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1- In order to define a "consensual attitude" in case of breech presentation, we queried the AUDIPOG network on obstetrical practice in search for the more frequently accepted criteria for normal delivery. 2- For consensual practices that could be identified, early neonatal complications were compared between women cared for in maternity wards applying these practices and those cared for in maternity wards not applying these practices.1- A confidential survey was sent to participating obstetrics units to determine their practical attitude in case of breech presentation. A consensual attitude was established on the basis of their responses. 2- Crude and adjusted comparisons were made concerning neonatal results between the consensual and non consensual groups of obstetrics units.Response rate was 85% for 175 obstetrics departments consulted. Six criteria were identified leading to classification of 42% of the units as consensual obstetrics units. The risk of major neonatal complications was lower in the consensual group than in the non-consensual group: adjusted OR=0.27 (95% CI: 0.09-0.85).A questionnaire on obstetrical practice can help define consensual attitudes associated with lower risk of neonatal complications.

To describe the evolution of medical practices in breech presentation at term and to compare early neonatal complications according to initial obstetrical decision on the type of delivery.71919 pregnancies are included in the AUDIPOG Database from 1994 to 2000. Among this cohort, pregnant women with a singleton in breech, at term were selected which represented 2136 women after the exclusion of in utero deaths and medical abortions. The first outcome was global criteria of severe early neonatal complications ("death during per or immediate post partum or transfer of the newborns to an intensive care or surgery unit"). The size of the sample authorized a power of 90%.The rate of cesarean section before labor was 40%. We found 2.3% of early neonatal complications in the group in which labor was accepted vs. 1.9% in the group with cesarean section performed before labor (p0.05). After having taken into account prognostic factors, we do not see a significant difference for the risk of neonatal complications between the two groups (OR=1.33; 95% CI: 0.63-2.80).The analysis of the AUDIPOG Database describes the French obstetrical practice in breech presentation at term. We do not find a different risk in morbi-mortality as regards to the initial obstetrical choice regarding the type of delivery, but the absence of randomization in our study does not authorize a strong medical evidence to guide national recommendations.

The purpose of this study was to describe the care level, legal status and size of the maternity units where deliveries take place in France according to risk level for mother and infant. We analyzed the 1997-1998 data to better implement the network's perinatal policy.and methods. Our standardized sample included 4200 single births in 1997 and 3650 in 1998 collected by the French Sentinel Network after applying a sample rectification technique to offset the methodological problems created by the volunteer nature of the sample population. Distribution of care level, legal status and size of the maternity unit where deliveries took place were recorded according to the risk level of the patients.In 1997-1998, 22% of pregnant women delivered in level III maternity units and 33% in level II units. Twenty percent of the deliveries took place in level II maternity units with less than 1500 deliveries per year. During this period, women with diabetes or hypertension delivered more often in level III units (31% and 27% respectively) than women in the general population. This was not true for women with a previous perinatal death (23%). Inversely, births of infants before 33 weeks gestation or weighing less than 1500 g occurred more often in level III maternity units (55% and 59% respectively) than in the general population. Twenty-seven percent of the infants requiring neonatal transportation were born in level I maternity units. For 'low risk' mothers, delivery occurred more often in level I maternity units (more than 50%) or in small maternity units with less than 1000 deliveries per year (45%) than for the general population (45% and 36% respectively).These data obtained from the Sentinel Network provide precise information on where deliveries occur in France. These data will be useful for implementing the network's perinatal policy. They will also provide a means of following referral practices in the future.

The observation of medical practices and the analysis of outcome as a function of practices are essential today for monitoring and improvement of the healthcare system. The AUDIPOG Sentinel Network provides a tool for the self-assessment of practices that enables each unit to assess its position relative to a group of maternity wards.Pooling of individual data about births that occurred during the month of January each year in about a hundred volunteer wards allows assessing perinatal health indicators and following their evolution over time. A sample rectification technique, adapted from the quota method, allows offsetting the methodological problems created by volunteering and assessing perinatal indicators at the national level.The analysis of data collected from 1994 to 1997 indicates a number of trends, even in the short run, and justifies that a real practice monitoring and assessment tool be set up in order to improve perinatal health.

The purpose of this work was to comparatively assess the results of mass screening programs for breast cancer implemented in six French departments in 1986, within the scope of the National Fund for Health Prevention, Education and Information of the National Health Insurance Office of Salaried Workers.The data collected by the screening centres were analyzed by ten assessment teams that were independent from the program promotion staff, all using the same evaluation form. A complementary population study performed in eight French districts then, allowed assessing the frequency of self-referred screening (mammography performed out of program).The rate of participation in screening programs, in relation to the invited population, ranged from 21 to 48%, according to the district (36% in average). This low participation was probably related to the extent of self-referred screening. In fact, 19 to 40% of women, according to the district, had previously had a screening mammographic coverage: rate was around 68% in women aged 50 to 69 years. Positive findings with mammography ranged from 4.5 to 15.8% (10.1% in average), while intervention rates ranged from 0.7 to 1.6% and detection rates from 3.8 to 6.2%. The ratio between benign tumors and cancers ranged from 0.7 to 2.1 according to the district. In order to enlighten the judgement on French results, we propose a comparison with the international standards in force.The various experiences with breast cancer screening in France show that this screening is technically feasible on the basis of existing medical structures. However, some criteria are still below the expected values, especially if compared with international standards. This result is probably accounted for by the high rate self-referred screening before age 40 in France. In these conditions, the question is whether extending breast cancer screening programs in France is an appropriate course of action.

