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International audience; Background: Describe the 1-year hospitalization and in-hospital mortality rates, in infants born after 31 weeks ofgestational age (GA).Methods: This nation-wide population-based study used the French medico-administrative database to assess thefollowing outcomes in singleton live-born infants (32–43 weeks) without congenital anomalies (year 2011): neonatalhospitalization (day of life 1 – 28), post-neonatal hospitalization (day of life 29 – 365), and 1-year in-hospital mortalityrates. Marginal models and negative binomial regressions were used.Results: The study included 696,698 live-born babies. The neonatal hospitalization rate was 9.8%. Up to 40 weeks,the lower the GA, the higher the hospitalization rate and the greater the likelihood of requiring the highest levelof neonatal care (both p < 0.001). The relative risk adjusted for sex and pregnancy-related diseases (aRR) reached21.1 (95% confidence interval [CI]: 19.2-23.3) at 32 weeks. The post-neonatal hospitalization rate was 12.1%. Theraw rates for post-neonatal hospitalization fell significantly from 32 – 40 and increased at 43 weeks and thispersisted after adjustment (aRR = 3.6 [95% CI: 3.3–3.9] at 32 and 1.5 [95% CI: 1.1–1.9] at 43 compared to 40 weeks).The main causes of post-neonatal hospitalization were bronchiolitis (17.2%), gastroenteritis (10.4%) ENT diseases(5.4%) and accidents (6.2%). The in-hospital mortality rate was 0.85‰, with a significant decrease (p < 0.001)according to GA at birth (aRR = 3.8 [95% CI: 2.4–5.8] at 32 and 6.6 [95% CI: 2.1–20.9] at 43, compared to 40 weeks.Conclusion: There’s a continuous change in outcome in hospitalized infants born above 31 weeks. Birth at 40 weeksgestation is associated with the lowest 1-year morbidity and mortality.

La "Donna di Ostuni", the Lady from Ostuni (fortified medieval city, on the southern Italian Adriatic coast) is the skeleton of "the human most ancient mother" ever found by paleoanthropologists, grave dated of 28,000 years BP. It concerns a 20-years-old woman buried with her baby in her womb estimated at 8 months gestation. To date, the cause of the maternal-fetal deaths is qualified of unknown origin. We propose that eclampsia may be a possible explanation for these deaths (mother and baby together). Eclampsia (convulsions), the curse of human births (non-existent in other mammals), has been described since writings has existed 5000 years ago in all civilisations. This plausible description dating from Palaeolithic times, 28,000 years BP, long before the emergence of agriculture (10,000 years BP) may be an interesting milestone. Further, she was buried with a shell-made headdress, as represented in several "Venus" figurines retrieved in all the Eurasiatic area (notably the "Willemdorf Venus"). The authors propose a new hypothesis that this headdress could be a protective device for pregnant women not only for birthing, but also against the terrorising convulsions (eclampsia) which could happen in all human pregnancy, especially in the first ones (primiparae).

Background: Retrospective studies suggest that early hypoproteinemia has prognostic value for adverse outcome in preemies, but the underlying pathophysiology is unknown. We hypothesized that the prognostic relevance of hypoproteinemia could be related to its association with impaired cardiovascular function and organ perfusion during transition. Objectives: To describe the plasma protein status and the measures of cardiovascular function according to the outcome in infants Methods: One hundred and twenty-eight infants were prospectively included from birth to discharge. During the first 24 h of life, we assessed the cardiovascular function and systemic and organ blood flow by Doppler ultrasound, and monitored cerebral and renal regional oxygen saturation (cRSO2, rRSO2) using near-infrared spectroscopy. These measures were analyzed in relationship to hypoproteinemia (total plasma protein level Results: Hypoproteinemia was associated with a higher risk of a severe adverse outcome after adjustment of confounding variables (adjusted OR = 6.8; 95% CI 1.3-34). Compared to normoproteinemic infants and after adjustment for gestational age, hypoproteinemic ones had more significantly: hypotension (7 vs. 13%, p = 0.03), abnormal capillary refilling time (20 vs. 36%, p < 0.001), abnormal renal blood flow (resistive index 0.78 ± 0.11 vs. 0.85 ± 0.09, p = 0.04), lower rRSO2 (82.9 ± 9.2 vs. 73.6 ± 10.5%, p = 0.04), and lower systemic vascular resistance (0.155 ± 0.058 vs. 0.108 ± 0.037 mm Hg/L/kg; p = 0.04). The cRSO2 patterns were significantly decreased in infants with severe adverse outcome and independent from protein status. Conclusion: Hypoproteinemia is associated with impaired cardiovascular function. Further studies are required to elucidate the interplay between changes in protein levels, postnatal hemodynamics and clinical outcome.

International audience; Abstract : Objectives : To analyse published cost-of-illness studies that had assessed the cost of prematurity according to gestational age at birth. Methods : A review of the literature was carried out in March 2011 using the following databases: Medline, ScienceDirect, The Cochrane Library, Econlit and Business Source Premier, and a French Public-Health database. Key-word sequences related to ‘prematurity’ and ‘costs’ were considered. Studies that assessed costs according to the gestational age (GA) at the premature birth (

Background Bronchiolitis is a distressing respiratory condition and the most common cause of hospitalization during the first year of life. The hospitalization of an infant is a stressful event for parents and deserves careful consideration. The objective of this work was to develop and validate a self-administered instrument that comprehensively assesses the impact on parents of the hospitalization of their infant for bronchiolitis. Methods The Impact of Bronchiolitis Hospitalization Questionnaire (IBHQ©) was developed using a literature review and pre-study interviews with both parents and clinicians. For finalization and psychometric validation, it was included in a multicenter, longitudinal, observational study conducted in France. Parents of infants under the age of 1 year and hospitalized for bronchiolitis were asked to complete the questionnaire at hospital discharge, and 3 months after. Results Seven hundred and seven questionnaires were completed by the parents of the 463 eligible infants. After finalization, based on principal component analyses, the IBHQ included 30 core items allowing the calculation of 7 dimension core scores (Worries and distress; Fear for future; Guilt; Impact on daily organization; Physical impact; Impact on behavior with hospitalized infant; Financial impact), as well as 16 optional items, allowing the calculation of 5 optional dimension scores (Disturbed breastfeeding; Physical reaction of hospitalized infant; Impact on feeding; Impact on behavior with other infants; Siblings’ reaction). Internal consistency reliability and construct validity of the IBHQ were satisfactory. The highest impact was observed for “Worries and distress”, “Fear for future” and “Impact on daily organization” scores. Conclusions The IBHQ is a reliable and valid instrument for assessing the multifaceted impact on parents of the hospitalization of their infant for bronchiolitis.

