Publications by authors named "M Doret-Dion"

13 Publications

[Impact of the healthcare pathway on the rate of obstetrical interventions in small for gestational age fetuses (IATROPAG Study)].

Gynecol Obstet Fertil Senol 2021 Mar 4. Epub 2021 Mar 4.

Hospices Civils de Lyon, Département de gynécologie obstétrique, Hôpital Femme Mère Enfant, Centre Hospitalo-Universitaire, 59, boulevard Pinel, 69500 Bron, France; Université de Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, 69008 Lyon, France. Electronic address:

Background: While previous studies have demonstrated an improvement in implementation of clinical practices and an improved neonatal prognosis when growth restricted fetuses were followed within a standardized healthcare pathway, the objective of this study was to assess the prevalence of obstetric interventions in small-for-gestational-age (SGA) fetuses followed within a standardized care pathway compared to a traditional care pathway.

Methods: We conducted a retrospective study between 2015 and 2017, in a type III maternity hospital in Lyon, in a population of SGA fetuses, considered as such in case of antenatal diagnosis of fetal weight<10th percentile but>3rd centile without umbilical Doppler abnormality during antenatal surveillance and without ultrasound argument suggesting intrauterine growth retardation (IUGR). We collected the gestational age at diagnosis, obstetrical events and prevention of preterm delivery (antenatal corticosteroids), gestation age at birth, the method of delivery (spontaneous or induced), indication of induction, the method of birth (spontaneous, instrumental extraction or caesarean section), and the immediate neonatal outcome including cord pH, Apgar score at 5minutes, birth weight and fetal sex. After diagnosis, the choice of the pathway was left to the practitioner depending on their habit, their ability to manage the follow-up and their organizational constraints.

Results: Over the study period, and after exclusion of IUGR, 96 SGA were followed up in the traditional pathway and 106 SGA were followed up in the standardized pathway P=0.75. The traditional pathway showed in multivariate analysis a higher prevalence of antenatal corticosteroid therapy for SGA (16,6%) between 2015 and 2017 with OR 7.3 95% CI [1.41-38.43] when compared to the standardized pathway (3,7%). Similarly, the traditional pathway proposes a higher prevalence of induction of labor (54,1%) than the standardized pathway (33,9%) between 2015 and 2017 with OR 3.19 95% CI [1.70-7.80]. The "a posteriori" post-hoc power of the study is 82.9%.

Conclusion: This study confirms the absence of excessive obstetrical intervention in the SGA population when followed in a standardized healthcare pathway. The latter would reduce unnecessary obstetrical interventions while respecting the intrinsic neonatal prognosis of small for gestational age fetuses.
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http://dx.doi.org/10.1016/j.gofs.2021.03.004DOI Listing
March 2021

Standardized healthcare pathway in intrauterine growth restriction and minimum evidence-based care.

J Gynecol Obstet Hum Reprod 2021 Jan 19;50(1):101998. Epub 2020 Nov 19.

Hospices Civils de Lyon, Department of Obstetrics and Gynecology, Femme Mère Enfant Hospital, University Hospital Center, 59 Boulevard Pinel, 69500, Bron, France; University of Lyon, University Claude Bernard Lyon 1, University of Saint-Étienne, HESPER EA 7425, F-69008 Lyon, F-42023, Saint-Etienne, France. Electronic address:

Introduction: Fetal growth restricted fetuses are less likely to receive evidence-based care; a previous work demonstrated an improvement in neonatal prognosis when fetuses with intrauterine growth restriction (IUGR) received minimum evidence based-care.

Objective: The objective of the study was to evaluate the impact of a standardized healthcare pathway on the implementation of the recommended clinical practice in the antenatal management of IUGR fetuses, in comparison to a traditional pathway. The quality of the implementation of practice has been defined whether or not minimum evidence-based care (MEC), defined according to the recommendations of the French college of gynecologists and obstetricians (CNGOF), has been implemented.

Study Design: From a historical cohort of 31,052 children, born at the Femme Mère Enfant Hospital (Lyon, France) between January 1st, 2011 and December 31st, 2017, we selected the population of IUGR fetuses. We compared the rate of MEC between the IUGR fetuses followed-up in the traditional healthcare pathway versus the IUGR fetuses followed-up in a standardized healthcare pathway between 2015 and 2017.

Results: A total of 245 IUGR were tracked between 2015 and 2017. Over this period, 120 fetuses were followed within the traditional pathway and 125 within the IUGR pathway. The standardized pathway resulted in a higher rate of MEC (86,4%) when compared to IUGR fetuses followed-up in the traditional pathway (27,5% (OR* 20 (95 % CI 10.0-39.7). Among early-onset IUGR: 31 % received MEC in the traditional pathway versus 83 % in the standardized pathway (p<0.001). Among late-onset IUGR: 22 % received MEC in the traditional pathway versus 92 % in the standardized pathway (p<0.001). The provided care in the standardized pathway resulted in an increase of complete antenatal corticosteroid therapy (92,8 %) when compared to the traditional pathway (50.0 %; p<0.001) and a reduction of the rate of caesarean sections before labor for non-reassuring fetal heart rate (15 %) when compared to the traditional pathway (41.3 % p=0.007).

