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Objective: To estimate the prevalence of severe stress urinary incontinence (SUI) among perimenopausal women and to examine potential obstetric risk factors., Design: Mail survey of female volunteers for epidemiological research., Setting: Postal questionnaire on SUI., Population: Three thousand one hundred and fourteen women aged 49-61 years who comprised the GAZEL cohort., Methods: Logistic regression using data from the entire cohort to estimate the impact of risk factors. A second logistic regression using data from women who had given birth included obstetric history., Main Outcome Measure: Prevalence of severe SUI defined by the response 'often' or 'all the time' to the question 'Does urine leak when you are physically active, cough or sneeze?', Results: Two thousand six hundred and twenty-five women (85%) completed and returned the questionnaire The frequency of SUI reported in the preceding four weeks was as follows: 'never' 32%, 'occasionally' 28%, 'sometimes' 26%, 'often' 10% and 'all the time' 5%. Prevalence of severe SUI was lowest among nulliparous women (7%), but it was similar among parous women regardless of birth number (14-17%). The prevalence of severe SUI was not associated with mode of delivery (14% for women delivered by caesarean only vs 16% for vaginal births). Significant risk factors for severe SUI were high body mass index (BMI >30), diabetes mellitus, previous incontinence surgery, parity and first delivery under the age of 22 years., Conclusion: Previous pregnancy itself is a risk factor for severe SUI among women who reach the age of 50. In this age group the impact of the mode of delivery (spontaneous, forceps or caesarean) on severe SUI is slight.

Introduction: Rates of caesarean sections in more-developed countries have been rising since 1970, and vary greatly between less-developed countries. Present estimates, based on data from more-developed countries need to be validated with data from less-developed countries. We estimated the need for caesarean section for maternal indication in a population of pregnant women in west Africa (MOMA survey)., Methods: The expected caesarean section rate was calculated from the rate of obstetric risk in the MOMA population, and rates of caesarean section in published work., Findings: Three-quarters of women from hospitals of sub-Saharan Africa were delivered by caesarean section for maternal reasons. Such intervention was needed for six main reasons, protracted labour, abruptio placentae, previous caesarean section, eclampsia, placenta praevia, and malpresentation. Although the observed rate of caesarean section in west African women is 1.3%, our results, combined with those of published work suggest a range of 3.6-6.5% (median, 5.4%)., Interpretation: Our method might not be strictly accurate, but it is simple and provides informative findings that can help policy makers and health planners in sub-Saharan Africa to design and follow up programmes to reach the optimum caesarean section rate. Moreover, application of this method to hospital data could improve practitioners' assessments in these countries.

Data on maternal morbidity make it possible to assess how many women are likely to need essential obstetric care, and permit the organization, monitoring and evaluation of safe motherhood programmes. In the present paper we propose operational definitions of severe maternal morbidity and report the frequency of such morbidity as revealed in a population-based survey of a cohort of 20,326 pregnant women in six West African countries. The methodology and questionnaires were the same in all areas. Each pregnant woman had four contacts with the obstetric survey team: at inclusion, between 32 and 36 weeks of amenorrhoea, during delivery and 60 days postpartum. Direct obstetric causes of severe morbidity were observed in 1215 women (6.17 cases per 100 live births). This ratio varied significantly between areas, from 3.01% in Bamako to 9.05% in Saint-Louis. The main direct causes of severe maternal morbidity were: haemorrhage (3.05 per 100 live births); obstructed labour (2.05 per 100), 23 cases of which involved uterine rupture (0.12 per 100); hypertensive disorders of pregnancy (0.64 per 100), 38 cases of which involved eclampsia (0.19 per 100); and sepsis (0.09 per 100). Other direct obstetric causes accounted for 12.2% of cases. Case fatality rates were very high for sepsis (33.3%), uterine rupture (30.4%) and eclampsia (18.4%); those for haemorrhage varied from 1.9% for antepartum or peripartum haemorrhage to 3.7% for abruptio placentae. Thus at least 3-9% of pregnant women required essential obstetric care. The high case fatality rates of several complications reflected a poor quality of obstetric care.