International audience; OBJECTIVE: We aimed to investigate the predictive value for severe adverse outcome of plasma protein measurements on day one of life in very preterm infants and to compare total plasma protein levels with the validated illness severity scores CRIB, CRIB-II, SNAP-II and SNAPPE-II, regarding their predictive ability for severe adverse outcome. METHODS: We analyzed a cohort of infants born at 24-31 weeks gestation, admitted to the tertiary intensive care unit of a university hospital over 10.5 years. The outcome measure was "severe adverse outcome" defined as death before discharge or severe neurological injury on cranial ultrasound. The adjusted odd ratio (aOR) and 95% confidence interval (95% CI) of severe adverse outcome for hypoproteinemia (total plasma protein level \textless40 g/L) was calculated by univariate and multivariate analyses. Calibration (Hosmer-Lemeshow goodness-of-fit) was performed and the predictive ability for severe adverse outcome was assessed for total plasma protein and compared with CRIB, CRIB-II, SNAP-II and SNAPPE-II, by calculating receiver operating characteristic (ROC) curves and their associated area under the curve (AUC). RESULTS: 761 infants were studied: 14.4% died and 4.1% survived with severe cerebral ultrasound findings. The aOR of severe adverse outcome for hypoproteinemia was 6.1 (95% CI 3.8-9.9). The rank order for variables, as assessed by AUCs and 95% CIs, in predicting outcome was: total plasma protein [0.849 (0.821-0.873)], SNAPPE-II [0.822 (0.792-0.848)], CRIB [0.821 (0.792-0.848)], SNAP-II [0.810 (0.780-0.837)] and CRIB-II [0.803 (0.772-0.830)]. Total plasma protein predicted severe adverse outcome significantly better than CRIB-II and SNAP-II (both p\textless0.05). Calibration for total plasma protein was very good. CONCLUSIONS: Early hypoproteinemia has prognostic value for severe adverse outcome in very preterm, sick infants. Total plasma protein has a predictive performance comparable with CRIB and SNAPPE-II and greater than other validated severity scores.

International audience; BACKGROUND: Obstetric hemorrhages are a frequent cause of maternal death all over the world, but are not routinely monitored. Health systems administrative databases could be used for this purpose, but data quality needs to be assessed. OBJECTIVES: Using blood transfusion data recorded in administrative databases to estimate the frequency of obstetric hemorrhages. Research design A population-based study. Subjects Validation sub-sample: all mothers who gave birth in a French region in 2006-07 (35 123 pregnancies). Main study: all mothers who gave birth in France in 2006-07 (1 629 537 pregnancies). METHOD: Linkage and comparison of administrative data on blood transfusions with data from the French blood agency ('gold standard'), and, based on this validation, the construction of a multivariable regression model to correct the number of pregnant women identified as having received a transfusion in the national administrative database. RESULTS: The blood transfusion rate observed in the gold standard was 7.12‰. The sensitivity of the administrative data was estimated at 66.3% and the positive predictive value at 91.3%. The estimated total number of pregnant women who received blood transfusions in France in 2006-07 was 10 941 (6.71‰). CONCLUSIONS: The administrative data, available in most countries, can be used to estimate the frequency of obstetric hemorrhages.

Objective To compare prediction of perinatal deaths among preterm infants based on fetal weight standards versus a new subpopulation-based birthweight standard. Design Population-based cohort study. Setting France. Population A total of 9100 preterm singletons, born between 24 and 36 weeks of gestation in 2000–09, in Burgundy (France). Methods We first classified all newborns as either small for gestational age (SGA) or not, based on alternative fetal weight or birthweight standards, including a new birthweight standard that excludes infants born to mothers with disease related to the weight of a fetus. Based on discrepancies between the different classifications, we then divided the newborns into four groups, and compared their risks of stillbirth and in-hospital death, using a generalised linear model with relative risks (RR). Main outcome measures Perinatal deaths, including, in separate analyses, stillbirths and in-hospital deaths. Results The preterm infants classified as SGA by our new subpopulation-based birthweight standard but not by the conventional birthweight standard had a significantly higher risk of both stillbirth (RR = 2.6; 95% confidence interval [95% CI] = 1.9–3.6) and in-hospital death (RR = 2.8; 95% CI = 1.8–4.5). In contrast, no risk increase was found for infants classified as SGA by the fetal standard only (RR = 1.1; 95% CI = 0.7–1.7 for stillbirths, and RR = 0.5; 95% CI = 0.3–1.3 for in-hospital deaths). Conclusions Our subpopulation-based birthweight standard identified a subgroup of preterm newborns who have significantly increased risks of perinatal death but are not classified as SGA by the conventional birthweight standard. In contrast, the subgroup classified as SGA by the fetal standards only, but not by our subpopulation-based birthweight standard, had no increased risk of mortality, compared with non-SGA infants.

Objective. To describe the chloride balance in infants born 25–32-week gestation, analyze the association of chloride changes with hydroelectrolytic status and their relationship with perinatal conditions, morbidities, and neurological outcome.Methods. For 7 days after birth, sodium and chloride balance, plasma potassium, phosphate, and total carbon dioxide (tCO2) were prospectively determined and strong ion difference (SID) calculated. Three multivariate regression analyses were performed to identify factors associated with high plasma chloride concentration, low SID, and low tCO2.Results. 107 infants were studied. Plasma chloride concentration was significantly positively associated with plasma sodium concentration. Higher plasma chloride and lower SID were significantly associated with lower plasma tCO2. Chloride intake was the main independent factor associated with high plasma chloride, low SID, and low plasma tCO2, with lesser contribution of sodium intake and low gestational age (GA). Also, patent ductus arteriosus and birth weight loss were independent factors affecting plasma chloride and SID. Neither high chloride levels nor low SID were associated to impaired neurological outcome.Conclusions. In preterm infants, chloride balance is influenced by GA and by interrelationship between sodium and chloride intake. High chloride levels are associated with metabolic acidosis but not related to increased risk of impaired neurological outcome.

International audience; BACKGROUND: While intrauterine insemination (IUI), a simple, inexpensive and non-invasive technique, is the most used assisted reproduction technology (ART) worldwide, the risk of major birth defects following IUI is paradoxically not well documented. METHODS: Retrospective cohort study performed in Burgundy, France, over a 9-year period which consisted of the cross analysis of two prospective databases, the Burgundy perinatal network database and the database of the assisted conception units in Burgundy. A total of 1348 ART singletons [in vitro fertilization technologies (IVFT): n= 903; IUI: n= 445] matched with 4044 infants conceived naturally, 552 ART twins (IVFT: n= 362; IUI: n= 190) matched with 1656 twins who were conceived naturally. The major birth defects were categorized according to the European Surveillance of Congenital Anomalies classification EUROCAT. RESULTS: Compared with naturally conceived singletons, singletons born after IUI and IVFT had a higher prevalence of major congenital malformations, with adjusted odd ratios (AOR) of 2.0 [95% confidence interval (CI) 1.0-3.8] and 2.0 (CI 1.3-3.1); 3.6 and 4.2% of infants born, respectively. All twins and unlike-sex twins born after IVFT but not IUI, have an increased prevalence of major birth defects compared with naturally conceived twins; AOR of 3.0 (CI 1.6-5.6) and 3.7 (CI 1.1-16.9), respectively. When comparing IUI with IVFT, no differences were observed for singletons (AOR 1.0; CI 0.4-2.2), all twins (AOR 0.4; CI 0.1-1.2) and unlike-sex twins (AOR 0.3; CI 0.1-4.5). CONCLUSIONS: The risk of major birth defects in singletons conceived through IUI was increased over naturally conceived singletons. This risk was no different from that observed after IVFT.