Conclusion: The standardized pathway improves the implementation of the local recommendations in the management of early- and late-onset IUGR. This study is the first to suggest a standardized care pathway in prenatal medicine. A medico-economic study could estimate the health care savings that such a pathway would provide by allowing a medical management in accordance with the recommendations.
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http://dx.doi.org/10.1016/j.jogoh.2020.101998DOI Listing
January 2021

A Framework Proposal for Quality and Safety Measurement in Gynecologic Emergency Care.

Obstet Gynecol 2020 11;136(5):912-921

Université Paris-Saclay, UVSQ, Unité de recherche 7285, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Montigny-le-Bretonneux, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Service de gynecologie & obstétrique, Poissy, Université Paris Diderot, Sorbonne Paris Cité, AP-HP; Inserm, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Paris, Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, AUDIPOG, Université Claude Bernard Lyon 1, Laennec, Lyon, Service de Gynécologie Obstétrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, Service de Gynécologie Obstétrique Hôpital Lariboisière, Paris, Service de Gynécologie Obstétrique Hôpital Jeanne de Flandre CHRU, Lille, Service de Gynécologie Obstétrique CHI de Villeneuve-Saint-Georges, Villeneuve Saint-Georges, Service de Gynécologie, Obstétrique et Médecine de la Reproduction, CHU Cochin Paris, Université Paris Descartes, Paris Sorbonne Cité, Paris, Gynécologie chirurgicale, CHU de Rennes, Rennes, Service de gynécologie-obstétrique, hôpitaux de Nantes, CHU Hôtel-Dieu, Nantes, Université de Nantes, Nantes, Service de Gynécologie Obstétrique, hôpital de La Conception, Assistance publique-Hôpitaux de Marseille, Marseille, Service de gynécologie obstétrique, Hôpital Bichat, APHP, Paris, Université Diderot Paris, Paris, Unité de recherche EA 7285, Université Versailles St-Quentin (UVSQ), Montigny-le-Bretonneux, Centre Hospitalier Universitaire Hautepierre, Hôpital de Hautepierre, Strasbourg, Département de l'assurance qualité, de la gestion des risques et des droits du patient, hôpitaux Universitaires de Paris Nord Val de Seine, APHP, Paris, Unité d'Epidémiologie Clinique, URC Robert Debré, APHP, Paris, Inserm CIC-EC 1426; Inserm et Université Paris Diderot UMR 1123 ECEVE, Paris, Paris, Institut de recherche pour le développement (IRD), université Paris Descartes, UMR 196, CEPED, Paris, UMR 1153 Equipe EPOPé, INSERM, Paris, France; and CHR la Citadelle, Université de Liège, Belgium.

Objective: To define and assess the prevalence of potentially life-threatening gynecologic emergencies among women presenting for acute pelvic pain for the purpose of developing measures to audit quality of care in emergency departments.

Methods: We conducted a mixed-methods multicenter study at gynecologic emergency departments in France and Belgium. A modified Delphi procedure was first conducted in 2014 among health care professionals to define relevant combinations of potentially life-threatening conditions and near misses in the field of gynecologic emergency care. A prospective case-cohort study in the spring of 2015 then assessed the prevalence of these potentially life-threatening emergencies and near misses among women of reproductive age presenting for acute pelvic pain. Women in the case group were identified at 21 participating centers. The control group consisted of a sample of women hospitalized for acute pelvic pain not caused by a potentially life-threatening condition and a 10% random sample of outpatients.

Results: Eight gynecologic emergencies and 17 criteria for near misses were identified using the Delphi procedure. Among the 3,825 women who presented for acute pelvic pain, 130 (3%) were considered to have a potentially life-threatening condition. The most common diagnoses were ectopic pregnancies with severe bleeding (n=54; 42%), complex pelvic inflammatory disease (n=30; 23%), adnexal torsion (n=20; 15%), hemorrhagic miscarriage (n=15; 12%), and severe appendicitis (n=6; 5%). The control group comprised 225 hospitalized women and 381 outpatients. Diagnostic errors occurred more frequently among women with potentially life-threatening emergencies than among either hospitalized (odds ratio [OR] 1.7, 95% CI 1.1-2.7) or outpatient (OR 14.7, 95% CI 8.1-26.8) women in the control group. Of the women with potentially life-threatening conditions, 26 met near-miss criteria compared with six with not potentially life-threatening conditions (OR 25.6, 95% CI 10.9-70.7).

