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La chirurgie de l'obésité connaît un essor particulièrement remarquable en France lors de cette dernière décennie. Elle est pratiquée, dans 80 % des cas, chez des femmes en âge de procréer. L'amélioration de la fertilité après chirurgie bariatrique reste actuellement discutée et les conséquences en termes de natalité méritent attention au sein de cette population. Qu'en est-il en réalité ? L'objectif principal de cette étude était d'étudier l'évolution de la natalité chez ces femmes, avant et après chirurgie bariatrique et en comparaison avec les femmes en population générale. L'objectif secondaire était de comparer la natalité en fonction de la classe d'IMC. Les données sont issues de la base médico-administrative du PMSI nationale. Les femmes incluses sont âgées de 18 à 45 ans, ayant un acte de chirurgie bariatrique associée à un code d'obésité, sur une période allant de 2012 à 2016. Les codes grossesses ont été extraits sur une période de 2012 à 2018. Les données brutes INSEE ont été utilisées pour la comparaison avec les femmes de la population générale. Nous avons ensuite comparé les taux et odds ratio d'avoir une naissance vivante avant et après chirurgie bariatrique, par âge et en fonction de la classe d'IMC. Au total, 69 932 femmes ont été incluses entre 2012 et 2016, avec un âge médian de 33 ans [27 ; 39] au moment de la chirurgie. Parmi elles, 9391 (13 %) avaient un IMC supérieur à 50 kg/m2 avant chirurgie. La natalité avant et après chirurgie bariatrique était similaire (OR : 1,00, IC95 % [0,97 ; 1,03]), hormis pour les femmes inférieures à 27 ans où elle diminuait de façon significative (OR : 0,91, IC95 % [0,86 ; 0,95]). La natalité des femmes ayant recourt à la chirurgie bariatrique diffère de celle de la population générale avec un taux plus élevé dans les âges les plus jeunes (< 24 ans) et présentant un pic et un déclin plus précoce dans la vie. Avant chirurgie, la natalité des femmes ayant un IMC > 50 kg/m2 était moins importante que celle des femmes avec un IMC entre 40 et 50 kg/m2 et devenait similaire après chirurgie bariatrique. La natalité avant et après chirurgie bariatrique restait similaire, hormis pour les femmes inférieures à 27 ans où elle diminuait de façon significative. La chirurgie bariatrique augmentait les chances d'avoir une naissance vivante pour les femmes présentant un IMC supérieur à 50 kg/m2, les rendant comparable à celles des femmes ayant un IMC entre 40 et 50 kg/m2. [ABSTRACT FROM AUTHOR]

Objectives: There is little data on pregnant women with imported malaria in high-income countries, especially regarding offspring outcomes. We wanted to determine pregnancy outcomes of imported malaria in pregnant women in mainland France., Patients and Methods: We conducted a retrospective, descriptive study of outcomes in pregnant women hospitalized with malaria from 2004 to 2014 in two regions of mainland France. An adverse outcome was defined as a miscarriage, stillbirth, preterm birth (<35 weeks of gestation), low birth weight (LBW) defined as less than 2500 g, or congenital malaria., Results: Of 60 pregnancies, 5 were excluded because of elective abortions; 55 were investigated, of which 11 were primigravidae and 44 multigravidae. Pregnancies were singleton (n = 51) or twin (n = 4). Mean age was 30.4 years (range:19-45 y). Among the 55 cases, 9 ended in a miscarriage (8 singletons and 1 twin pregnancy) and 1 had a stillbirth at 21 weeks of gestation, all immediately after the malarial episode. 45 gave birth (29 vaginal deliveries and 16 caesarean sections) to 48 (42 singletons and 6 twins) newborns. Amongst these, 30 were healthy full-term newborns, 10 had LBW, and 8 were preterm. Overall, 26 of 55 (47.3%) pregnancies, and 29 of 59 (49.2%) offsprings had adverse outcomes. Compared to singleton pregnancies, twin pregnancies were associated with adverse outcomes (p = 0.0438)., Conclusions: Imported malaria has a severe impact on pregnancy outcomes. Prevention and management of imported malaria in pregnancy should be optimized., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To report the first 6 months of experience of a nongovernmental-organization-managed obstetric care unit in a war refugee camp, with problems