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Objectives. – Two randomized trials found that monitoring labor by analyzing the fetal electrocardiogram (STAN™) appears to offer better sensitivity and specificity in screening for metabolic acidosis than cardiotocography (CTG) does. We report here the results of a descriptive study of 173 cases between 1 June 2001 and 31 May 2002, the objectives of which were twofold: to determine the number of possible false negatives (defined by neonatal metabolic acidosis with a pH less than 7.05 and base deficit (BD) greater than 12 mmol/l, in the absence of a STAN™ decisions event more than 30 min before birth), and to assess whether STAN™ indicated the need for operative intervention too late in cases of fetal distress.Patients and methods. – Our study was conducted on an at-risk population with CTG changes. STAN™ was used with a scalp electrode to monitor labor according to a protocol based upon the FIGO CTG classification and the clinical instructions used in the Swedish trial. Accordingly, we compared two groups: in group 1, a STAN™ decision event required a rapid conclusion to labor, while in group 2, the absence of any STAN™ decision event meant that labor continued, despite the changes in the tracing.Results. – We found seven cases with a neonatal pH less than 7.05, but only one may involve a false negative by this method. The mean arterial pH and the number of fetuses born with an arterial pH less than 7.10 did not differ significantly between the two groups, nor were there any significant differences in the mean BD at birth, or the number of children with a BD greater than 12 mmol/l.Conclusion. – The results appear to indicate that use of STAN™ with the usual CTG enables an appropriate response to cases of fetal distress, but it remains difficult to determine the real benefits that can be expected from this method in France. Longer assessment in our population is required before we can assess its actual advantages. [Copyright &y& Elsevier]

Résumé: La cataracte congénitale est une maladie rare, dont l’incidence est estimée à 0,5 % naissance en France. Une étude de la bibliographie montre que la cataracte congénitale est idiopathique dans 50 % des cas, les formes héréditaires représentant 25 % des cas. Les autres causes de cataracte congénitale sont représentées par les embryofœtopathies virales acquises durant la grossesse, les affections métaboliques et les aberrations chromosomiques entrant dans le cadre des syndromes polymalformatifs. Les auteurs rapportent le cas d’un syndrome de Lowe de diagnostic néonatal suspecté devant la découverte d’une cataracte bilatérale initialement isolée. Le bilan morphologique a été complété secondairement par des anomalies cérébrales (lésions périventriculaires). Le bilan étiologique réalisé en anténatal était négatif. Le syndrome de Lowe est une cause rare de cataracte anténatale, dont à ce jour seul un cas a été rapporté. [ABSTRACT FROM AUTHOR]

A new coronavirus (SARS-CoV-2) highlighted at the end of 2019 in China is spreading across all continents. Most often at the origin of a mild infectious syndrome, associating mild symptoms (fever, cough, myalgia, headache and possible digestive disorders) to different degrees, SARS-Covid-2 can cause serious pulmonary pathologies and sometimes death. Data on the consequences during pregnancy are limited. The first Chinese data published seem to show that the symptoms in pregnant women are the same as those of the general population. There are no cases of intrauterine maternal-fetal transmission, but cases of newborns infected early suggest that there could be vertical perpartum or neonatal transmission. Induced prematurity and cases of respiratory distress in newborns of infected mothers have been described. Pregnancy is known as a period at higher risk for the consequences of respiratory infections, as for influenza, so it seems important to screen for Covid-19 in the presence of symptoms and to monitor closely pregnant women. In this context of the SARS-Covid-2 epidemic, the societies of gynecology-obstetrics, infectious diseases and neonatalogy have proposed a French protocol for the management of possible and proven cases of SARS-Covid-2 in pregnant women. These proposals may evolve on a daily basis with the advancement of the epidemic and knowledge in pregnant women. Subsequently, an in-depth analysis of cases in pregnant women will be necessary in order to improve knowledge on the subject., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Goals: Preeclampsia (PE) is a leading cause of maternal and neonatal morbidity and mortality. Early treatment by aspirin has been shown to significantly reduce PE risk before 37weeks supporting the implementation of first-trimester screening., Subjects and Methods: A targeted