flir, Torcy, France). Temperature changes were detected for the three modes. In particular, "heat tunnels" crossing the sample were visualized from the early stages of the experiment. Heat conduction from the transducer was also involved in the global warming of the sample. The study widens the prospects for studies on tolerability, potentially in addition to classic approaches such as those using thermocouples.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ultrasmedbio.2019.10.008DOI Listing
February 2020

Combined Endoloop ligation and pessary cerclage devices for delayed interval delivery: A first case report.

Taiwan J Obstet Gynecol 2019 07;58(4):579-580

Department of Obstetrics and Gynecology, University Hospital, Clermont-Ferrand, France; University Clermont-Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.tjog.2019.05.028DOI Listing
July 2019

Phthalate Exposure in Pregnant Women: Risk Perception and Preventive Advice of Perinatal Health Professionals.

Matern Child Health J 2019 Mar;23(3):335-345

Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Faculté de Pharmacie, Département de Santé Publique et Environnement, Clermont-Ferrand, France.

Objectives The main objective of the PERI-HELPE study (Perception of Risk-HEaLth Professionals and Environment Study) was to describe the knowledge of perinatal health professionals about phthalates and the preventive advice they give to pregnant women about exposure to these chemicals. The secondary objective was to determine whether giving preventive advice was associated with the perception of phthalates. Methods A cross-sectional study was performed in 2015 in France. One hundred and eighty-nine perinatal health professionals (obstetricians, midwives and general practitioners) replied to an online self-administered questionnaire (participation rate: 11%). Results Only 17% of health professionals felt able to provide appropriate answers to pregnant women about phthalates. Advice was given by 23% (avoid plastic kitchen cling film) to 75% (prefer homemade dishes) about eating habits, by less than 42% for the use of cosmetics and less than 25% for that of consumer products. After adjusting for covariates, the awareness that pregnant women are daily exposed to phthalates (44% of professionals) was associated with dietary advice [avoid pre-packaged food (OR 2.2; 95% CI 1.1-4.4), prefer homemade dishes (OR 2.6; 95% CI 1.2-5.9) and avoid plastic kitchen cling film (OR 2.4; 95% CI 1.0-5.6)] but not with advice about cosmetics or consumer products. The perception of phthalate exposure as a high risk (66%) was not associated with preventive advice. Conclusions for Practice Our sample size was not very large but the findings nevertheless show the lack of knowledge of perinatal health professionals about phthalates. If they are to take on a preventive role, health professionals in France need to be better informed about phthalates and more fully trained in environmental health in general.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10995-018-2668-xDOI Listing
March 2019

Laryngotracheoesophageal cleft, a rare differential diagnosis of esophageal atresia.

J Gynecol Obstet Hum Reprod 2018 Dec 16;47(10):577-579. Epub 2018 Sep 16.

Pôle Femme Et Enfant, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand Cedex 1, France; Equipe "Translational approach to epithelial injury and repair", Université Clermont-Auvergne, CNRS, Inserm, GReD, 63000 Clermont-Ferrand, France. Electronic address:

A laryngotracheoesophageal cleft, commonly called laryngeal cleft (LC), is a congenital malformation of the posterior part of the larynx creating an abnormal communication between the laryngotracheal axis and the pharyngoesophageal axis. The prenatal ultrasonographic features associating absent stomach, polyhydramnios and mediastinal "pouch sign" are usually considered pathognomonic for esophageal atresia. This observation demonstrates that they can also correspond to a severe form of laryngotracheoesophageal cleft extending to the carina.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jogoh.2018.09.003DOI Listing
December 2018

In utero exposure to arsenic in tap water and congenital anomalies: A French semi-ecological study.

Int J Hyg Environ Health 2018 09 30;221(8):1116-1123. Epub 2018 Jul 30.

Université Clermont Auvergne, CNRS, Sigma Clermont, Institut Pascal - UFR Pharmacie, Département Santé Publique et Environnement, Clermont-Ferrand, France.

Introduction: Congenital anomalies (CA) are responsible for high rates of mortality and long-term disabilities. Research on their risk factors including environmental factors is needed. Studies on exposure to arsenic (As) in tap water and the risk of CA have not provided conclusive evidence, particularly when levels of exposure were low (from 10 to 50 μg As/L). The main objective of this study was to assess the association between exposure to As in tap water and the risk of any major CA. The secondary objectives were to assess this association for the most common types of congenital anomalies (in the heart, musculoskeletal, urinary and nervous systems).

Methods: A semi-ecological study was conducted from births recorded at the University Hospital of Clermont-Ferrand, France, in 2003, 2006 and 2010. The medico-obstetric data were available at individual level. Children with congenital anomalies were identified from the database of the regional registry of congenital anomalies: the Centre d'Etudes des Malformations Congénitales Auvergne (CEMC-Auvergne). As exposure was estimated from the concentrations of As measured during sanitary control of tap water supplied in the mothers' commune of residence (aggregate data). French guidelines for As in tap water were used to identify the two groups: "≥ 10 μg As/L group" and "[0-10) μg As/L group". Multivariable logistic regression models were fit.

Results: 5263 children (5.1% with a CA) were included. In stratified analysis by gender of the child, positive associations between As exposure exceeding 10 μg/L and risk of any major CA (adjusted OR = 2.41; 95%CI: 1.36-4.14) and of congenital heart anomalies (adjusted OR = 3.66; 95%CI: 1.62-7.64) were only shown for girls. No association was found for boys.