Conclusions: Potentially life-threatening gynecologic emergencies are high-risk conditions that may serve as a useful framework to improve quality and safety in emergency care.
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http://dx.doi.org/10.1097/AOG.0000000000004132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575026PMC
November 2020

Rationale and design of ePPOP-ID: a multicenter randomized controlled trial using an electronic-personalized program for obesity in pregnancy to improve delivery.

BMC Pregnancy Childbirth 2020 Oct 7;20(1):602. Epub 2020 Oct 7.

Department of medicine, endocrinology division, Mc Master university, Hamilton, Canada.

Background: Pre-pregnancy obesity and excessive gestational weight gain (GWG) are established risk factors for adverse pregnancy, delivery and birth outcomes. Pregnancy is an ideal moment for nutritional interventions in order to establish healthier lifestyle behaviors in women at high risk of obstetric and neonatal complications.

Methods: Electronic-Personalized Program for Obesity during Pregnancy to Improve Delivery (ePPOP-ID) is an open multicenter randomized controlled trial which will assess the efficacy of an e-health web-based platform offering a personalized lifestyle program to obese pregnant women in order to reduce the rate of labor procedures and delivery interventions in comparison to standard care. A total of 860 eligible pregnant women will be recruited in 18 centers in France between 12 and 22 weeks of gestation, randomized into the intervention or the control arm and followed until 10 weeks of postpartum. The intervention is based on nutrition, eating behavior, physical activity, motivation and well-being advices in which personalization is central, as well as the use of a mobile/tablet application. Inputs includes data from the medical record of participants (medical history, anthropometric data), from the web platform (questionnaires on dietary habits, eating behavior, physical activity and motivation in both groups), and adherence to the program (time of connection for the intervention group only). Data are collected at inclusion, 32 weeks, delivery and 10 weeks postpartum. As primary outcome, we will use a composite endpoint score of obstetrical interventions during labor and delivery, defined as caesarean section and instrumental delivery (forceps and vacuum extractor). Secondary outcomes will consist of data routinely collected as part of usual antenatal and perinatal care, such as GWG, hypertension, preeclampsia, as well as fetal and neonatal outcomes including premature birth, gestational age at birth, birth weight, macrosomia, Apgar score, arterial umbilical cord pH, neonatal traumatism, hyperbilirubinemia, respiratory distress syndrome, transfer in neonatal intensive care unit, and neonatal adiposity. Post-natal outcomes will be duration of breastfeeding, maternal weight retention and child weight at postnatal visit.

Discussion: The findings of the ePPOP-ID trial will help design e-health intervention program for obese women in pregnancy.

Trial Registration: ClinicalTrials.gov Identifier: NCT02924636 / October 5th 2016.
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http://dx.doi.org/10.1186/s12884-020-03288-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7542973PMC
October 2020

Pregnancy-related thrombosis risk in patients with protein C deficiency and comparison with pregnant women with heterozygous factor V Leiden mutation.

Blood Coagul Fibrinolysis 2020 Jan;31(1):55-59

Clinical Haemostasis Unit, Louis Pradel Cardiological University Hospital.

: The risk of pregnancy-related venous thromboembolism is high in patients with inherited thrombophilia. The aim of this study was to compare the risk of pregnancy related-venous thromboembolism of women with protein C (PC) deficiency to patients with heterozygous factor V Leiden mutation. 145 consecutive pregnant women with confirmed PC deficiency or heterozygous factor V Leiden mutation were prospectively enrolled in the study. Lyon venous thromboembolism-risk score was used to individually tailor antithrombotic prophylaxis. The use of a validated clinical score presents the advantage to have a homogenous management of the venous thromboembolism risk in patients having similar risk factors. 53 pregnancies with PC deficiency were compared with 190 pregnancies in heterozygous factor V Leiden mutation carriers. 50% of the patients with PC deficiency and 64% of the heterozygous factor V Leiden mutation carriers were asymptomatic. According to the Lyon-venous thromboembolism risk score, 50% of patients with PC deficiency and 51% of heterozygous factor V Leiden carriers did not received any antepartum heparin prophylaxis. 34 and 37% of patients respectively received heparin prophylaxis during the third trimester only. No venous thromboembolism was observed in patients with PC deficiency and one postpartum venous thromboembolism occurred in a patient with heterozygous factor V Leiden. In the absence of randomized controlled clinical studies, we report here a large prospective series of pregnant women with PC deficiency. In our cohort, no difference of outcome, in terms of venous thromboembolism, was observed between pregnant women with PC deficiency and those with heterozygous factor V Leiden. Based on our results, low-molecular-weight heparin prophylaxis should not be mandatory in all pregnant women with PC deficiency. Similar prophylaxis strategies may be applied to women with factor V Leiden mutation or PC deficiency.
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http://dx.doi.org/10.1097/MBC.0000000000000878DOI Listing
January 2020