screening was recently implemented at Toulouse University Hospital for women in their first pregnancy or those with personal or familial history of PE. It uses Fetal Medicine Foundation (FMF) algorithm that combines maternal characteristics, clinical, biophysical and biochemical (PAPP-A, Pregnancy Associated Plasma Protein-A, and PlGF, Placental Growth Factor) data. We describe this first population of pregnant women and compare our results with those of a mini-test that excludes PlGF and biophysical data., Results: Between October 2016 and September 2017, 500women have benefited from this screening. In such targeted population, we identified 3,6 % (n=18) of women at high risk to develop PE before 34weeks and 9,6 % (n=48) of women at high risk to develop PE between 34 and 37weeks. When we recalculated the risk using the mini-test, only 10women (56 %) were identified at high risk of early PE., Conclusion: For the first time in France, we report the result of a targeted screening of PE during the first trimester using the FMF algorithm. We describe the screened population and show that it is more efficient than the mini-test., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Objective: Develop recommendations for the practice of induced abortion., Materials and Methods: The Pubmed database, the Cochrane Library and the recommendations from the French and foreign Gyn-Obs societies or colleges have been consulted., Results: The number of induced abortions (IA) has been stable for several decades. There are a lot of factors explaining the choice of abortion when there is an unplanned pregnancy (UPP). Early initiation and choice of contraception in connection to the woman's life are associated with lower NSP. Reversible contraceptives of long duration of action should be positioned fist in line for the teenager because of its efficiency (grade C). Ultrasound before induced abortion must be encouraged but should not be obligatory before performing IA (Professional consensus). As soon as the sonographic apparition of the embryo, the estimated date of pregnancy is done by measuring the crown-rump length (CRL) or by measuring the biparietal diameter (BIP) from 11 weeks on (grade B). Reliability of these parameters being±5 days, IA could be done if measurements are respectively less than 90mm for CRL and less than 30mm for BIP (Professional consensus). A medical IA performed with a dose of 200mg mifepristone combined with misoprostol is effective at any gestational age (EL1). Before 7 weeks, mifepristone followed between 24 and 48hours by taking misoprostol orally, buccally sublingually or eventually vaginally at a dose of 400 ug possibly renewed after 3hours (EL1, grade A). Beyond 7 weeks, misoprostol given vaginally, sublingually or buccally are better tolerated with fewer side effects than oral route (EL1). It is recommended to always use a cervical preparation during an instrumental abortion (Professional consensus). Misoprostol is a first-line agent for cervical preparation at a dose of 400 mcg (grade A). Aspiration evacuation is preferable to curettage (grade B). A perforated uterus during an instrumental suction should not be considered as a scarred uterus (Professional consensus). IA is not associated with increased subsequent risk of infertility or ectopic pregnancy (EL2). The pre-abortion medical consultations does not affect, most of the time, the decision to request an IA. Indeed, a majority of women is quite sure of her choice during these consultations. Acceptability of the method of IA and satisfaction appears to be larger when they are able to choose the abortion method (grade B). There is no relationship between an increase in psychiatric disorders and IA (EL2). Women with psychiatric histories are at increased risk of mental disorders after the occurrence of an UPP (EL2). In case of instrumental abortion, oral estrogen-progestogen contraceptives and the patch should be started from the day of the abortion, the vaginal ring inserted within 5 days of IA (grade B). In case of medical abortion, the vaginal ring should be inserted within a week of taking mifepristone, oral estrogen-progestogen contraceptives and the patch should be initiated on the same day or the day after taking prostaglandins (grade C). In case of instrumental abortion, the contraceptive implant may be inserted on the day of the abortion (grade B). In case of medical abortion, the implant can be inserted on the day of mifepristone (grade C). The copper Intrauterine Device (IUD) and levonorgestrel should be inserted preferably on the day of instrumental abortion (grade A). In case of medical abortion, an IUD can be inserted within 10 days following mifepristone after ensuring by ultrasound of the absence of intrauterine pregnancy (grade C)., Conclusion: The implementation of these guidelines may promote a better and more homogenous care for women requesting IA in our country., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

