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Objectives: Our aim is to compare the new French EPOPé intrauterine growth curves, developed to address the guidelines 2013 of the French College of Obstetricians and Gynecologists, with reference curves currently used in France, and to evaluate the consequences of their adjustment for fetal sex and maternal characteristics., Population and Methods: Eight intrauterine and birthweight curves, used in France were compared to the EPOPé curves using data from the French Perinatal Survey 2010. The influence of adjustment on the rate of SGA births and the characteristics of these births was analysed., Results: Due to their birthweight values and distribution, the selected intrauterine curves are less suitable for births in France than the new curves. Birthweight curves led to low rates of SGA births from 4.3 to 8.5% compared to 10.0% with the EPOPé curves. The adjustment for maternal and fetal characteristics avoids the over-representation of girls among SGA births, and reclassifies 4% of births. Among births reclassified as SGA, the frequency of medical and obstetrical risk factors for growth restriction, smoking (≥10 cigarettes/day), and neonatal transfer is higher than among non-SGA births (P<0.01)., Conclusion: The EPOPé curves are more suitable for French births than currently used curves, and their adjustment improves the identification of mothers and babies at risk of growth restriction and poor perinatal outcomes., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Objectives: We developed intrauterine growth references, called EPOPé curves, in line with recommendations for screening of intra-uterine growth restriction issued in 2013 by the French College of Obstetricians and Gynecologists., Population and Methods: Using the French Perinatal Survey (FPS) 2010, we adapted the methodology developed by Gardosi (1) to model intrauterine growth and its distribution and (2) to adjust for physiological fetal and maternal factors influencing fetal weight. Based on this model, 3 reference curves (unadjusted, adjusted for fetal sex, and adjusted for fetal sex, and maternal height, weight and parity) were proposed. We applied these models to births in the 2010 FPS and the French hospital discharge database (PMSI) in 2011-2012., Results: Among singleton live births in the FPS and the PMSI, the model adjusted for fetal sex identified 3.2 and 3.3% of births below the 3rd centile respectively, and 10.0 and 10.2% below the 10th. In model adjusted for maternal factors, 4.0% of births from the FPS 2010 were reclassified, but population rates remained at 3.0 and 10.0%., Conclusion: This growth model is appropriate for French births, and allows for the implementation of a homogeneous definition of small for gestational age infants during pregnancy and at birth., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Objective: To study trends in smoking before and during pregnancy in national samples of pregnant women and changes in characteristics of smokers over time, and describe the current relation between maternal smoking during pregnancy and fetal growth., Population and Methods: Five nationally representative samples of singleton live births in metropolitan France (1972, 1981, 1995, 1998 and 2003) were used to study the change in smoking rates during pregnancy over the past 30 years. We further examined changes in smoking rates between 1998 and 2003 according to maternal characteristics. Finally, we estimated the effect of smoking on fetal growth in 2003., Results: Prevalence of smoking decreased over time, but the rate remained high, 21 % in 2003. The decrease was more important among women at low risk of adverse pregnancy outcomes, resulting in increased social disparities. We confirmed the strong dose-response relation between tobacco use during pregnancy and fetal growth., Conclusion: It is important to verify that smoking during pregnancy is still decreasing and to develop policies to encourage women to quit smoking during pregnancy, especially for highly exposed groups., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Objective: The aim of this article is to describe conditions of abortions practices in France., Materials and Methods: The study was based on the COCON survey. This survey was carried out among a representative sample of 2863 women aged 18 to 44 living in metropolitan France. Women were interviewed by telephone. The analysis was performed among a sub-sample of 320 women who had had an abortion between 1996 and 2000. Results were compared with those of the national notification of induced abortions., Results: Altogether, the way in which abortions were carried out was appropriate, but differences were observed according to the type of hospital: access to care was easier in the private sector; however a pre-abortion interview was less often carried out and a post-abortion interview less often proposed in the private sector. Besides, in both sectors, women were rarely allowed to choose the abortion technique, or the type of anesthesia in the case of a surgical abortion., Conclusion: The COCON study is the first population based survey describing the characteristics of care regarding voluntary abortion. It shows the persistence of differences in practices between the public and the private sectors.

Objective: To describe the trends in multiple maternity rates and the main responsible factors, and to present the main medical risks associated with multiple births., Method: A review of studies describing the situation in Europe and America North., Results: Multiple maternity rates have increased dramatically in France and in other Western countries since the mid 1970s. However the triplet maternity rates leveled off in the 1990s in several European countries. One-fourth to one-third of the increase in multiple maternities is explained by the increase in maternal age. Moreover 30 to 50% of twin maternities and at least three-fourths of triplet maternities would occur after fertility treatments, according to surveys or estimations made from various sources. Twins and triplets have high risks for mortality and morbidity. In France in 1995/98, among live birth twins, the proportion of births before 37 weeks was 43.7% and the proportion of births before 33 weeks was 8.1%. The risk fraction of preterm delivery (<37 weeks) attributable to twins rose from 13% in 1981 to 19% in 1995/98. This trend is explained by the increase in occurrence of multiple births as much as by an increase in preterm births among twins. A similar situation is found in Canada and the USA. Whereas triplets have very high risk of preterm birth, the risk fraction attributable to triplets is very much lower than for twins: in Canada it was 1.1% in 1995-97., Conclusion: These results suggest that research and preventive interventions should not be restricted to triplets, but should also include twins.