Conclusion: This French semi-ecological study provides additional arguments for the association between exposure to As exceeding 10 μg/L in tap water and the risk of CA especially in a context of low exposure. Further studies are needed to better understand the interaction between arsenic exposure and child gender.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijheh.2018.07.012DOI Listing
September 2018

Practices during the active second stage of labor: A survey of French midwives.

Midwifery 2018 May 8;60:48-55. Epub 2018 Feb 8.

Université Clermont Auvergne, CNRS, CHU Clermont-Ferrand, SIGMA, INSTITUT PASCAL, F-63000 Clermont-Ferrand, France; Réseau de Santé en Périnatalité d'Auvergne, F-63000 Clermont-Ferrand, France; AUDIPOG (Association des Utilisateurs de Dossiers Informatisés en Pédiatrie, Obstétrique; et Gynécologie), RTH Laennec Medical University, 7 rue Guillaume Paradin, 69372 Lyon Cedex 08, France.

Objective: the principal objective of our study was to describe the practices reported by French midwives during the active second stage of labor (expulsion phase).

Design: this cross-sectional Internet survey questioned French midwives who attended at least one childbirth in 2013.

Setting: this open survey was posted on a website from June 15 through December 1, 2014.

Participants: 1496 midwives from 377 maternity units participated in the study.

Measurements And Findings: the midwives most often reported suggesting horizontal positions during the active second stage (supine with footholds, lithotomy, lithotomy with knees turned in, or lateral positions). Non-horizontal positions were more often proposed by midwives in level I units (p<0.0001). Almost half the midwives responding (46.4%), especially those working in level III units (51.1%, p = 0.006), advised Valsalva pushing. The mean maximum pushing time was 35.3 minutes±12.8 minutes. Nearly all the midwives favored the 'hands on' technique at childbirth (91.4%), and 24% reported using warm compresses on the perineum at childbirth.

Key Conclusion: most midwives advised horizontal positions for childbirth. The practices of French midwives differed as a function of where they worked. The midwives, especially those in level III facilities, reported that they cannot always ensure 'physiological childbirth'.

Implications For Practice: the practices of French midwives must become more evidence-based. The development of professional guidelines for midwives in France appears essential. This study also helps to prioritise national training for midwives.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.midw.2018.02.001DOI Listing
May 2018

Exposure to arsenic in tap water and gestational diabetes: A French semi-ecological study.

Environ Res 2018 02 21;161:248-255. Epub 2017 Nov 21.

Université Clermont Auvergne, CNRS, Institut Pascal, UFR Pharmacie, Département Santé Publique et Environnement, Clermont-Ferrand, France.

Introduction: The increase in the prevalence of gestational diabetes mellitus (GDM) and its consequences for mother and children prompts research on their risk factors including environmental factors. Studies on exposure to arsenic (As) in tap water and the risk of GDM have not provided conclusive evidence, particularly when levels of exposure were low (from 10 to 50µg As/L). The main objective of this study was to assess the association between exposure to As in tap water and the risk of GDM.

Methods: A semi-ecological study was conducted from births recorded at the University Hospital of Clermont-Ferrand, France, in 2003, 2006 and 2010. Individual medical/obstetric data were available. As exposure was estimated from the concentrations of As measured during sanitary control of tap water supplied in the mothers' commune of residence (aggregate data). French guidelines for As in tap water were used to identify groups potentially exposed, designated "As +" (≥ 10µg As/L) and "As -" (< 10µg As/L). Multivariate logistic regression analysis was performed.

Results: 5053 women (5.7% with a GDM) were included. Overall, women in the As + group had a higher risk of GDM than those in the As - group (adjusted OR = 1.62; 95%CI: 1.01-2.53). Stratified analysis of pre-pregnancy body mass index (BMI) showed a positive association only for obese or overweight women (adjusted OR = 2.30; 95%CI: 1.13-4.50).

Conclusion: This French semi-ecological study provides additional arguments for an association between As exposure and the risk of GDM in particular in a context of low exposure. Further studies are needed to assess a potential interaction between As exposure and body mass index.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.envres.2017.11.016DOI Listing
February 2018

Positions during the first stage and the passive second stage of labor: A survey of French midwives.

Midwifery 2018 Jan 17;56:79-85. Epub 2017 Oct 17.

Université Clermont Auvergne, CNRS, CHU Clermont-Ferrand, SIGMA, INSTITUT PASCAL, F-63000 Clermont-Ferrand, France; Réseau de Santé en Périnatalité d'Auvergne, F-63000 Clermont-Ferrand, France; AUDIPOG (Association des Utilisateurs de Dossiers Informatisés en Pédiatrie, Obstétrique et Gynécologie), RTH Laennec Medical University, 7 rue Guillaume Paradin, 69372 Lyon Cedex 08, France.

Objective: the objective of our study was to describe the practices reported by French midwives during labor (first stage and passive phase of the second stage).

Design: this cross-sectional internet questionnaire surveyed French midwives who attended at least one delivery in 2013.

Setting: this open survey was posted on a website from June 15 through December 1, 2014.

Participants: 1496 midwives from 377 maternity units participated in the study. Nearly 93% of the midwives worked in an obstetric unit, 5.9% had a mixed practice, and 1.3% worked in private practice.

Measurements And Findings: during the first stage of labor, midwives reported suggesting that women without epidural analgesia use a birthing ball (98.1%) and that they walk around (97.4%). For women with epidural analgesia, most suggested motion in horizontal positions. Epidural analgesia was proposed more often by midwives from level II (75.7%) and level III (73.5%) maternity wards than by those at level 1 units (57.7%) (p<0.0001). The midwives preferred a lateral position during the first stage for women with epidural analgesia and during the second stage for women both with and without it. Midwives in practice for 5 years or less suggested a kneeling position for women with epidural analgesia more often than more experienced midwives.