This work is based on a current review of the literature (Pubmed, Medline, Cochrane library, Cochrane database of systematic reviews, EMBASE, RCOG, ACOG) including meta-analysis, randomised trials, cohorts, reviews, controlled studies published up to 2016 in French or English., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Objective: Assessing inter- and intra- observer agreement in the reading of fetal heart rate (FHR) between two different paper speeds (1 and 2cm/min) using FIGO classification., Material and Methods: Single-centre experimental study consisting in reading 60minutes FHR tracings by six readers (3 midwives and 3 obstetricians) during 1cm and 2cm/min sessions within a period of three weeks. The reading guideline was based on FIGO classification. Inter- and intra-observer agreement was assessed thanks to Kappa coefficient (K) and percentage of agreement (PA) using the classification of FHR tracings drawn up by readers., Results: Intra-observer agreement reached 60% between the two paper speeds, and PA ranged from 48 to 67%. Inter-observer agreement was poor to moderate (K=0.42 for 1cm/min sessions and K=0.38 for 2cm/min sessions). Inter-observer agreement was significantly higher for normal tracings (PA ranged from 55.2% for 2cm/min sessions to 57.4% for 1cm/min sessions). The preterminal category had the lowest concordance rates (PA=19% for 1cm/min sessions and 20, 7% for 2cm/min sessions)., Conclusion: This study did not highlight significant differences in intra- and inter-observer variability between the two FHR paper speeds. The 1cm/min paper speed, which is commonly used in France, is more economical and gives a better bedside overview of FHR. Therefore, it should be recommended., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Benckiser's haemorrhage is a serious obstetrical complication, following a vasa previa rupture. Incidence of vasa previa is estimated between 1/1150 and 1/5000 pregnancies. This case report illustrates the consequences of a suspected vasa previa rupture. There is no French recommendation of how to treat vasa previa. Different methods of prevention are described and examined thanks to a literature review., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Congenital cataract is a rare disease whose incidence is estimated to 0.5% of birth in France. A study of the literature shows that congenital cataract is idiopathic in 50% of cases, hereditary forms representing 25% of cases. Other causes of congenital cataract are represented by viral embryofoetopathies acquired during pregnancy, metabolic disorders and chromosomal aberrations within the scope of malformative syndromes. The authors report the case of a neonatal diagnosis of Lowe syndrome suspected by the discovery of bilateral cataract initially isolated. The morphological exploration was completed by secondary brain abnormalities (periventricular lesions). The etiological prenatal exploration was negative. Lowe syndrome is a rare cause of antenatal cataract, which so far only one case has been reported., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Objectives: To evaluate the effectiveness and safety of misoprostol for cervical ripening or induction of labor at term., Methods: A critical review of studies identified from searches of PubMed and the Cochrane libraries using the following keywords: "misoprostol", "cervical ripening", "epidemiology", "pregnancy outcome", "maternal morbidity", "perinatal death"., Results: Vaginal misoprostol in doses of 25 μg three- to six-hourly was similar as dinoprostone in effectiveness (caesarean section rate or vaginal delivery in 24 hours) (LE1) and risks (uterine hyperstimulation, adverse neonatal outcome, uterine rupture, maternal side-effects) (LE1). Published medico-economic studies are not sufficient to evaluate a potential profit to the use of vaginal misoprostol 25 μg (Avis d'Experts). The use of misoprostol in women with prior cesarean delivery or major uterine surgery has been associated with an increase in uterine rupture and therefore should be avoided (LE4)., Conclusions: Review of the current literature favors the use of vaginal misoprostol 25 μg three- to six-hourly equally to dinoprostone accordingly with previous French and international guidelines (World Health Organization and American College of Obstetricians and Gynecologist). The use of misoprostol 25 μg supposes a preparation by the pharmacist to ensure the safety of this precise posology. Medico-economic studies are warranted to attest an economic profit to the use of misoprostol 25 μg in comparison to dinoprostone., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)