International audience; OBJECTIVE: We aimed to investigate the relationship between day-1 hypoproteinemia and severe adverse outcome (SAO) in very preterm infants admitted to the neonatal intensive care unit (NICU). STUDY DESIGN: Retrospective study of all patients born from 24 to 31 weeks gestation and cared for in our NICU over an 8-year period. Infants were excluded if the serum protein value on the first day of life was not available. RESULT: A total of 913 patients were included. In all, 14.6% presented with SAO (death or severe neurological injury on cranial ultrasound). Hypoproteinemia (total protein level \textless40 g l(-1)) on day 1 of life occurred in 19.5 % of all patients. The rate of SAO was 33.7% in patients with hypoproteinemia and 9.9% in those with normoproteinemia (P\textless0.0001). Logistic and multiple regression analysis confirmed that the association hypoproteinemia-SAO remained significant after adjustment for the other major predictors of outcome present at baseline (odds ratio 3.4; 95% confidence interval 2.1-5.4; P\textless0.0001). CONCLUSION: Hypoproteinemia was highly associated with SAO in this cohort of critically ill preterm infants. We are unable to explain the link between hypoproteinemia and adverse outcome in our population. This investigation serves as a hypothesis-generating report of a large preterm infants sample, and suggests the need to assess the predictive accuracy for adverse outcome of hypoproteinemia in future prospective studies.

Resume La neonatologie est la specialite ayant la plus forte prevalence d’erreurs medicamenteuses (EM) estimee a 5 % des prescriptions environ. Ces EM surviennent a toutes les etapes du circuit du medicament : prescription, transcription, dispensation, administration et surveillance. L’erreur de dose est la plus commune des EM de prescription. La prevention des EM est globale. La mise en place d’un logiciel d’aide a la prescription est efficace sur les erreurs de prescription mais ne dispense pas des autres mesures preventives.

Background and Purpose— Perinatal arterial ischemic stroke (PAIS) is a common cause of hemiplegic cerebral palsy in children. The diagnosis of PAIS is based on cerebral imaging. The objective of our study was to determine prenatal risk factors associated with PAIS. Methods— A retrospective case–control study was nested in the whole population of Burgundy, France, from January 2000 to December 2007. Case patients were confirmed by review of brain imaging and medical records. Three control subjects per case were randomly selected from the study population by sex, term, place, and year of birth. Results— PAIS was confirmed in 32 patients and its incidence was one per 4400 live births. In comparison to control subjects, clinical conditions significantly associated to cases were gestational diabetes (16.1% versus 4.2%; P =0.04), fetal heart rate abnormalities (35.5% versus 10.9%; P =0.001), and meconium-stained liquor (40% versus 12%; P P =0.08) and during pregnancy (32.1% versus 16.7%; P =0.07), cord abnormalities (29% versus 14.1%; P =0.06), and cesarean delivery (28.1% versus 14.6%; P =0.08). In the multivariate analysis, maternal smoking during pregnancy (OR, 3.1; 95% CI, 1.1–8.8; P =0.04) was the only risk factor significantly associated with PAIS. Conclusions— This study is the first to identify maternal smoking during pregnancy as an independent prenatal risk factor of PAIS. Additional prospective studies are needed to confirm this result and to investigate the role of maternal smoking in fetal and neonatal thrombogenesis.

International audience; BACKGROUND AND OBJECTIVE: Accurate data on the optimal chloride (Cl) intake in premature infants are scarce. The aim of the present study was to describe Cl intakes in the first 10 days of life and to assess the relations between high Cl intakes and corrected serum Cl level or markers of severe acidosis in infants \textless28 weeks' gestation. METHODS: Retrospective cohort study including all of the infants \textless28 weeks admitted to the neonatal intensive care unit during a 3-year period and cared for from birth until day 10 or more. RESULTS: Fifty-six infants were included. Cumulative total Cl intakes reached 9.6 ± 3.7 mmol/kg at day 3 and 49.2 ± 13.5 mmol/kg at day 10. Inadvertent intakes (from intravenous fluids other than parenteral nutrition) represented on average 70% of total Cl intakes in the first 3 days. Difference between Cl and sodium intakes reached 7.8 ± 4.8 mmol/kg at day 10 and mainly originated from parenteral nutrition. By multivariate analysis, cumulative Cl intake \textgreater10 mmol/kg during the first 3 days was an independent risk factor of base excess \textless-10 mmol/L. Cumulative Cl intake \textgreater45 mmol/kg during the first 10 days was an independent risk factor of corrected chloremia \textgreater115 mmol/L and of base excess \textless-10 mmol/L. CONCLUSIONS: Cumulative Cl intake \textgreater10 mmol/kg during the first 3 days (ie, 3.3 mmol · kg (-1) · day(-1) on average) and \textgreater45 mmol/kg during the first 10 days (ie, 4.5 mmol · kg (-1) · day(-1) on average) may have unwanted metabolic consequences and should be avoided. Imbalance between electrolytes provided by the parenteral nutrition solution need to be detected and corrected.

International audience; Stress reactivity is a complex phenomenon associated with multiple and multimodal expressions and functions. Herein, we hypothesized that compared with healthy controls (HCs), adolescents with borderline personality disorder (BPD) would exhibit a stronger response to stressors and a deficit in self-perception of stress due to their lack of insight. Twenty adolescents with BPD and 20 matched HCs performed a socially evaluated mental arithmetic test to induce stress. We assessed self- and heteroperception using both human ratings and affective computing-based methods for the automatic extraction of 39 behavioral features (2D + 3D video recording) and 62 physiological features (Nexus-10 recording). Predictions were made using machine learning. In addition, salivary cortisol was measured. Human ratings showed that adolescents with BPD experienced more stress than HCs. Human ratings and automated machine learning indicated opposite results regarding self- and heteroperceived stress in adolescents with BPD compared to HCs. Adolescents with BPD had higher levels of heteroperceived stress than self-perceived stress. Similarly, affective computing achieved better classification for heteroperceived stress. HCs had an opposite profile; they had higher levels of self-perceived stress, and affective computing reached a better classification for self-perceived stress. We conclude that adolescents with BPD are more sensitive to stress and show a lack of self-perception (or insight). In terms of clinical implications, our affective computing measures may help distinguish hetero- vs. self-perceptions of stress in natural settings and may offer external feedback during therapeutic interaction.