The identification of intrauterine growth retarded infants remains a problem. It is useful to distinguish between small for date which uses the reference of a statistical birthweight limit and intrauterine growth retardation. A study comprising nearly 100,000 births from many French regions allowed a definition of the limits of birthweights taking into account gestational age, sex, birth rank, maternal height and pregravid maternal weight. This new approach distinguished two groups of newborns, the "constitutionaly small" and those who are newly called "growth retarded". The validity of this new classification is discussed.

The collection of nearly 100,000 births from 22 maternity hospitals in various French regions permitted to establish foetal growth curves for weight, height and head circumference. The 50th percentiles of weight at term obtained in this sample are not different from those given by Leroy and Lefort in the Paris region in 1971. However below 38 weeks of gestation, we found that 50th percentiles are 100 or 150 g less than those given by Leroy and Lefort. The discussion from international papers show large variations of the 10th percentile for weight in according to gestational age and sex, these variations are often related to the choice of different target populations.

A first experiment aimed at collecting data from 98 maternity hospitals grouped in the AUDIPOG Sentinel Network addressed 7,837 deliveries in January, 1994. The technique used for recovering the results was adapted from the quota method and aimed at strict respect of marginal distributions of deliveries per regional area and per hospital type, and at the best the joint distribution of deliveries per regional area/hospital type, to obtain estimates of perinatal health indicators. Selection indicators (age, family status, socio-economic conditions, previous history), practising indicators (supervision of the pregnancy, entrance motive, presentation, delivery mode, anaesthetic) and result indicators (prematurity, small for date, transfer, pathology of the new-born) are given.

A specific survey was carried out on a sample of men and women of childbearing age to study their attitudes towards parenthood and to analyse psycho-social aspects which may have an effect thereon. The analysis took into account; the children number, woman's age, socio-economic status and occupational activity. Whatever the factor studied, it was constantly observed that the demand for an additional child (in particular the third child) was expressed more often by men than by women.

An allometric study of the relative growth of the head and the body of the fetus and of the newborn shows that there is a more rapid growth of the head in relationship to the length of the fetus before the 30th week of pregnancy and then there is a slowing down between the 30th and the 40th weeks, followed by a re-acceleration after birth for full term infants. This phenomenon is not shown in premature babies born before the 30th week of pregnancy who continue their head growth with the same speed after birth and slow down only for a short time near their theoretical term. These results led to a hypothesis being formed that cephalic growth is slowed down in the uterus because of steric (molecular) congestion, a slow-down that is slightly demonstrated in breech presentations and much later in very premature babies. This opens the way to a discussion on the final results of this phenomenon on the brain.

The authors using the information obtained by X-ray pelvimetry and ultrasound cephalometry in 300 cases of contracted pelves, suggest a diagram of cephalo-pelvic disproportion that can be used in the great majority of cases of contracted pelves. It is not applicable to those where there is significant deformation of the middle strait or an abnormality of presentation. It is divided into three zones: 1. A superior zone, favourable, into which the majority (60%) of cases of contracted pelvis fit. The risk of a serious dystocia during delivery is so small (less than 2%) that it can be considered scarcely different from those found in women with a normal pelvis. 2. An intermediate zone into which 24% of cases of contracted pelvis fit where the prognosis is uncertain. The labour should be considered as an "at risk" labour and a trial of labour conducted. 3. A lower zone into which 16% of the cases fit and which consists of two categories: --those in which the biparietal diameter is equal to or less than 90 mm. Prophylactic caesarean section should be avoided in these cases where disproportion is rare and where there is a risk of delivering a premature infant: and --those more numerous (9 out of 10) where the biparietal diameter is more than 90 mm and where, unless there is a clinically definitely favourable prognosis, it is justifiable to carry out prophylactic caesarean section. If this line is followed: one can avoid a large number of trials of labour, all of which are inconvenient and some of which are dangerous for the child; few unnecessary caesarean sections are carried out.

The present study involves 214 patients whose cervical smear showed signs of human papilloma virus infection (HPV), matched with 1042 controls. We demonstrate increasing odds ratio with the total number of sexual partners since first sexual intercourse (p less than 0.0001). Moreover the cases have more often changed partners in the year preceding the diagnosis (odds ratio 2.6 p less than 0.0001). Their male partners more often have occupations that expose them to "extra-conjugal adventures" (p = 0.0005). Using a logistic regression analysis we demonstrate the independence of the masculine and feminine risk factors. After adjustment for age, reason for consulting and marital status the following factors are related to HPV infection: new partner, total number of sexual partners since first sexual intercourse and partner's occupation.