Key Conclusion: the practices of French midwives vary with their place of practice and their experience.

Implications For Practice: to promote normal labor, French midwives must reappropriate vertical positions and analgesic alternatives to epidurals.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.midw.2017.10.010DOI Listing
January 2018

Congenital unilateral renal agenesis: Prevalence, prenatal diagnosis, associated anomalies. Data from two birth-defect registries.

Birth Defects Res 2017 Sep 19;109(15):1204-1211. Epub 2017 Jul 19.

Centre d'Etude des Malformations Congénitale, CEMC-Auvergne, Clermont-Ferrand, France.

Background: The different mechanisms leading to a solitary kidney should be differentiated because the long-term outcome might be different. The fetal period is the best moment to make a true diagnosis of congenital unilateral renal agenesis (URA). The objective was to determine the prevalence of URA at birth. The secondary objectives were to describe the evolution of sensitivity of prenatal diagnosis over time and the different forms of URA (isolated and associated with other malformations) detected up to 1 year.

Methods: The cases were retrospectively identified through two French population-based birth defect registries (Auvergne and Bas-Rhin) between 1995 and 2013. Stillbirths and fetuses up to 22 weeks of gestation and infants up to 1 year old with URA were included.

Results: A total of 177 cases of URA were registered. The prevalence at birth was 4.0/10,000. The overall prenatal prevalence was 3.6/10,000 (isolated URA: 2.8/10,000). URA were isolated (59.9%), associated with isolated contralateral congenital anomaly of kidney or urinary tract (CAKUT) (7.3%) and with other extra-renal anomalies (32.8%). The total proportion of contralateral CAKUT was 15%. Only three cases presented an aneuploidy, prenatally detected and conducting to a termination of pregnancy. The sensitivity of prenatal diagnosis improved over time (from 54.2% in 1995 to 1997 to 95.8% in 2010 to 2013; p = 0.002).

Conclusion: Our study provides estimates of prevalence of URA at birth. A longitudinal cohort from the antenatal period to puberty should be performed to determine the prognosis of the contralateral kidney among these children with isolated, associated with contralateral CAKUT and URA with extra-renal anomalies. Birth Defects Research 109:1204-1211, 2017. © 2017 Wiley Periodicals, Inc.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/bdr2.1065DOI Listing
September 2017

Exposure of hospitalised pregnant women to plasticizers contained in medical devices.

BMC Womens Health 2017 06 20;17(1):45. Epub 2017 Jun 20.

Axe TGI-PEPRADE, Institut Pascal, Sigma Clermont, CNRS, Université Clermont Auvergne, 63001, Clermont-Ferrand, France.

Background: Medical devices (MDs) in polyvinyl chloride (PVC) are not a well-known source of exposure to plasticizers, in particular during pregnancy. Because of its toxicity, the di-(2-ethylhexyl) phthalate (DEHP) has been replaced by other plasticizers such as di (isononyl)-cyclohexane-1,2-dicarboxilic acid (DINCH), tri-octyltrimellitate (TOTM) and di-(isononyl) phthalate (DiNP). Our study aimed to quantify the plasticizers (DEHP and alternative plasticizers) contained in PVC medical devices used for hospitalised pregnant women and to describe which these MDs had been used (type, number, duration of exposure).

Methods: The plasticizers contained in the MDs used for daily care in the Obstetrics Department of a French University Hospital were extracted from PVC (after contact with a chloroform solution), identified and quantified by gas-chromatography-mass-spectrometry analysis. A total of 168 pregnant women hospitalised in the Obstetrics Department with at least one catheter were included in the observational study. The median number of MDs containing plasticizers used and the daily duration of exposure to the MDs were compared in three groups of pregnant women: "Pathology group" (women hospitalised for an obstetric disorder who did not give birth during this hospitalisation; n = 52), "Pathology and delivery group" (hospitalised for an obstetric disorder and who gave birth during this stay; n = 23) and "Delivery group" (admitted for planned or spontaneous delivery without obstetric disorder; n = 93).

Results: DiNP, TOTM and DINCH were the predominant plasticizers contained in the MDs at an amount of 29 to 36 g per 100 g of PVC. Women in the "Pathology group" (preterm labour or other pathology) were exposed to a median number of two MDs containing TOTM and one MD containing DiNP, fewer than those in the "Pathology and delivery group" (p < 0.05). Women in the "Pathology group" had a median exposure of 3.4 h/day to MDs containing DiNP and 8.2 h/day to MDs containing TOTM, longer than those in the "Delivery group" (p < 0.01).

Conclusions: Our study shows that the medical management of pregnant women in a hospital setting entails exposure to MDs containing alternative plasticizers (DiNP, TOTM and DINCH).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12905-017-0398-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5480197PMC
June 2017

Perception of Environmental Risks and Health Promotion Attitudes of French Perinatal Health Professionals.

Int J Environ Res Public Health 2016 12 18;13(12). Epub 2016 Dec 18.

EA 4681, PEPRADE, Clermont Université, Université d'Auvergne, 28 Place Henri-Dunant BP 38, 63001 Clermont-Ferrand, France.