International audience; Objective: To assess the risk of preterm birth associated with nonsteroidal anti-inflammatory drugs (NSAIDs), focusing on early exposure in the period from conception to 22 weeks of gestation (WG). Design: National population-based retrospective cohort study. Setting: The French National Health Insurance Database that includes hospital discharge data and health claims data. Population: Singleton pregnancies (2012–2014) with a live birth occurring after 22WG from women between 15 and 45 years old and insured the year before the first day of gestation and during pregnancy were included. We excluded pregnancies for which anti-inflammatory medications were dispensed after 22WG. Methods: The association between exposure and risk of preterm birth was evaluated with GEE models, adjusting on a large number of covariables, socio-demographic variables, maternal comorbidities, prescription drugs and pregnancy complications. Main outcome measures: Prematurity, defined as a birth that occurred before 37WG. Results: Among our 1 598 330 singleton pregnancies, early exposure to non-selective NSAIDs was associated with a significantly increased risk of preterm birth, regardless of the severity of prematurity: adjusted odds ratio (aOR) = 1.76 (95% CI 1.54–2.00) for extreme prematurity (95% CI 22–27WG), 1.28 (95% CI 1.17–1.40) for moderate prematurity (28–31WG) and 1.08 (95% CI 1.05–1.11) for late prematurity (32–36WG), with non-overlapping confidence intervals. We identified five NSAIDs for which the risk of premature birth was significantly increased: ketoprofen, flurbiprofen, nabumetone, etodolac and indomethacin: for the latter, aOR = 1.92 (95% CI 1.37–2.70) with aOR = 9.33 (95% CI 3.75–23.22) for extreme prematurity. Conclusion: Overall, non-selective NSAID use (delivered outside hospitals) during the first 22WG was found to be associated with an increased risk of prematurity. However, the association differs among NSAIDs. Tweetable abstract: French study for which early exposure to non-selective NSAIDs was associated with increased risk of prematurity.

International audience; Objective: Our aim was to describe risk factors associated with 34DPT in operative and non-operative vaginal deliveries, over a five-year period. Study design: This was a retrospective cohort study including 39,227 vaginal deliveries from 2013 to 2017 in a single French University Hospital. Annual characteristics of the analyzed population were recorded. Univariate logistic regression was used to evaluate the association between these characteristics and 34DPT. Multivariate analysis was used to identify combinations of risk factors associated with instrumental delivery.Results: The rate of perineal tears was constantly rising but rate of 34DPT was stable, ranging between 0.8 and 1.4% over the study period. Cesarean section rate was stable between 18.8% and 19.6%. Rate of diabetes, preeclampsia and obesity (BMI < 40) was increasing and episiotomy rate decreasing (from 19.8% to 11.8%). Operative deliveries rate remained stable between 11 and 12.8%. Multivariate regression showed that gestational age over 39 weeks (aOR 1.18, 95% CI [1.02; 1.35]), birth weight over 3500 g (aOR 1.62, 95% CI [1.05; 2.49]) were associated with 34DPT in patients without operative vaginal deliveries but not episiotomy. Gestational age (aOR 1.71, 95% CI [1.18; 2.47]), episiotomy (aOR 0.55, 95% CI [0.38; 0.79]) and diabetes (aOR 1.73, 95% CI [1.15; 2.61]) were associated with 34DPT among patients with operative vaginal deliveries.Conclusion: In a tertiary medical center model with low cesarean section rate, factors associated with 34DPT were different among patients with or without operative vaginal delivery. The question of the protective effect of mediolateral episiotomy against 34DPT in case of operative delivery deserves further investigations.

Background Patients undergoing gynaecological surgery are known to experience anxiety. While the use of music selected by patients based on their personal taste has hardly been evaluated, a recent study suggests that musical preferences significantly alter the anxiolytic and relaxing effects of music. Our study aims to determine whether self-selected music decreases patient anxiety prior to gynaecological surgery, as compared with predetermined music from a software programme such as MUSIC CARE®. Methods The study will consist of a clinical trial comparing the effects of self-selected music versus predetermined music on patient anxiety prior to gynaecological surgery. A minimum of 170 patients will be randomised in a 1:1 ratio. Inclusion criteria will be: women aged 18–55 years, awaiting scheduled gynaecological surgery under general/local anaesthesia or under sedation; having created a personal 20-min playlist; and not having received anxiolytic drugs prior to surgery. The primary outcome will be the difference between the preoperative anxiety score taken 15 to 20 min before the music-listening session and the preoperative anxiety score taken shortly after the session, as measured with the STAI for state anxiety. Discussion This study should help to identify more effective non-medical treatments for preoperative anxiety, as well as to adapt music therapy to the cultural context of patients. Trial registration ClinicalTrials.gov, ID: NCT03226834. Registered on 24 July 2017.

Background In Reunion Island, a French overseas department, the burden of preterm birth and perinatal mortality exceed those observed in mainland France, despite similar access to standard perinatal care. The purpose of the study was to compare the outcome of two cohorts of NICU-admitted very preterm infants born between 24 and 31 weeks of gestation (WG): the registry-based OGP (Observatoire de la Grande Prématurité, Reunion Island, 2008–2013) cohort, and the nationwide EPIPAGE-2 (mainland France, 2011) observational cohort. Methods The primary outcome was adverse neonatal outcomes defined as a composite indicator of in-hospital mortality or any of three following severe morbidities: bronchopulmonary dysplasia (BPD), necrotising enterocolitis, or severe neurological injury (periventricular leukomalacia or grade III-IV intraventricular haemorrhages). Logistic regression modelling adjusting for confounders was performed. Results A total of 1272 very preterm infants from the Reunionese OGP cohort and 3669 peers from the mainland EPIPAGE-2 cohort were compared. Adverse neonatal outcomes were more likely observed in the OGP cohort (32.6% versus 26.6%, p Conclusions Despite similar guidelines for standard perinatal care, very preterm infants born in Reunion Island have a higher risk for death or severe morbidity compared with those born in mainland France.

International audience

International audience; Background: Early diagnosis is essential to improve the treatment and prognosis of newborn infants with nosocomial bacterial infections. Although cytokines and procalcitonin (PCT) have been evaluated as early inflammatory markers, their diagnostic properties have rarely been compared.Objectives: This study evaluated and compared the ability of individual inflammatory markers available for clinician (PCT, semi-quantitative determination of IL-8) and of combinations of markers (CRPi plus IL-6 or quantitative or semi-quantitative determination of IL-8) to diagnose bacterial nosocomial infections in neonates.Methods: This prospective two-center study included neonates suspected of nosocomial infections from September 2008 to January 2012. Inflammatory markers were measured initially upon suspicion of nosocomial infection, and CRP was again measured 12–24 h later. Newborns were retrospectively classified into two groups: those who were infected (certainly or probably) and uninfected (certainly or probably).Results: The study included 130 infants of median gestational age 28 weeks (range, 24–41 weeks). Of these, 34 were classified as infected and 96 as uninfected. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), and positive and negative likelihood ratios (LR+ and LR-) for PCT were 59.3% (95% confidence interval [CI], 38.8–77.6%), 78.5% (95% CI, 67.8–86.9%), 48.5% (95% CI, 30.8–66.5%), 84.9% (95% CI, 74.6–92.2%), 2.7 (95% CI, 1.6–4.9), and 0.5 (95% CI, 0.3–0.8), respectively. Semi-quantitative IL-8 had the highest specificity (92.19%; 95% CI, 82.70–97.41%), PPV (72.22%; 95% CI, 46.52–90.30%) and LR+ (6.17, 95% CI, 2.67–28.44), but had low specificity (48.15%; 95% CI, 28.67–68.05%). Of all markers tested, the combination of IL-6 and CRPi had the highest sensitivity (78.12%; 95% CI, 60.03–90.72%), NPV (91.3%; 95% CI, 82.38–96.32%) and LR- (0.29; 95% CI, 0.12–0.49). The combination of IL-6 and CRPi had a higher area under the curve than PCT, but with borderline significance (p = 0.055).Conclusions: The combination of IL-6 and CRPi was superior to other methods, including PCT, for the early diagnosis of nosocomial infection in neonates, but was not sufficient for sole use. The semi-quantitative determination of IL-8 had good diagnostic properties but its sensitivity was too low for use in clinical practice.