Background: The goal of our study was to develop a predictive model of resource use for pregnancy and perinatal care based on the knowledge of the distribution of risk factors in a given population of pregnant women., Methods: Data recorded in Outcome of Pregnancy Certificates (CIG) from 11 voluntary maternities of the district of Seine-Saint-Denis allowed us to identify those pathologies that were predictive of premature births and prenatal hospitalization of mothers. We built a classification of disease states and of risk level. A logistic regression using disease states as dependent variables and risk levels as independent variables allowed us to compute expected rates with their confidence intervals., Results: Among singletons, malformations, diabetes, toxemia, intra-uterin growth retardation, premature rupture of membranes covered 25% of all pregnancies but explained 64% of maternal hospitalizations; 90% of all mothers hospitalized and with delivery before 37 weeks gestation had at least one of these disease states. But 85% of the women who did not belong to disease classes had a normal pregnancy and delivery., Conclusions: In a given population, the distribution of risk levels is predictive of the incidence of disease per class. Then, given the length of stay of mothers per class, the rate of transfer of babies and the length of stay in postnatal care, we can simulate bed occupancy and compute bed capacities. The precision of the model is globally good, despite the relatively modest size of our initial data base: it will improve with the use of the model and the expected more widespread availability of data in France.

The objective of this study was to analyse the relation between severity of maternal condition at the time of intensive care unit (ICU) admission and various individual and institutional factors. This study analysed data from a retrospective population-based study in three French regions during 1991. The population study included 355 patients who were admitted to an ICU during pregnancy, delivery or within 42 days after delivery, for an obstetrical cause. The main outcome measure was the severity of maternal condition at ICU admission estimated from the level of consciousness and from the Simplified Acute Physiology Score (SAPS). The most severe maternal condition was associated with a change in hospital category (from the initially chosen hospital to the hospital referring for ICU) (OR 3.8, 95% CI 1.5-9.6) and with treatment in a private hospital at ICU referral (OR 3.3, 95% CI 1.3-8.3). Foreign nationality was the only individual factor related to very severe maternal condition. These results suggest that health care organisation during pregnancy affects the prognosis of severe maternal condition. The factors involved appear to include the management of unpredictable disorders, the conditions of maternal transfers before ICU admission, and antenatal care of foreigners.

Objective: To identify risk factors among pregnant and newly delivered women to be treated in intensive care unit (ICU)., Study Design: A case-control survey of pregnant women or delivered within the past 42 days admitted to ICU was performed in three regions of France. Two controls by subject were matched for hospital and outcome (vaginal delivery, caesarean section, abortion or ectopic pregnancy). Bivariate and multivariate analyses, using different models were done. The conference intervals (CI) are 95% intervals. The odds ratio (OR) were adjusted on matching factors in univariate analysis, and adjusted on all factors included in the multivariate analysis., Results: 375 subjects treated in ICU and 750 controls were included in the study. These women did not differ in age, marital status or social class, but the cases were more often of non-European nationality. They had more often medical antecedents which were also more serious. The subjects consulted at the maternity facility less frequently than did controls. The following variables increased the risk of ICU admission: no maternal consultation at the maternity ward (OR 2.8, CI 1.5-5.1) serious past medical history (OR 2.7, CI 2.0-3.6), non-European ascertained before the condition of the patient worsens it is argued that more attention could be paid to them. Regarding the risk associated to multiple pregnancy, further efforts to prevent them ought to be considered.

Introduction: In order to understand why maternal mortality is higher in France than in other comparable countries, an epidemiological survey was carried out concerning critical illness during pregnancy, delivery and post partum, to ascertain the frequency of critical illnesses, and describe the characteristics of the patients as well as of the obstetrical services caring for them., Material and Method: The survey was carried out on all obstetric patients treated in intensive care units (ICU), in three French regions for one year. A detailed questionnaire was retrospectively filled out by a specialized investigator, according to the patient's medical file., Results: The frequency of critical illness was estimated at 310 SD 36 per 100,000 live births. Hypertensive diseases (26%) are the most frequent diagnosis that motivated admission to ICU, followed by the hemorrhages (20%), and then the indirect obstetric causes (17%). A large part of these patients was affected by seriously poor conditions before the present pregnancy. Public hospitals were most often implicated in the care of these patients since the beginning of the pregnancy and still more at the moment of the delivery. There was no difference in prenatal care from one type of hospital to another. On the contrary, pathologies and hospitalisation during pregnancy then the causes and the time of admission to ICU as well as the seriousness of maternal conditions were statistically different from one type of hospital to much more frequently in such pregnancies. Letality did not differ according to the various classes of maternity ward but did differ according to the pathologies leading to the treatment in ICU., Conclusion: A large proportion of pregnant women experience seriously critical illness; the relationship between critical illness and maternal mortality according to health care must be studied in depth.

Objective: To ascertain the frequency of serious diseases in pregnant women., Study Design: A population based survey was performed in France. The cases were all the women admitted for treatment in intensive care unit (ICU). The severity of the cases was measured with the simplified acute physiology score (SAPS) the lethality and the rate of still birth., Results: 435 obstetric patients were included. The estimated frequency of severe diseases was 310 S.D.36 per 100,000 live births. The most frequent diagnose that motived admission in ICU was hypertensive diseases. The lethality rates differed greatly between specific disorders. The lethality rate was lower when scheduled maternity was located in a teaching hospital., Conclusion: Regarding these results it appears that the majority of obstetric patients with severe diseases are referred to suitable care, but a small proportion of women who had to change their type of care registered a significant higher lethality.