The exposure of pregnant women to environmental contaminants is a subject of international concern. However, the risk perception of these contaminants by health professionals (HP) has not been extensively investigated. The main objective of the PERI-HELPE study (Perception of Risk-HEaLth Professionals & Environment Study) was to assess the risk perception of environmental exposure of pregnant women by perinatal HPs. The secondary objectives were to describe the preventive attitudes of perinatal HPs concerning chemicals exposure of pregnant women and to identify the barriers to preventive attitude. A cross-sectional study was performed in 2015 in France. One hundred eighty-nine HPs (obstetricians, midwives, and general practitioners) replied to an online self-administered questionnaire (participation rate: 11%). Carbon monoxide, pesticides and lead were the contaminants most frequently perceived as a high risk for pregnant women. A minority of HPs asked women about their chemical exposure and advised them to reduce exposure. The lack of information, training and scientific evidence in environmental health were the main difficulties declared by the HPs to advise pregnant women. Despite the low response rate, our findings provide important information to encourage French health authorities to take into account the difficulties encountered by HPs and set up appropriate training programs in Environmental health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph13121255DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5201396PMC
December 2016

Policies for management of postpartum haemorrhage: the HERA cross-sectional study in France.

Eur J Obstet Gynecol Reprod Biol 2016 Oct 10;205:21-6. Epub 2016 Aug 10.

Inserm, U 1153, Equipe Epopè, CRESS, Université Paris Descartes 5, Paris, France.

Objective: The principal objective of this study was to describe the policies reported by French maternity units for the prevention and early management of postpartum haemorrhage (PPH). The second objective was to assess their variation according to hospital level and status.

Study Design: Cross-sectional observational study of French maternity units, from January 2010 to April 2011. The medical supervisor (obstetrician or midwife) of participating maternity wards completed a questionnaire designed to ascertain the unit's protocol for preventing and managing PPH after both vaginal and caesarean deliveries at a gestational age >22 weeks (or a birth weight >500g). The main outcome measure was the percentage of units reporting protocols adhering to the principal criteria for adequate management defined by the 2004 French guidelines for PPH.

Results: 252 maternity units participated in the survey. Almost all units had a written protocol for PPH (97.2%). For vaginal deliveries, 82.5% of units had a definition of PPH (>500ml) and 92.8% had a policy of preventive oxytocin use. For caesareans, only 23.8% defined PPH (as >1000ml), 68.8% used manual delivery of the placenta, and 76.9% recommended oxytocin injection immediately after the birth. The first-line medication for PPH was oxytocin (96.3%) and the second-line treatment a prostaglandin (97.5%). Level III maternity units had a definition of haemorrhage for vaginal deliveries more often than did other levels of care (P=0.04). Manual removal of the placenta after caesareans was significantly more frequent in level I than level III units (P=0.008) and in private than other types of maternity units. Medical management of haemorrhage did not differ according to level of care or maternity status.

Conclusions: The responses by maternity unit supervisors showed significant improvement in the management of PPH accordingly to the 2004 French guidelines, especially for the third stage of labour. This improvement did not differ between hospitals by levels of care or legal status.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejogrb.2016.08.008DOI Listing
October 2016

Incidence of immediate postpartum hemorrhages in French maternity units: a prospective observational study (HERA study).

BMC Pregnancy Childbirth 2016 08 24;16:242. Epub 2016 Aug 24.

Pôle Femme et Enfant, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, 63003, France.

Background: Most estimates of postpartum hemorrhage (PPH) are calculated from studies that use administrative or medical birth databases, and only a few from prospective observational studies. Our principal objective was to estimate the incidence of PPH according to their severity (mild or severe) in vaginal deliveries (>500 mL, ≥1000 mL) and cesareans (>1000 mL and ≥1500 mL). The secondary objectives were to describe the incidence of PPH according to maternity unit characteristics, causes, and types of PPH management.

Methods: This prospective observational study took place in French maternity wards. Women who gave birth at a term ≥ 22 weeks were eligible for the study. 182 maternity units participated in a study with prospective data collection from 1 February, 2011, to 31 July, 2011. The main outcome measure was PPH incidence.

Results: PPH incidence after vaginal delivery was 3.36 % [95 % CI: 3.25-3.47 %] and after cesareans 2.83 % [95 % CI: 2.63-3.04 %]. The incidence of severe PPH after vaginal delivery was 1.11 % [95 % CI: 1.05-1.18 %] and after cesareans 1.00 % [95 % CI: 0.88-1.13 %]. This incidence rate varied according to maternity unit characteristics. The principal cause of PPH for both modes of delivery was uterine atony (57.7 % for vaginal births and 66.3 % for cesareans). Vascular embolization was more frequent among women with cesareans (10.0 vs. 2.9 %), who also required transfusions more often (44.4 vs 12.7 %).

Conclusions: The incidence of PPH was lower than the rate expected from the literature. Effective treatment of uterine atony and optimizing the identification of blood loss remain important priorities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12884-016-1008-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4995746PMC
August 2016

Reply.

Birth 2016 06;43(2):185-6

EA 4681, PEPRADE, Clermont Université, Université d'Auvergne, Clermont-Ferrand, France.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/birt.12224DOI Listing
June 2016

Impact of prenatal diagnosis on the outcome of patients with a transposition of great arteries: A 24-year population-based study.

Birth Defects Res A Clin Mol Teratol 2016 Mar 21;106(3):178-84. Epub 2015 Dec 21.

EA 4681, PEPRADE, Clermont Université, Université d'Auvergne, Clermont-Ferrand, France.