The aims of this paper are to present a review of the literature on the patients'and professionals'opinions about third trimester termination of pregnancy and to give the main results of two studies that we have recently conducted. On the whole, publications indicate that the patients'distress is not linked with the moment when pregnancy is terminated. However questions about the fetus death, in utero feticide, and the organization of funerals remain sensitive and communication with patients on these matters needs to be improved. Studies in other countries indicate that professionals are not prepared to recommend late terminations of pregnancy mainly because the fetus is viable and should be considered as a patient. The mother's and the couple's point of view seem not to be enough taken into account. French obstetricians seem to consider more acceptable third trimester TOP than their european colleagues. For them, not setting a limit to the gestational age allows more thorough evaluation of the diagnosis and more parental reflection. They mention major ethical dilemmas, independently from gestational age, and suggest that current practices should be openly debated.

In 1987, 162,352 legal abortions have been recorded in France; 55% of them were performed before 9 weeks of amenorrhea. Abortions were performed earlier among married than among unmarried women, and the proportion of early abortions increased with the women's age. The method of abortion was: vacuum aspiration for 73% of women, curettage (associated to vacuum aspiration or not) for 21%; 65% had their abortion performed under general anaesthesia, and 19% under local anaesthesia. Since 1976, there has been an increasing proportion of vacuum aspirations, and of local anaesthesia. In the private sector, abortions were performed at an earlier gestational age, but curettage was more frequent than in the public sector, and general anaesthesia, quasi systematic. There were also wide regional variations. There results were consistent across years. Data are collected on the day of intervention; thus, they do not allow an exhaustive estimation of the rate of complications: in 30% of cases, the information was missing. For the cases for whom the information was available, the rate of immediate complications was 0.6%. In 1990, modification of the notification form should allow better monitoring of new techniques.

This study is of a 4-year follow-up of two groups of mothers, the first having had caesarean operations and the second vaginal deliveries. We have already published studies of the results after delivery, after two months and after one year. The purpose of this 4-year follow-up after delivery is to determine the effects of caesarean operation on the numbers of future pregnancies and their results and to look at the long-term consequences for the physical and psychological health of the mothers. Fifty-eight mothers who had had caesarean operations and fifty mothers as controls replied to a postal questionnaire. The response level was 52%. From the social and the medical point of view there was no significant difference between those who replied and those who did not. The results indicate that mothers who had had a caesarean operation were less likely to have another baby or did so in lower numbers. They further had more difficulty in conceiving another pregnancy than did the control mothers (the differences were not statistically significant). After four years they were often more tired than the others, apart from objective medical and social differences. The use of health services was not linked to the method of delivery, but 9% of women who had had a caesarean consulted a psychiatrist in the last three years but none of the controls did. The replies show that caesarean section contributed to or re-awoke a labile psychological state. The data do not make it possible for us to say that women who had had a caesarean operation had particular psychological characteristics.(ABSTRACT TRUNCATED AT 250 WORDS)

The rates of third-degree tears in deliveries with and without episiotomy were compared in five samples: three French samples, a Belgian one and a Dutch one. Those samples corresponded to 48,430 single vaginal deliveries. The rates of episiotomy ranged from 29.3% to 54.2%. The results demonstrate that the risk of third-degree tears in vertex uncomplicated deliveries without episiotomy is low, and that in numerous cases third-degree tears are not prevented by an episiotomy. When uncomplicated deliveries of primipara were considered, results from four of the five samples showed that third-degree tears were not significantly more frequent in deliveries without episiotomy.

A psychosociological survey was carried out at the "Maternité Baudelocque", in Paris; 645 women were interviewed during their stay at the hospital after delivery, according to a semi-structured questionnaire. The main purpose of this survey was to study the factors able to improve the quality of prenatal care and women behaviour during pregnancy. The interview was composed of questions on the kind of medical care received during pregnancy, the participation in training for childbirth program, the changes in daily life (rest, nutrition, smoking) and the search for extra-information about pregnancy. On the whole, the interviewed mothers received intensive prenatal care. However, some individual features influenced the quality of this medical care, especially the active role of the women themselves. The data pointed out not only the impact of the involvement in training for childbirth, but also the influence of a personal search for information, which promotes the understanding and acceptance of the medical team requirements.

From national surveys on representative samples of births, in France, in 1972 and in 1981, prenatal care and outcome of pregnancy among immigrant women--having been born outside continental France--have been studied. In spite of an increase in the number of prenatal visits, between 1972 and 1981, foreign women born in North Africa or in other non-European countries in 1981 had still less prenatal visits than women born in continental France. Few differences in outcome of pregnancy according to the women's birthplace in 1981 are shown, preterm deliveries' and birthweight less than 2,500 g rates had decreased between 1972 and 1981 among most groups of women. Nevertheless, in 1981 stillbirth was more frequent among foreign women, especially women born in North Africa.

Semi-directed interviews were conducted with 103 primiparous women between the 3rd and the 6th day after delivery to compare the effects of the two methods of anaesthesia on the way they experienced caesarean operation. Analysis of the contents of the interviews show that the mothers who had caesarean operation under general anaesthesia were more often depressed than those who had an epidural. Overall, the experience of delivery was more satisfying when the caesarean took place under an epidural because it enabled the mother to take part in the delivery. The mothers who were unconscious because they had a general anaesthetic felt sorrow that they deprived of the experience of the delivery. All the same, it must be said that one-third of the women felt ill-at-ease owing to delivery under epidural, both physically and psychologically. The first contacts with the infant are earlier and less disagreeable after epidural analgesia, but in the days following the delivery the interactions between mother and baby and the comments the mothers make about their child do not differ markedly whichever form of anaesthesia has been used.

The study of a national sample of births showed that, in 1976, more than 50% of French women worked during pregnancy. Working during pregnancy was, on the whole, associated with better antenatal care, and better outcome of pregnancy. This relationship remained after taking into account the more favourable social characteristics of working women. Nonetheless, physically hard working conditions were associated with a high risk of preterm delivery.