International audience; Witnessing a “Grand-mal” epileptic crisis is undoubtedly one of the most impressive events which may happen to any observer (including those who have chosen to work in the medical field). Convulsions have been described and written down since the beginning of writings 5,000 years ago in all continents. Specific to humans, eclampsia, which is a grand-mal epilepsy, happens naturally in 1% of all human births and is responsible of a very high rate of maternal deaths near or at delivery, with also often the death of the foetus or the newborn. Further, it happens preferentially during the first pregnancy, therefore in very young previously very healthy women. Mankind has then eternally lived with this apparent “curse” happening in its reproduction. The terror that inspires this spectacular feature, even nowadays, has undoubtedly shaped the human conscience and interpretations since the beginning of our species, moreover because it happens during the paramount emotional event which is a birth. The author wishes that (paleo) anthropologists and archaeologists integrate this datum in their reflections. For example, the upper Palaeolithic so-called “Venuses”, could be protective talismans for pregnant women not only for birthing, but also against the terrorizing convulsions (eclampsia) which could happen in all human pregnancy, especially in the first ones (primiparae).

International audience; IntroductionUne avancée récente dans l’approche à l’IRA néonatale repose sur l’identification de différents degrés de réduction aiguë de la fonction rénale, comprenant un continuum pathologique dont l’IRA est le stade le plus sévère et où les variations de la créatinine plasmatique (Crp) sont corrélées à la dysfonction rénale. Selon cette conception, l’exploration de paramètres précoces d’hypoperfusion rénale permet une anticipation de l’IRA et une prise en charge plus précoce et préventive de ses complications. Cette étude souhaitait caractériser le lien entre l’hémodynamique dans les premières 24 h et la fonction rénale dans la première semaine de vie dans une cohorte de grands prématurés, population très sensible aux perturbations de la fonction rénale.MéthodesAu total, 128 prématurés < 32 SA ont été inclus dès la naissance. Pendant les premières 24 h de vie, les paramètres hémodynamiques cliniques, échographiques (volémie, débit cardiaque, contractilité, résistances vasculaires, canal artériel–diamètre et shunt à 6 h de vie), la perfusion d’organe (Doppler) et l’oxygénation tissulaire par le NIRS (rSO2 cérébrale et rénale) ont été enregistrés. L’association entre ces paramètres, ainsi qu’entre les facteurs de risques connus d’IRA et la mesure de la créatinine plasmatique (Crp) dans la première semaine de vie a été analysée. L’IRA a été définie par un taux de Crp > 130 mmol/L à j2.RésultatsDouze enfants (9,4%) ont présenté une IRA. La Crp maximale (mmol/L) était de 155 ± 30 dans le groupe IRA vs 82 ± 16 dans le groupe sans IRA. Les facteurs significativement associés à l’IRA étaient : l’AG, le poids de naissance, la voie d’accouchement, la protidémie à H12, la rSO2 cérébrale, le canal artériel traité, la rSO2 rénale, l’index de résistance dans l’artère rénale. L’analyse multivariée a montré que les facteurs de risque indépendants liés à l’augmentation de la Crp étaient : le canal artériel traité (p = 0,002), l’hypoprotidémie à H12 (p = 0,01), une plus basse mesure de rSO2 rénale (p = 0,02) et un plus faible AG (p = 0,03).ConclusionsNos résultats montrent pour la première fois que l’hypoprotidémie à H12 et l’hypoxie tissulaire rénale mesurée par le NIRS sont des facteurs de risque précoces d’anomalie de la fonction rénale chez le grand prématuré.

International audience; Suicidal behaviour in adolescence is a major public health issue. It is the consequence of a sum of individual, relational and environmental difficulties that weaken the subject in a period of great vulnerability. The main aspects of their care consist in developing a good therapeutic link and adapting the adolescent's environment. Prevention is the concern of everyone, especially healthcare professionals who are regularly consulted before suicidal acts.; Les conduites suicidaires à l’adolescence sont un enjeu majeur de santé publiqueElles font suite à une constellation de difficultés individuelles, relationnelles et environnementales, qui fragilisent le sujet dans une période de grande vulnérabilitéLe soin passe par le lien thérapeutique et l’adaptation de l’environnement de l’adolescentLa prévention est l’affaire de tous, et particulièrement des soignants, qui sont régulièrement sollicités avant un passage à l’acte.

The objective of this study was to evaluate laparoscopy training using pelvitrainers for gynaecological surgeons in a low-income country.The study was carried out in Madagascar from April 2016 to January 2017. The participants were gynaecological surgeons who had not previously performed laparoscopy. Each surgeon was timed to evaluate the execution times of four proposed exercises, based on the fundamentals of laparoscopic surgery (FLS) programme's skills manual, as follows: exercise 1, involving a simple object transfer; exercises 2 and 3, comprising complex object transfers; and exercise 4, a precision cutting exercise. The 8-month training and evaluation programme was divided into different stages, and the four following evaluations were compared: a pretest (T0), assessment at the end of the first training (T1) and auto-evaluation at 2 months (T2) and 8 months (T3).Eight participants were included. The median time was significantly reduced (P0.05) at each evaluation for exercises 1, 2 and 4 compared to the pretest. For exercise 3, there was no difference between T0 and T1 (P=0.07). After 8 months of training, all participants progressed in all exercises.Our study showed that it is possible and beneficial to develop a programme for teaching laparoscopic surgery in low-income countries before providing the necessary equipment.

International audience; Objectives: To investigate the incidence of early − (delivery

International audience; In vitro fertilization (IVF) is nowadays a reliable and common method for couple who need medically assisted procreation. Complications are rare. We report in this paper, the case of a woman with severe endometriosis who developed ureteral obstruction complicated by a renal rupture of the fornix due to ovarian hyperstimulation during an IVF attempt. The condition was diagnosed by CT scan and resolved with insertion of double-J catheter in the left ureter.