Background: Transposition of great arteries (TGA) defined as the combination of concordant atrioventricular and discordant ventriculo-arterial connections is one of the most common congenital heart defects. Prenatal diagnosis of TGA remains difficult. To determine the impact of antenatal diagnosis we evaluated the sensitivity of antenatal detection and the neonatal mortality of TGA considering two study periods and two major types of TGA.

Methods: A cross-sectional study was performed. Data were collected from a French population-based birth defect registry. From 1988 to 2012, 94 fetuses with TGA were registered. The study period was subdivided into the 1988 to 1999 period and the 2000 to 2012 period. Two types of TGA were considered: isolated TGA (n = 66) and associated TGA (n = 28). A stratified analysis was performed considering the study periods and the types of TGA.

Results: Considering the study periods, the sensitivity of prenatal detection of TGA increased significantly (9.8% vs. 51.5%, p = 0.0001). The same trend was found for associated TGA (4.8% vs. 33.3%, p = 0.002) and isolated TGA (21.1% vs. 100%, p < 0.001). A late diagnosis of TGA (7 days after birth) was observed in 13.2% of cases. Neonatal mortality decreased significantly over time for isolated TGA (25.0% vs. 0 p = 0.01). Prenatal diagnosis of both types of TGA did not improve survival.

Conclusion: We demonstrated that prenatal diagnosis and neonatal mortality of TGA varied greatly according to the malformation type and the study period. This could be explained by an improvement in terms of medical management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/bdra.23474DOI Listing
March 2016

Does maternal race influence the short-term variation of the fetal heart rate? An historical cohort study.

Eur J Obstet Gynecol Reprod Biol 2015 Oct 1;193:102-7. Epub 2015 Aug 1.

Centre Hospitalier Universitaire de Clermont-Ferrand, 58 Rue Montalembert 63000, Clermont-Ferrand Cedex 1 63003, France; Clermont Université, Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), 28 place Henri-Dunant BP 38, 63001 Clermont-Ferrand, France; AUDIPOG (Association des Utilisateurs de Dossiers informatisés en Pédiatrie, Obstétrique et Gynécologie), RTH Laennec Medical University, 7 rue Guillaume Paradin, 69372 Lyon Cedex 08, France.

Objectives: The main aim of this article was to analyze short-term variation (STV) of the fetal heart rate according to maternal race. The secondary aim was to study the baseline fetal heart rate according to this factor.

Study Design: This single-center historical cohort study covered the period from November 2008 through December 2011 (n=182). The inclusion criteria were: black women from sub-Saharan Africa or white European women, with a singleton pregnancy ≥34 weeks and fetal heart rate recorded by computerized analysis (Oxford Sonicaid System 8002) at a prenatal visit. The exclusion criteria were: medication likely to modify fetal heart rate, abnormal fetal heart rate tracing, and being in labor. A multiple linear regression analysis was used to study the association between maternal race and STV.

Results: STV was lower by 2.6ms in fetuses of black women (n=55) compared to those of white women (n=127) (8.9±2.1ms vs. 11.4±3.4ms) (p<0.001). The basal fetal heart rate was higher (p=0.001), and the recording criteria were met less often for the black women (p=0.04). After adjustment for maternal age, body mass index at the beginning of pregnancy, maternal cigarette smoking, parity, gestational diabetes, gestational age at the time of the fetal heart rate recording, and the time between the last meal and the recording, mean STV was lower by 3.1±0.6ms in fetuses of black compared with white women (p<0.001).

Conclusion: STV is lower in fetuses of black women compared to those of white women in a low-risk population. A study of black and white women with high-risk pregnancies is necessary to assess the impact of medical practices on perinatal outcome after STV analysis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejogrb.2015.07.007DOI Listing
October 2015

Reliability of student midwives' visual estimate of blood loss in the immediate postpartum period: a cross-sectional study.

Int J Nurs Stud 2015 Dec 3;52(12):1798-803. Epub 2015 Jul 3.

AUDIPOG Sentinel Network (Association des Utilisateurs de Dossiers Informatisés en Pédiatrie, Obstétrique et Gynécologie), Faculté de Médecine RTH Laennec, Lyon, France; Department of Public Health, Clermont-Ferrand University Hospital Center, France; EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement) at University of Auvergne France; Department of Obstetrics & Gynecology, Clermont-Ferrand University Hospital Center, France.

Background: In France, postpartum hemorrhage (blood loss≥500mL in the first 24h postpartum) is the leading direct obstetric cause of maternal mortality. In French practice, PPH is mainly diagnosed by a quantitative assessment of blood loss, performed by subjective methods such as visual estimates. Various studies have concluded that visual estimates are imprecise, tend to underestimate blood loss, and thus to delay diagnosis of PPH.

Objectives: The principal objective of this study was to assess the accuracy of visual estimates of blood loss by student midwives. The secondary objectives were to study intraobserver agreement of these assessments, to assess the accuracy of visual estimates for threshold values, and to look for a region effect.

Design: A cross-sectional multicentre study.

Setting: All French midwifery schools (n=35).

Participants: Volunteer French student midwives at their fifth (final) year (n=463).

Methods: The online questionnaire contained 16 photographs (8 different, each presented twice) of simulated volumes of blood loss (100, 150, 200, 300, 500, 850, 1000, and 1500mL). A 50-mL reference standard for calibration accompanied each photograph. Only one answer could be selected among the 7 choices offered for each photograph. Comparisons used χ(2) and Kappa tests.

