Publications by authors named "Pierre Chabanier"

3 Publications

  • Page 1 of 1

Association Between Planned Cesarean Delivery and Neonatal Mortality and Morbidity in Twin Pregnancies.

Obstet Gynecol 2017 06;129(6):986-995

Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Service de Gynécologie Obstétrique, Université Paris Diderot, INSERM, U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, Maternité Notre Dame de Bon Secours, Groupe Hospitalier Saint-Joseph, and Université René Descartes, Paris, Hôpital François Mitterrand, Service de Gynécologie Obstétrique, Pau, CHU de Nice, Service de Gynécologie Obstétrique, and Université de Nice Sophia Antepolis, Nice, CHU de Bordeaux, Service de Gynécologie Obstétrique, Bordeaux, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Service de Gynécologie Obstétrique, and Université d'Aix-Marseille, Marseille, CHRU de Lille, Maternité Jeanne de Flandre, and Université de Lille 2, Lille, CHU de Nîmes, Service de Gynécologie Obstétrique, Nîmes, Université de Montpellier 1, Montpellier, CHU de Caen, Service de Gynécologie Obstétrique, and Université de Caen, Caen, Réseau Aurore, Lyon, CHU d'Amiens, Service de Gynécologie Obstétrique, and Université d'Amiens, Amiens, CHU de Reims, Service de Gynécologie Obstétrique, and Université de Reims, Reims, France; Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service de Gynécologie Obstétrique, and Université Pierre et Marie Curie, Paris, CHU de Strasbourg, Service de Gynécologie Obstétrique, and Université de Strasbourg, Strasbourg, CHU de Rouen, Service de Gynécologie Obstétrique, and Université de Rouen, Rouen, Maternité Régionale de Nancy, and Université de Nancy, Nancy, CHU de Toulouse, Service de Gynécologie Obstétrique, and Université Toulouse III Paul Sabatier, Toulouse, CHRU de Tours, Service de Gynécologie Obstétrique, and Université de François Rabelais, Tours, CHU de Potiers, Service de Gynécologie Obstétrique, and Université de Poitiers, Poitiers, CHU de Rennes, Service de Gynécologie Obstétrique, and Université de Rennes 1, Rennes, CHU de Besançon, Service de Gynécologie Obstétrique, and Université de Besançon, Besançon, Centre Hospitalier Intercommunal de Poissy, Service de Gynécologie Obstétrique, Poissy, Université de Versailles Saint-Quentin-en-Yvelines, Versailles, Hospices Civiles de Lyon, Hôpital de la Croix Rousse, Service de Gynécologie Obstétrique, and Université de Lyon 1, Lyon, CHU de Dijon, Service de Gynécologie Obstétrique, and Université de Bourgogne, Dijon, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service de Gynécologie Obstétrique, and Université Paris Sud, Le Kremlin Bicêtre, CHU d'Angers, Service de Gynécologie Obstétrique, and Université d'Angers, Angers, CHU de Clermont-Ferrand, Service de Gynécologie Obstétrique, and Université d'Auvergne, Clermont-Ferrand, CHU de Nantes, Service de Gynécologie Obstétrique, and Université de Nantes, Nantes, and URC-CIC P1419, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, Maternité Port-Royal, and and DHU risques et grossesse, Paris, France.

Objective: To evaluate the association between the planned mode of delivery and neonatal mortality and morbidity in an unselected population of women with twin pregnancies.

Methods: The JUmeaux MODe d'Accouchement (JUMODA) study was a national prospective population-based cohort study. All women with twin pregnancies and their neonates born at or after 32 weeks of gestation with a cephalic first twin were recruited in 176 maternity units in France from February 2014 to March 2015. The primary outcome was a composite of intrapartum mortality and neonatal mortality and morbidity. Comparisons were performed according to the planned mode of delivery, planned cesarean or planned vaginal delivery. The primary analysis to control for potential indication bias used propensity score matching. Subgroup analyses were conducted, one according to gestational age at delivery and one after exclusion of high-risk pregnancies.

Results: Among 5,915 women enrolled in the study, 1,454 (24.6%) had planned cesarean and 4,461 (75.4%) planned vaginal deliveries, of whom 3,583 (80.3%) delivered both twins vaginally. In the overall population, composite neonatal mortality and morbidity was increased in the planned cesarean compared with the planned vaginal delivery group (5.2% compared with 2.2%; odds ratio [OR] 2.38, 95% confidence interval [CI] 1.86-3.05). After matching, neonates born after planned cesarean compared with planned vaginal delivery had higher composite neonatal mortality and morbidity rates (5.3% compared with 3.0%; OR 1.85, 95% confidence interval 1.29-2.67). Differences in composite mortality and morbidity rates applied to neonates born before but not after 37 weeks of gestation. Multivariate and subgroup analyses after exclusion of high-risk pregnancies found similar trends.

Conclusion: Planned vaginal delivery for twin pregnancies with a cephalic first twin at or after 32 weeks of gestation was associated with low composite neonatal mortality and morbidity. Moreover, planned cesarean compared with planned vaginal delivery before 37 weeks of gestation might be associated with increased composite neonatal mortality and morbidity.
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http://dx.doi.org/10.1097/AOG.0000000000002048DOI Listing
June 2017

Incidence of obstetrical thrombotic thrombocytopenic purpura in a retrospective study within thrombocytopenic pregnant women. A difficult diagnosis and a treatable disease.

BMC Pregnancy Childbirth 2015 Jun 17;15:137. Epub 2015 Jun 17.

Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.

Background: Thrombotic thrombocytopenic Purpura (TTP) defined as ADAMTS-13 (A Disintegrin And Metalloprotease with ThromboSpondin type 1 domain 13) activity <10 % is a rare aetiology of thrombocytopenia during pregnancy, although the precise incidence is unknown. During pregnancy, the diagnosis of TTP is crucial as it has high feto-maternal morbidity-mortality and requires urgent plasma exchange. The purpose of this study was to assess the incidence of TTP retrospectively and to describe case presentations and follow-up.

Methods: A monocentric retrospective study (2008-2009) was conducted among pregnant women followed in a tertiary care obstetrical unit who experienced at least one episode of severe thrombocytopenia (platelets ≤75 G/L) during 2008 and 2009. In cases of uncertain aetiology of thrombocytopenia, ADAMTS-13 activity was assessed by the full length technique.

Results: Among 8,908 deliveries over the 2 year period, 79 women had a platelet count nadir ≤75 G/L. Eighteen had a known aetiology of thrombocytopenia and 11 were lost to follow-up. Among 50 remaining patients, ADAMTS-13 activity was undetectable (<5 %) in 4, consistent with the diagnosis of TTP. Platelet count spontaneously normalized in 3 patients after delivery. None presented focal cerebral involvement. Three of the four, who were primipara patients, had a sustained severe deficiency in the absence of anti-ADAMTS-13 antibodies, and ADAMTS-13 gene sequencing indicated a constitutive deficiency. The fourth, a multipara patient, had an acquired, auto-immune TTP. Placental pathology in the three primipara patients showed severe and non-specific ischemic lesions. Two patients lost their babies shortly after birth. In subsequent pregnancies in these two patients, prophylactic plasma infusion initiated early with increasing volume throughout pregnancy prevented TTP relapse, improved placental pathology, and led to normal delivery.

Conclusions: The prevalence of TTP among thrombocytopenic pregnant women is high, up to 5 % in a tertiary unit. Platelet count normalization after delivery does not eliminate TTP. Clinicians should be aware of TTP during pregnancy, and, even if assessed retrospectively, ADAMTS-13 assessment is of particular importance for identifying patients with congenital TTP. In these patients, preventive plasma infusion and/or exchange can dramatically improve foetal prognosis, resulting in successful childbirth.
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http://dx.doi.org/10.1186/s12884-015-0557-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4469004PMC
June 2015

Survival and morbidity of preterm children born at 22 through 34 weeks' gestation in France in 2011: results of the EPIPAGE-2 cohort study.

JAMA Pediatr 2015 Mar;169(3):230-8

Department of Neonatal Pediatrics and Intensive Care, Cochin Hotel Dieu Hospital, Paris, France.

Importance: Up-to-date estimates of the health outcomes of preterm children are needed for assessing perinatal care, informing parents, making decisions about care, and providing evidence for clinical guidelines.

Objectives: To determine survival and neonatal morbidity of infants born from 22 through 34 completed weeks' gestation in France in 2011 and compare these outcomes with a comparable cohort in 1997.

Design, Setting, And Participants: The EPIPAGE-2 study is a national, prospective, population-based cohort study conducted in all maternity and neonatal units in France in 2011. A total of 2205 births (stillbirths and live births) and terminations of pregnancy at 22 through 26 weeks' gestation, 3257 at 27 through 31 weeks, and 1234 at 32 through 34 weeks were studied. Cohort data were collected from January 1 through December 31, 1997, and from March 28 through December 31, 2011. Analyses for 1997 were run for the entire year and then separately for April to December; the rates for survival and morbidities did not differ. Data are therefore presented for the whole year in 1997 and the 8-month and 6-month periods in 2011.

Main Outcomes And Measures: Survival to discharge and survival without any of the following adverse outcomes: grade III or IV intraventricular hemorrhage, cystic periventricular leukomalacia, severe bronchopulmonary dysplasia, retinopathy of prematurity (stage 3 or higher), or necrotizing enterocolitis (stages 2-3).

Results: A total of 0.7% of infants born before 24 weeks' gestation survived to discharge: 31.2% of those born at 24 weeks, 59.1% at 25 weeks, and 75.3% at 26 weeks. Survival rates were 93.6% at 27 through 31 weeks and 98.9% at 32 through 34 weeks. Infants discharged home without severe neonatal morbidity represented 0% at 23 weeks, 11.6% at 24 weeks, 30.0% at 25 weeks, 47.5% at 26 weeks, 81.3% at 27 through 31 weeks, and 96.8% at 32 through 34 weeks. Compared with 1997, the proportion of infants surviving without severe morbidity in 2011 increased by 14.4% (P < .001) at 25 through 29 weeks and 6% (P < .001) at 30 through 31 weeks but did not change appreciably for those born at less than 25 weeks. The rates of antenatal corticosteroid use, induced preterm deliveries, cesarean deliveries, and surfactant use increased significantly in all gestational-age groups, except at 22 through 23 weeks.

Conclusions And Relevance: The substantial improvement in survival in France for newborns born at 25 through 31 weeks' gestation was accompanied by an important reduction in severe morbidity, but survival remained rare before 25 weeks. Although improvement in survival at extremely low gestational age may be possible, its effect on long-term outcomes requires further studies. The long-term results of the EPIPAGE-2 study will be informative in this regard.
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http://dx.doi.org/10.1001/jamapediatrics.2014.3351DOI Listing
March 2015