International audience; Introduction – The Registry of Congenital Malformations (CM) in Reunion Island (REMACOR) oversees the surveillance of CM for public health and research purposes. This surveillance consists of the exhaustive collec- tion of cases, and temporal analysis of CM. Since 2013, REMACOR has retrospectively geolocalized the data to allow their spatial analysis and the detection of health signals the methodology of which is presented hereunder.Materials and methods – Each case is geolocated according to the mother’s address, using the reference address databases. Birth-related prevalence is then calculated by aggregating cases according to the different administrative scales. The choice of the suitable scale is determined using a Poisson test that estimates the minimum number of births required to perform the analysis in a statistically signi cant manner, and then a compromise between this representativeness of information, data completeness and spatial resolution.Results – 95% of the cases could be geolocalized. Different cluster detection methods are used to identify the most affected areas. Finally, clusters detected at different scales are nally intersected to calculate an index of belonging to 1, 2 or 3 scales.Discussion and conclusion – The spatialized database set up now allows REMACOR to consider the spatial heterogeneity of the distribution of the most frequent CM in order to inform public health stakeholders.; Introduction: Le Registre des malformations congénitales de La Réunion (Remacor) assure la surveillance de ces pathologies à des fins de santé publique et de recherche. Cette surveillance consiste en un recueil exhaustif des cas et en l'analyse temporelle de leur survenue. Afin de permettre leur analyse spatiale et la détection de signaux sanitaires, le Remacor a géocodé rétroactivement les données et mis en place une surveillance spatialisée, dont les choix méthodologiques sont présentés ici.Matériel et méthodes: Chaque cas est géolocalisé conformément à l'adresse de la mère. Les prévalences relatives aux naissances sont ensuite calculées par agrégation des cas selon les différentes échelles administratives. Le choix de l'échelle est déterminé à l'aide d'un test de Poisson qui permet d'estimer le nombre de naissances minimum nécessaire pour réaliser l'analyse de manière statistiquement significative, puis d'un compromis entre cette significativité de l'information, la complétude des données et la résolution spatiale.Résultats: Il a été possible de géolocaliser 95% des cas. Différentes méthodes de détection d'agrégats de cas ont été utilisées afin de repérer les zones les plus touchées. Enfin, les agrégats détectés à différentes échelles ont été intersectés pour calculer un indice d'appartenance à 1, 2 ou 3 échelles.Discussion et conclusion: La base de données spatialisée mise en place permet aujourd'hui au Remacor de prendre en compte l'hétérogénéité spatiale de la distribution des malformations congénitales les plus fréquentes pour informer les acteurs de la santé publique.

Background It is currently recognized that an optimized nutritional approach, consisting of an early and substantial supply of protein and energy by parenteral route, may be beneficial for very low birth weight infants and recent guidelines endorse this strategy. However, the impact of the enhanced parenteral nutrition (PN) on acid-basic balance has never been investigated. The aim of the present study is to assess the effect of nutrient intake on acid-base homeostasis in a large population of preterm infants on PN. Methods This observational study described the acid-base profile of very preterm infants (≤29 week's gestation) receiving PN during the first week of life. For this purpose three different cohorts of infants who received increasing (group 1 to group 3) nutritional intakes were considered. Nutrition data were recorded daily and correlated to acid-base data (pH, base excess, and lactate). The outcome measure to assess metabolic acidosis was the base excess (BE). Results 161 infants were included. 1127 daily nutritional records and 795 blood gas data were analyzed. The three groups were different with regard to nutritional intravenous intakes. Group 3 in particular had a higher mean intake of both amino acids (3.3 ± 0.8 g/kg/d) and lipids (2.8 ± 1.4 g/kg/d) during the first week of life. Metabolic acidosis was more severe in the group with the highest parenteral intake of amino acids and lipids: mean BE = -8.7 ± 3.4 (group 3); -6.4 ± 3.4 (group 2); -5.1 ± 3.0 (group 1)]. At the multivariate analysis the significant risk factors for metabolic acidosis were: gestational age, initial base excess, amino acid and lipid intravenous intakes. Discussion Acid-base homeostasis was influenced by the nutritional intake. Earlier and higher intravenous amino acid and lipid intakes particularly increased the risk of metabolic acidosis. The nutritional tolerance was different depending on gestational age, and the smaller infants (24-26 week's gestation) displayed greater acidotic disequilibrium and a higher need of bicarbonate.

Eclampsia (together with epilepsy) being the first disease ever written down since the beginning of writings in mankind 5000 years ago, we will make a brief presentation of the different major steps in comprehension of Pre-eclampsia. 1) 1840. Rayer, description of proteinuria in eclampsia, 2) 1897 Vaquez, discovery of gestational hypertension in eclamptic women, 3) In the 1970’s, description of the “double” trophoblastic invasion existing only in humans (Brosens & Pijnenborg,), 4) between the 1970’s and the 1990’s, description of preeclampsia being a couple disease. The “paternity problem” (and therefore irruption of immunology), 5) at the end of the 1980’s, a major step forward: Preeclampsia being a global endothelial cell disease (glomeruloendotheliosis, hepatic or cerebral endotheliosis, HELLP, eclampsia), inflammation (J. Roberts. C Redman, R Taylor), 6) End of the 1990’s: Consensus for a distinction between early onset preeclampsia EOP and late onset LOP (34 weeks gestation), EOP being rather a problem of implantation of the trophoblast (and the placenta), LOP being rather a pre-existing maternal problem (obesity, diabetes, coagulopathies etc…). LOP is predominant everywhere on this planet, but enormously predominant in developed countries: 90% of cases. This feature is very different in countries where women have their first child very young (88% of world births), where the fatal EOP (early onset) occurs in more than 30% of cases. 7) What could be the common factor which could explain the maternal global endotheliosis in EOP and LOP? Discussion about the inositol phospho glycans P type.

SummaryWhat is known The neonatal intensive care units (NICUs) are at the highest risk of drug dose error of all hospital wards. NICUs also have the most complicated prescription modalities. The computerization of the prescription process is currently recommended to decrease the risk of preventable adverse drug effects (pADEs) in NICUs. However, Computer Prescribing Order Entry–Clinical Decision Support (C.P.O.E./C.D.S.) systems have been poorly studied in NICUs, and their technical compatibility with neonatal specificities has been limited. Objectives We set up a performance study of the preselected prescription of drugs for neonates, which limited the role of the prescriber to choosing the drugs and their indications. Methods A single 29 bed neonatal ward used this neonatal C.P.O.E./C.D.S. system for all prescriptions of all hospitalized newborns over an 18-month period. The preselected prescription of drugs was based on the indication, gestational age, body weight and post-natal age. The therapeutic protocols were provided by a formulary reference (330 drugs) that had been specifically designed for newborns. The preselected prescription also gave complete information about preparation and administration of drugs by nurses. The prescriber was allowed to modify the preselected prescription but alarms provided warning when the prescription was outside the recommended range. The main clinical characteristics and all items of each line of prescription were stored in a data warehouse, thus enabling this study to take place. Results Seven hundred and sixty successive newborns (from 24 to 42 weeks’ gestation) were prescribed 52 392 lines of prescription corresponding to 65 drugs; About 30·4% of neonates had at least one out of licensed prescription; A prescription out of the recommended range for daily dose was recorded for 1·0% of all drug prescriptions. What is new? The C.P.O.E./C.D.S. systems can currently provide a complete preselected prescription in NICUs according to dose rules, which are specific to newborns and also comply with local specificities (therapeutic protocols and formulation of drugs). The role of the prescriber is limited to the choice of drugs and their indications. The prescriber still retains the possibility of modifying each item of the prescription, with all other prescription items being calculated by the C.P.O.E. system. In these conditions, the prescribers rarely modified the preselected prescription and the rate of out of range prescription was low. A multicentric study is required to confirm and extend these observations. Conclusions This study showed the feasibility of preselected prescription in NICUs and a low rate of out of range prescriptions. The preselected prescription could play a key role in lowering the dose error rate in NICUs.