Results: The participation rate was 48.43% (463/956), and 7.408 visual estimates were collected. Estimates were accurate for 35.34% of the responses. The reproducibility rate for the visual estimates (0.17≤к≤0.48) and for the accurate visual estimates (0.11≤к≤0.55) were moderate for 4 of the 8 volumes (100, 300, 1000, and 1500mL). The percentage of accurate responses was significantly higher for volumes≤300mL than for those ≥500mL (52.94% vs. 17.17%, p<0.0001) and those ≥1000mL (52.94% vs. 18.30%, p<0.0001). The percentage of accurate responses varied between the regions (p=0.042).

Conclusion: Despite the help of a visual aid, both the accuracy and reproducibility of the visual estimates were low.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijnurstu.2015.06.015DOI Listing
December 2015

Prenatal Screening of 21 Microdeletion/Microduplication Syndromes and Subtelomeric Imbalances by MLPA in Fetuses with Increased Nuchal Translucency and Normal Karyotype.

Cytogenet Genome Res 2015 21;146(1):28-32. Epub 2015 Jul 21.

Service de Cytogx00E9;nx00E9;tique Mx00E9;dicale, Unitx00E9; de Mx00E9;decine Fx0153;tale, CHU Clermont-Ferrand, Clermont-Ferrand, France.

Fetuses with increased nuchal translucency thickness (NT) are at increased risk for chromosomal abnormalities. In case of a normal karyotype, a minority of them may present with structural abnormalities or genetic syndromes, which may be related to submicroscopic chromosomal imbalances. The objective of this study was to evaluate whether MLPA screening of 21 syndromic and subtelomeric regions could improve the detection rate of small chromosomal aberrations in fetuses with increased NT and a normal karyotype. A total of 106 prenatal samples from fetuses with NT ≥ 99th centile and normal R- and G-banding were analyzed by MLPA for subtelomeric imbalances (SALSA P036 and P070) and 21 syndromic regions (SALSA P245). One sample showed a benign CNV (dup(8)pter, FBXO25 gene), and 1 patient was found to have a loss of 18 qter and a gain of 5 pter as a result of an unbalanced translocation. The incidence of cryptic pathogenic variants was <1% or 2.7% when only fetuses with other ultrasound abnormalities were taken into account. Submicroscopic imbalances in fetuses with increased NT may be individually rare, and genome-wide screening seems more likely to improve the diagnostic yield in these fetuses.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000435865DOI Listing
March 2016

[Management of preterm labor on cervical-uterine incompetence using a pessary cerclage obstetrical].

Pan Afr Med J 2015 24;20:284. Epub 2015 Mar 24.

Service de Gynécologie-Obstétrique et Biologie de la Reproduction, CHU Estaing, 1, Place Lucie Aubrac, 63001 Clermont-Ferrand.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.11604/pamj.2015.20.284.5847DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4483363PMC
April 2016

Prenatal diagnosis of the VACTERL association using routine ultrasound examination.

Birth Defects Res A Clin Mol Teratol 2015 Oct 2;103(10):880-6. Epub 2015 Jun 2.

Pôle Gynéco-Obstétrique-Reproduction Humaine, CHU Clermont-Ferrand, Clermont-Ferrand, France.

Background: The prognosis and early neonatal management of the VACTERL association depend mainly on the severity of malformations ascertained prenatally.

Methods: Here we reviewed the spectrum of clinical features observed in cases of VACTERL association ascertained prenatally through ultrasound examination but examined at birth and compared them with cases ascertained postnatally.

Results: From 1995 to 2011, a total of 19 cases of VACTERL association were observed in our center; 10 were ascertained prenatally and confirmed after birth whereas 9 were ascertained only after birth. The types and frequencies of malformations observed prenatally were as follows: renal malformations (45%), tracheoesophageal fistula (44%), cardiac malformations (20%), vertebral (13%), and limb (11%) defects. Anal atresia was never detected using routine prenatal ultrasound examination.

Conclusion: Further studies of fetuses with the VACTERL association are necessary to better delineate the malformations spectrum observed prenatally to improve the early recognition of the VACTERL association.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/bdra.23346DOI Listing
October 2015

Severe secondary postpartum hemorrhage: a historical cohort.

Birth 2015 Jun 13;42(2):149-55. Epub 2015 Apr 13.

EA 4681, PEPRADE, University of Auvergne, Clermont-Ferrand, France.

Objectives: The principal objective of our study was to describe the frequency of severe secondary postpartum hemorrhages (PPH). Our secondary objectives were to describe the different causes of PPH and to assess if the PPH etiologies varied by parity.

Methods: This is a historical cohort study covering the period from January 1, 2004, through February 13, 2013, in a level III maternity ward. Women were eligible if they were treated for severe secondary PPH during their postpartum hospitalization or were admitted for it after discharge but before the 42nd day postpartum, regardless of the type of delivery. Women were excluded if they gave birth before 22 weeks of gestation or if they had experienced only an immediate PPH (≤ 24 hours after delivery). Eligible patients were identified by the hospital's administrative software. Primiparas and multiparas were compared with Student's t test and a chi-squared or Fisher's exact test.

Results: The incidence of severe secondary PPH was 0.23 percent (n = 60/26,023). The mean time between delivery and PPH onset was 13.4 ± 10.8 days. The women's mean age was 30.4 ± 5.7 years and their mean body mass index was 23.4 ± 5.7 kg/m². Placental retention was the cause to which these hemorrhages were most frequently attributed (30.0%). Subinvolution of the placental bed was noted in 13.3 percent of the patients, endometritis in 10.0 percent, pseudoaneurysm of the uterine artery in 3.3 percent, and excessively strong resumption of menses in 3.3 percent; no cause could be determined for 16.7 percent of the cases. Neither clinical signs nor causes differed by parity.