We have examined 1,200 placentas in a fresh state and have compared the results of these examinations with maternal pathology on the one hand and the neo-natal pathology on the other hand. It turns out that most abnormalities of pregnancy are associated in a significant way with the pathological findings in the placenta, and that the good or pathological health of the newborn is significantly associated with the normal of pathological character of the placenta. The principal weakness in this method of examination is the absence of information about infection. This is why it seems important to us to carry out smears from the placenta before examining it macroscopically.

The mode of termination of pregnancy in case of placental sulfatase deficiency (PSD) has been considered in a 28-case series from our laboratory. After comparison with 75 other cases collected from the literature and also with reports concerned with normal pregnancies it appears that in the case of PSD: first, the gestation length is not increased; second, the parity of the patients has no influence on the mode of delivery; third, spontaneous vaginal delivery can occur (67.8% in our series, 43% in the literature series); fourth, the failure rate of labor, especially when induced, is higher than in a normal population; fifth, the high rate of C-section, largely due to the failure of labor, is enhanced by untimely interventions mostly in case of isolated PSD. If a pejorative incidence of PSD on the mode of delivery exists it must be at a moderate level, and intervention is unnecessary in absence of associated fetal and/or maternal complications.

Study objective: To analyse the relation between preterm birth and working conditions in Europe using common measures of exposure and to test whether employment related risks varied by country of residence. Design: A case-control study in which cases included all consecutive singleton preterm births and controls included one of every ten singleton term births in each participating maternity unit. Data about working conditions were obtained by interview from women after delivery. Setting: Sixteen European countries. Participants: The analysis included 5145 preterm and 7911 term births of which 2369 preterm and 4098 term births were to women employed during pregnancy. Analyses of working conditions were carried out for women working through at least the third month of pregnancy. Main results: Employed women did not have an excess risk of preterm birth. Among working women, a moderate excess risk was observed for women working more than 42 hours a week (OR = 1.33, CI = 1 .1 to 1.6), standing more than six hours a day (OR = 1 .26, CI = 1.1 to 1.5), and for women with low job satisfaction (OR = 1.27, CI = 1.1 to 1.5). There were stronger links in countries with a lower overall level of perinatal health and a common practice of long prenatal leaves. Conclusion: These findings show that specific working conditions affect the risk of preterm birth. They also suggest employment related risks could be mediated by the social and legislative context. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to assess how the French legislation requiring physicians to offer human immunodeficiency virus screening routinely at the beginning of prenatal care has been implemented and to explore areas in which improvement is required.Study Design: The survey included all births in France during a 7-day period in February 1995. A total of 12,341 women were asked whether they knew whether they had undergone a human immunodeficiency virus antibody test before or during the pregnancy. Factors that could have influenced their knowledge of whether they had been tested were also assessed.Results: Of the women questioned, 87.3% stated that they had been tested before or during pregnancy, 7.6% said that they had not been tested, and 5.1% stated that they did not know whether a test had been performed. Among those who said that they had not been tested before the pregnancy in question, 84. 9% reported that they were tested during the pregnancy. The multivariate analysis revealed that women from North Africa differed significantly from French women in both unawareness of screening status and the proportion who reported not being screened (odds ratio 2.1 with 95% confidence interval 1.6-2.9 and odds ratio 2.4 with 95% confidence interval 1.8-3.1, respectively). There was, however, no significant difference between women from sub-Saharan Africa and French women in these variables. A lower educational level was an important predictor of unawareness of screening status (odds ratio 2.6 with 95% confidence interval 2.0-3.4). Associations were observed between reporting of unscreened status and low levels of use of prenatal care services (<6 prenatal consultations odds ratio 1.3 with 95% confidence interval 1.0-1.6, <3 ultrasonographic examinations odds ratio 1.7 with 95% confidence interval 1.3-2.0, and no prenatal consultation at the maternity hospital odds ratio 1. 5 with 95% confidence interval 1.2-1.8).Conclusion: The 1995 National Perinatal Survey, which appears to indicate extensive human immunodeficiency virus screening of pregnant women in France, shows that the nonmandatory nature of the French policy of systematically offering prenatal human immunodeficiency virus screening has not prevented a high proportion of women from learning their screening status. The less comprehensive screening among women in certain subgroups suggests that human immunodeficiency virus information should be better adapted for these women. [ABSTRACT FROM AUTHOR]