International audience; Aims: To analyse the risk factors associated with home births and “en-route” deliveries that occurred in the south of Reunion Island. Patients and methods: Since 2001, all births have been recorded in an epidemiological database from 22 weeks’ gestation, including maternal and neonatal information. This study is based on a 15-year period (1/01/2001–31/12/2015).Results: Over this period, there were 656 cases of home births recorded across a total of 81,511 of all births in South Reunion (0.8%). Compared with births in maternity units, these deliveries occurred on the whole at night (67% vs. 54%, OR: 1.74 [1.4–2.1]), by multiparous women (OR: 5 [3.7–6.2]) and and highly multiparous women (5 or more children, OR: 4.1 [3.5–4.9]), women aged over 35 years (OR: 1.4 [1.2–1.7]), in single-parent families (women who live alone, OR: 1.47 [1.3–1.7]), households from a lower socioeconomic (without work OR: 1.24 [1.2–1.3]) and educational (primary or secondary school, OR: 2.4 [2.0–2.9]) background, and who had received fewer prenatal checkups (number of visits 6.4 vs. 9.0). From a neonatal point of view, prematurity was more common (17 vs. 9.9%, OR: 1.9 [1.6–2.4]), as was severe prematurity (< 33 weeks, 5.1 vs. 2.2%, OR: 2.38 [1.7–3.4]) and transfers to a neonatal unit (12.7 vs. 8.0%, OR: 1.67 [1.3–2.1]) were more significant (P< 0.0001). There were 43 perinatal deaths (9.4%, OR: 3.2 [2.3–4.6]) and one maternal death, in a 26-year old highly multiparous woman.Conclusions: In this context, specific monitoring of multiparous women from a low socioeconomic background appears to be a priority.; Objectifs : Analyser les facteurs de risque des accouchements à domicile et « en route » survenus dans le Sud de l’île de La Réunion. Patients et méthodes : Depuis 2001, toutes les naissances sont colligées dans une base de données épidémiologique à partir de 22 semaines d’aménorrhée avec les données maternelles et néonatales. Cette étude porte sur une période de 15 ans (1er janvier 2001–31 décembre 2015). Résultats : Pendant la période d’étude, il y a eu 656 cas recensés d’accouchements à domicile sur un total de 81 511 naissances totales dans le Sud Réunion (0,8 %). Par rapport aux naissances dans les maternités, ces accouchements surviennent surtout la nuit (67 vs 54 %, OR : 1,74 [1,4–2,1]), chez des multipares (OR : 5 [3,7–6,2]) et grandes multipares (cinq enfants et plus, OR : 4,1 [3,5–4,9]), chez des femmes de plus de 35 ans (OR : 1,4 [1,2–1,7]), dans des foyers monoparentaux (femmes vivant seules, OR : 1,47 [1,3–1,7]), des foyers niveau socio économique (sans profession, OR : 1,24 [1,2–1,3]) et éducatifs (niveau primaire ou collège, OR : 2,4 [2,0–2,9]) plus faibles, et ayant plutôt un moins bon suivi prénatal (nombre de visites : 6,4 vs 9,0). Du point de vue néonatal, on retrouve plus de prématurité (17 vs 9,9 %, OR : 1,9 [1,6–2,4]), de grande prématurité (< 33 SA, 5,1 vs 2,2 %, OR : 2,38 [1,7–3,4]) et de transferts en néonatologie (12,7 vs 8,0 %, OR : 1,67 [1,3–2,1]), de manière significative (p < 0,0001). Il y a eu 43 décès périnatals (9,4 %, OR : 3,2 [2–4,6]) et une mort maternelle chez une grande multipare de 26 ans. Conclusions : Dans notre contexte, un suivi particulier chez les multipares à bas niveau socio-économique semble prioritaire.

Study Objective To compare the probability of postoperative pregnancy in infertile women with ovarian endometrioma larger than 3 cm in diameter, managed by either ablation using plasma energy or cystectomy. Design A multicentric case-control study (Canadian Task Force classification II-2). Setting Six surgical departments, affiliated with 4 university hospitals and 2 private facilities. Patients One hundred four infertile patients with ovarian endometrioma larger than 3 cm. Interventions Endometrioma ablation using plasma energy was performed in 64 patients (61.5%) and cystectomy in 40 patients (38.5%). Measurements and Main Results Patients were enrolled in the CIRENDO prospective cohort database (NCT02294825) from June 2009 to June 2014 and managed in 6 different facilities. The minimum length of follow-up was 1 year. Postoperative probabilities of pregnancy in patietns and control subjects were estimated using the Kaplan-Meier method with 95% confidence intervals (CIs) and compared using the log-rank test. The Cox model was used to assess independent predictive factors for pregnancy. Patients managed by plasma energy were significantly older than patients managed by cystectomy, had significantly higher overall revised American Fertility Society (rAFS) score, and had higher rate of Douglas pouch obliteration, deep endometriosis, and colorectal localizations. After a mean follow-up of 35.3 ± 17.5 months (range, 12–60), fertility outcomes were comparable between the groups. The probability of pregnancy at 24 and 36 months after surgery in plasma energy and cystectomy groups was, respectively, 61.3% (95% CI, 48.2%–74.4%) versus 69.3% (95% CI, 54.5%–83%) and 84.4% (95% CI, 72%–93.4%) versus 78.3% (95% CI, 63.8%–90%). The Cox's model revealed that the type of surgical procedure on ovarian endometrioma had no statistically significant impact on the probability of pregnancy, after adjustment for women's age, bilateral cysts larger than 3 cm, colorectal endometriosis, and rAFS stage of endometriosis. Conclusion Postoperative pregnancy rates were comparable after management of ovarian endometrioma by either ablation using plasma energy or cystectomy despite an overall higher rate of unfavorable fertility predictive factors in women managed by ablation.

International audience

National audience

International audience; L’incompétence cervicale est l’une des causes directes de morbi-mortalité néonatale dont le seul traitement actuellement efficace est le cerclage du col. Notre objectif était d’évaluer les pratiques professionnelles en matière de cerclage à la Réunion, en comparant les indications et complications de cerclages effectués en 2010 et 2011, avec celles de la littérature ; afin d’optimiser la prise en charge et l’information des patientes à risque.ăMatériel et méthodesăCette étude rétrospective a examiné tous les dossiers de cerclage réalisés à la Réunion sur deux ans et a recueilli toutes les caractéristiques des patientes, du cerclage et de ses complications, notamment sur l’issue de la grossesse.ăRésultatsăNous avons recensé 200 cerclages, soit un taux de 0,71 % sur les naissances, la majorité étant des cerclages prophylactiques (75,5 %). Au total, 71 % des indications de cerclage à la Réunion ne relevaient pas des recommandations de la littérature avec une pratique large du cerclage prophylactique et une pratique du cerclage thérapeutique peu développée. On observait chez ces patientes moins d’accouchements prématurés (p = 0,003) et moins de chorioamniotites (p = 0,003).ăConclusionăLe cerclage permet de prolonger la grossesse. Cependant, il est important de respecter les recommandations pour repérer les patientes à risque d’accouchement prématuré et adapter le cerclage aux incompétences cervicales avérées dans le but d’améliorer leur prise en charge et de diminuer le taux de complications.ăSummaryăCervical incompetency is one of the direct causes of neonatal morbidity and mortality; a unique and efficient treatment of which is cervical cerclage. The objective of this study was the evaluation of physicians’ practice patterns concerning cerclage in Reunion Island, in order to reinforce the management and information of patients at risk. The indications and complications of cerclages effectuated in 2010 and 2011 were compared to the literature.ăMaterial and methodsăIn this retrospective study, all the medical records of cerclage realized in Reunion Island during two years were collected and analyzed, specifically data concerning patients’ cerclage, the complications, and the outcome of the pregnancy.ăResultsăWe listed 200 cerclages, which were predominantly prophylactic cerclages (75.5%) and represented 0.71% of all births. A total of 71% of the indications of cerclage in Reunion Island did not take into account the recommendations of the literature. Analysis revealed the frequent use of prophylactic cerclage and subsequently reflected the insufficient use of therapeutic cerclage. In those cases, the rate of premature delivery was indeed lower (P = 0.003), as well as the rate of chorioamniotitis (P = 0.003).ăConclusionăCerclage is an efficient treatment to extend the length of the pregnancy. Nevertheless, it is important to comply with the recommendations given by the literature, by spotting the patients at risk of premature delivery, and recommend cerclage only in case of real cervical incompetency, for the sake of improving their management and reducing the rate of complications.