Conclusion: Secondary PPH is rare. Accurate diagnosis is based most often on histopathologic findings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/birt.12164DOI Listing
June 2015

Ovarian thrombosis and uterine synechiae after arterial embolization for a late postpartum haemorrhage.

Case Rep Womens Health 2015 Jan 22;5:1-4. Epub 2014 Nov 22.

Department of Obstetrics and Gynaecology, Academic Medical Centre, France.

Background: We report two unusual separate complications after uterine artery embolization for a late postpartum haemorrhage. This report appeared important to us in view of the apparent absence of any other publications on this topic.

Case Presentation: We report the case of a 25-year-old woman, gravida 3, para 1, admitted for uterine bleeding 7 days after a spontaneous delivery at term, in our university hospital. A suction curettage and then, after persistent bleeding, uterine artery embolization were necessary. Immediately after the embolization, a bilateral ovarian thrombosis occurred, subsequently followed by amenorrhea, due to uterine synechiae, and depression. Hysteroscopic surgery was performed to remove the adhesions. A complete work-up for thrombophilia showed a heterozygous mutation of the factor V gene R506Q. The pathology examination found subinvolution of the placental bed. One month after treatment of the synechiae (and insertion of a copper IUD for contraception), the woman's menstrual cycle returned to normal. Her clinical examination 19 months later was normal.

Conclusions: This case teaches us that one rare complication can hide another! It is important to consider the diagnosis of subinvolution of the placental bed in cases of late PPH and to know the complications associated with vascular artery embolization in order to provide the most rapid and least invasive treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.crwh.2014.10.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5863026PMC
January 2015

Does induction of labor for constitutionally large-for-gestational-age fetuses identified in utero reduce maternal morbidity?

BMC Pregnancy Childbirth 2014 May 1;14:156. Epub 2014 May 1.

Faculté de médecine RTH Laennec, The AUDIPOG Sentinel Network (Association des Utilisateurs de Dossiers informatisés en Pédiatrie, Obstétrique et Gynécologie), 7 Rue guillaume Paradin, 69372 Lyon Cedex 08, France.

Background: The number of infants with a birth weight > 97th percentile for gestational age has increased over the years. Although some studies have examined the interest of inducing labor for fetuses with macrosomia suspected in utero, only a few have analyzed this suspected macrosomia according to estimated weight at each gestational age. Most studies have focused principally on neonatal rather than on maternal (and still less on perineal) outcomes. The principal aim of this study was to assess whether a policy of induction of labor for women with a constitutionally large-for-gestational-age fetus might reduce the occurrence of severe perineal tears; the secondary aims of this work were to assess whether this policy would reduce either recourse to cesarean delivery during labor or neonatal complications.

Methods: This historical cohort study (n = 3077) analyzed records from a French perinatal database. Women without diabetes and with a cephalic singleton term pregnancy were eligible for the study. We excluded medically indicated terminations of pregnancy and in utero fetal deaths. Among the pregnancies with fetuses suspected, before birth, of being large-for-gestational-age, we compared those for whom labor was induced from ≥ 37 weeks to ≤ 38 weeks+ 6 days (n = 199) to those with expectant obstetrical management (n = 2878). In this intention-to-treat analysis, results were expressed as crude and adjusted relative risks.

Results: The mean birth weight was 4012 g ± 421 g. The rate of perineal lesions did not differ between the two groups in either primiparas (aRR: 1.06; 95% CI: 0.86-1.31) or multiparas (aRR: 0.94; 95% CI: 0.84-1.05). Similarly, neither the cesarean rate (aRR: 1.11; 95% CI: 0.82-1.50) nor the risks of resuscitation in the delivery room or of death in the delivery room or in the immediate postpartum or of neonatal transfer to the NICU (aRR = 0.94; 95% CI: 0.59-1.50) differed between the two groups.

Conclusions: A policy of induction of labor for women with a constitutionally large-for-gestational-age fetus among women without diabetes does not reduce maternal morbidity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1471-2393-14-156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4012520PMC
May 2014

Appropriateness of elective caesarean deliveries in a perinatal network: a cross-sectional study.

BMC Pregnancy Childbirth 2014 Apr 9;14:135. Epub 2014 Apr 9.

The Clermont-Ferrand University Hospital, 58 Rue Montalembert, Clermont-Ferrand, 63003 Cedex 1, France.

Background: The overall caesarean rate in France has increased from 14.3% in 1994-1996 to 21.0% in 2010. This increased rate is a concern in all developed countries: delivery by caesarean induces both short- and long-term maternal complications, and its use requires careful reflection. The principal objective of this work was to describe the global appropriateness of indications for caesareans among a selected sample of planned caesareans performed within the Auvergne perinatal health network. The secondary objectives were to describe the inappropriate planned caesarean risk according to the maternity unit level and the impact of this medical assessment on the global caesarean rate in this network.

Methods: This audit among maternity units belonging to the Auvergne perinatal network in France included women who had a planned caesarean at term, were nulliparous or primiparous, and had a singleton pregnancy in cephalic presentation or a twin pregnancy with twin 1 in cephalic presentation. We used the French guidelines issued from 1998 through 2010 as our benchmark for appropriateness.

Result: We analysed 192 cases (100% of the records eligible for the audit). The rate of appropriate caesareans among these planned caesareans was 65.6%. Among the inappropriate caesareans, the rate of "maternal-preference" caesareans was 12.0% and the rate of "provider-preference" caesareans 22.4%. The risk of an inappropriate caesarean did not differ statistically between the level I and level II maternity wards, each compared to the level III hospital. The overall caesarean rate in our entire network decreased from 20.5% to 18.5% (p < 0.001) in the year after the audit. It also decreased in 8 of the network's 10 maternity units, although the difference was statistically significant only in 2.

Conclusions: About one third of planned caesareans were inappropriate in our sample and our audit appeared to have some effect on medical practice in the short run.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1471-2393-14-135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3986443PMC
April 2014

Maternal satisfaction as an outcome criterion in research on labor analgesia: data analysis from the recent literature.

Clin J Pain 2015 Mar;31(3):235-46

*Centre de Pharmacologie Clinique ‡PRI, Anesthésie-Réanimation Gynécologie-Obstétrique §Pôle Santé Publique ¶GORH (Gynécologie-Obstétrique) #Direction de la Recherche Clinique et des Innovations, CHU Clermont-Ferrand †Inserm, CIC1405 and U1107 "Neuro-Dol" ∥Univ Clermont1, EA 4681 PEPRADE, Clermont-Ferrand, France.

Objectives: To investigate whether maternal satisfaction (MS) is taken into consideration as an outcome criterion in clinical research on analgesia for labor.

Methods: A systematic review of articles reporting analgesia for labor from a panel of 17 influential journals was undertaken. A total of 116 articles were analyzed, including 282 within-study groups. The scope of MS, the type of outcome measure used, and the time of measurement were noted. Each available observation was assigned an ordinal value of MS (ordMS), according to data distribution. The factors influencing ordMS were identified by multivariable analysis.

Results: The methods used to assess MS were very variable, even within the different measurement tools reported. The weighted distribution of ordMS was 17.8%, 21.8%, 31.2%, and 29.3% for levels "poor," "fair," "good," and "excellent," respectively. In comparative studies, statistical differences for analgesia were related to statistical differences for MS (P<0.0001), but only the negative predictive value was high (0.87). Power to detect a difference in MS between treatment groups was low in general, but it influenced reporting of a significant difference for MS (P<0.0001). The obstetrical factors influencing ordMS were: the body mass index, the initial cervical dilatation, and the within-study percentage of nulliparous women. The techniques alternative to epidural analgesia negatively influenced ordMS.

Discussion: A standard and validated tool to assess MS in clinical research on analgesia for labor is still to be developed. Power should be improved by acting on sample sizes or sensitivity of the outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/AJP.0000000000000106DOI Listing
March 2015

False positive morphologic diagnoses at the anomaly scan: marginal or real problem, a population-based cohort study.

BMC Pregnancy Childbirth 2014 Mar 24;14:112. Epub 2014 Mar 24.

Service de Génétique Médicale, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.

Background: Congenital malformations occur in 3-4% of live births. Their prenatal detection is performed by ultrasound screening. Any announcement about a suspected malformation is a source of stress for the parents, and misdiagnosis during ultrasound screening can lead to expensive and sometimes iatrogenic medical interventions. In this study, we aim to determine the false-positive rate, first overall and then by anatomical system, of ultrasound screening for congenital malformations in the second and third trimesters of pregnancy.

Methods: Our sample includes all children born between 1 January, 2006, and 31 December, 2009, in the French region of Auvergne, whose mother had a prenatal ultrasound diagnosis of a congenital malformation during the second or third trimester of pregnancy confirmed by a follow-up ultrasound examination by an expert consultant ultrasonographer. The study included 526 fetuses, divided in 3 groups: false positives, diagnostic misclassifications, and true positives. The rates of false positives and diagnostic misclassifications were calculated for the sample as a whole and then by anatomical system.

Results: Overall, the false-positive rate was 8.8% and the rate of diagnostic misclassification 9.2%. The highest false-positive rates were found for renal and gastrointestinal tract malformations, and the highest diagnostic misclassification rates for cerebral and cardiac malformations. The diagnostic misclassification rate was significantly higher than the false-positive rate for cardiac malformations.

Conclusion: The false-positive rate during prenatal ultrasound is not insignificant; these misdiagnoses cause psychological stress for the parents and overmedicalisation of the pregnancy and the child.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1471-2393-14-112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3994389PMC
March 2014

Prenatal ultrasound findings observed in the Wolf-Hirschhorn syndrome: data from the registry of congenital malformations in Auvergne.

Birth Defects Res A Clin Mol Teratol 2013 Dec 6;97(12):806-11. Epub 2013 Nov 6.

CHU Clermont-Ferrand, Génétique Médicale, Clermont-Ferrand, France.

Background: Wolf-Hirschhorn syndrome (WHS) is associated with facial dysmorphism including high forehead, high nasal bridge, hypertelorism and severe mental retardation. WHS results from a 4p16.3 deletion. Only a small number of reports have been made on the prenatal ultrasound findings observed in WHS.

Cases: Here we report our experience on 10 cases of WHS ascertained prenatally between 1983 and 2009 through the CEMC-Auvergne registry of congenital malformations.

Conclusion: The assumption that a "Greek warrior helmet" facies is pathognomonic of WHS could lead to misdiagnosis. Other clinical findings such as severe and early onset intrauterine growth retardation, facial dysmorphism (high forehead, high nasal bridge, low-set ears, micrognathia, hypertelorism), atrial or ventricular septal defect, and renal dysplasia should help obstetricians to suspect the diagnosis of WHS prenatally.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/bdra.23194DOI Listing
December 2013