National audience

International audience; This workshop had four main objectives: (A) Trying to look at the preeclampsia (PE) problem “from the Space Shuttle”: why preeclampsia has emerged in humans (a specific human reproductive feature among 4300 mammal species)? (B) Epidemiology: there are major geographical differences concerning early onset PE and late onset PE throughout the world. (C) Vascular: The very promising use of pravastatin in the treatment of the vascular maternal syndrome (based on the metabolism of carbon monoxide (CO), the role of inositol phosphate glycans P-type (IPG-P), a major role in comprehending the insulin resistance phenotype in preeclampsia. (D) Immunology: the specialty of these workshops since their start in 1998; our understanding of the role of the immune system and the regulation of the deep implantation of the human trophoblast (and the obligatory compromises between the fetal/placental unit and the mother) have reached a kind of “maturity,” following the pivotal studies exploring the biology of repetitive sperm exposure in the female genital tract. The meeting of people who never meet each other in the course of their normal professional lives (obstetricians, evolutionists, geneticists, immunologists, fundamentalist vascular biologists, epidemiologists, anthropologists, neonatologists, etc.) permitted some fruitful reflections to be made again this year.

International audience

International audience

International audience

International audience; no abstract

We aimed to assess the prevalence of hospitalization for endometriosis in the general population in France and in each French region and to describe temporal trends, rehospitalization rates, and prevalence of the different types of endometriosis. The analyses were carried out on French hospital discharge data and covered the period 2008–2012 and a population of 14,239,197 women of childbearing age. In this population, the prevalence of hospitalization for endometriosis was 0.9%, ranging from 0.4% to 1.6% between regions. Endometriosis affected 1.5% of hospitalized women of childbearing age, ranging from 1.0% to 2.4% between regions. The number of patients hospitalized for endometriosis significantly increased over the study period (p<0.01). Of these, 4.2% were rehospitalized at least once at one year: ranging from 2.7% to 6.3% between regions. The cumulative rehospitalization rate at 3 years was 6.9%. The types of endometriosis according to the procedures performed were as follows: ovarian (40–50%), peritoneal (20–30%), intestinal (10–20%), and ureteral or bladder (

International audience

National audience; no abstract

Objective The aim of this study was to evaluate the effect of hydroxychloroquine (HCQ) on fetal preterm delivery and intrauterine growth restriction (IUGR) in a cohort of pregnant women with systemic lupus erythematosus (SLE). Methods Over an 11-year period (January 1, 2001 to December 31, 2011), all women with SLE and admitted to deliver after 22 weeks of gestation to Bordeaux University Hospital (France), were retrospectively enrolled in the present study. The population was then split into two groups based on the treatment they received: HCQ exposed (HCQ+) versus HCQ non-exposed (HCQ−) group. Results 118 pregnancies were included, 41 in the HCQ+ group and 77 in the HCQ− group. The rate of adverse fetal outcome was significantly lower in the HCQ+ group ( p = 0.001), particularly in terms of preterm delivery, 15.8 % versus 44.2 % ( p = 0.006), and IUGR, 10.5 % versus 28.6 % ( p = 0.03). No adverse outcomes were reported in the HCQ+ group. Conclusion HCQ reduces neonatal morbidity in women with SLE by significantly decreasing the rate of prematurity and intrauterine growth restriction.

Dear Editor, We found that chronic pelvic pain (CPP), although a frustrating issue for many gynecologists, is actually mostly under diagnosed and under treated. Women with CPP are challenging for the medical system. Many of them have multiple visits, hospitalizations, many imaging processes sometimes including “normal” laparoscopy, with no real answer for their problem. Endometriosis and adhesions are some of the main reasons, but only responsible for less than 50% of CPP cases. In 1993, pelvic pain was described by Peter Petros as being part of the “Posterior Fornix Syndrome” (PFS) a group of symptoms comprising pelvic pain, nocturia, urgency, frequency, and abnormal emptying [1,2]. The syndrome is caused by …

Introduction Objectif principal : determiner la prevalence des hospitalisations pour endometriose a la Reunion et en metropole. Objectif secondaire : apprecier l’evolution des soins chirurgicaux pour cette pathologie dans l’ile comparee a la metropole. L’endometriose est une maladie de la femme reglee. Les principaux modes de decouverte sont la douleur et l’infertilite. Le diagnostic de certitude repose sur la cœlioscopie et donc sur une hospitalisation. Methodes Du 1/01/2008 au 31/12/2012, a partir du PMSI national, nous avons releve les codes de diagnostic principal concernant l’endometriose (N800 a N809). Dans cette population, nous avons consulte les actes realises et ceux qui concernaient l’appareil genital, digestif, urinaire et le peritoine (actes specifiques). Resultats La frequence annuelle de l’hospitalisation pour endometriose dans la population feminine entre 15 et 49 ans est de 0,6 % en metropole et de 1 % a la Reunion. Le taux d’actes specifiques est stable en metropole mais varie a la Reunion a partir de 2011. La difference entre les pourcentages d’actes specifiques dans les deux groupes est significative jusqu’en 2010 puis non significative a partir de 2011 ou le taux reunionnais rejoint le taux metropolitain. Le taux de fuite de patientes de la Reunion vers la metropole est de 1,78 % par an en moyenne et en diminution. Discussion/conclusion Ces donnees epidemiologiques sont originales pour la Reunion comme pour la metropole. Les femmes hospitalisees representent les formes les plus graves de la maladie et les seules avec un diagnostic affirme. Le nombre des formes asymptomatiques ou non diagnostiquees est certainement important. La nature des soins chirurgicaux a la Reunion a rejoint celle en metropole en 2011. La part des actes specifiques a l’endometriose, (assez lourds et necessitant des praticiens specialisees dans une equipe pluridisciplinaire), n’est plus significativement differente. Le taux de fuite des patientes vers la metropole, tres faible, fait de la Reunion un modele d’etude interessant.

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