encountered and solutions implemented., Design: Prospective observational study of the maternity activity of Gynécologie Sans Frontières (GSF)., Setting: GSF's maternity unit, in Zaatari camp (Jordan)., Population: All pregnant women among Syrian refugees who came to the unit for delivery., Methods: The GSF's maternity unit is a light structure built with three tents, permitting low-risk pregnancy care and childbirth. Emergency cesarean deliveries were performed in the Moroccan army field hospital. High-risk pregnancies were transferred to Al Mafraq or Amman Hospital (Jordan) after assessment., Main Outcome Measures: Delivery characteristics, indications for referral., Results: From September 2012 to February 2013, 371 women attended the unit and 299 delivered in it. Delivery rates increased from 5/month to 112/month over the period. Mean gestational age at birth was 39(+3) gestational weeks (SD = 1.9). Median birthweight was 3100 g (25-75% interquartile range 2840-3430 g). Spontaneous vaginal deliveries were dominant and the major maternal complication was postpartum hemorrhage (n = 13). Eighty-two women were referred to Al Mafraq or Amman hospitals, mainly for preterm labor (32%) and congenital malformations (11%). We managed one case of stillbirth. Maternal mortality did not occur., Conclusions: Despite the difficulties of war, high-risk pregnant women were properly identified, permitting referrals when required. Cooperation with other nongovernmental organizations, including the United Nations High Commissioner for Refugees, was essential for the management of situations at risk of complications and to contain perinatal and maternal mortality., (© 2015 Nordic Federation of Societies of Obstetrics and Gynecology.)

Background: Despite serious long-term sequel, women with Fontan palliation have reached childbearing age. However there is paucity of data on the pregnancy outcomes and management of this condition. We aimed to determine the maternal and fetal outcomes of pregnancy in women with Fontan palliation., Methods: This multicentric, retrospective study included women with Fontan circulation followed in 13 French specialized centers from January 2000 to June 2014. All pregnancies were reviewed, including miscarriages, abortions, premature and term births. We reviewed maternal and fetal outcomes., Results: Thirty-seven patients had 59 pregnancies. Mean age was 27 ± 5 years at first pregnancy. There were 16 miscarriages (27%) and 36 live births with 1 twin pregnancy. Cardiac events occurred in 6 (10%) pregnancies, with no maternal death. The most common cardiac complication was atrial arrhythmia, which occurred in 3 patients. Hematological complications including thromboembolic/hemorrhagic events (n=3/7) occurred in 5 women antepartum (n=2/3), and 4 women postpartum (n=1/4). Two of the 3 thromboembolic events occurred in patients without anticoagulation. There was a high incidence of prematurity (n=25/36, 69%). Anticoagulation was associated with adverse neonatal outcome (OR=10.0, 95% CI [1.5-91.4], p<0.01). After a median follow-up of 24 months, there was no significant worsening of clinical status and thromboembolic disease noted., Conclusions: Pre-selected women can successfully complete pregnancy with Fontan circulation. There is an increase in cardiac and neonatal morbidity during pregnancy. Because thromboembolism could have a severe consequence on Fontan circulation, anticoagulation should be indicated during pregnancy and postpartum period., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objective: To survey French trainees in obstetrics and gynaecology on the type of short and long-term professional activity they wish to have following specialisation., Material and Methods: A questionnaire was sent to the 909 trainees in obstetrics and gynaecology during the academic year 2005-2006., Results: Answer rate was 34.5%. Almost all trainees (96.5%) wish to have a two-year hospital position before applying for consultant or beginning a private practice. Only 55.6% of these trainees think this option realistic. Overall, 78.7% of trainees wish to continue practicing obstetrics, 66.9% surgery, 41.4% ultrasound screening or prenatal diagnosis, 34.1% office gynaecology, 28% oncogynaecology and 23.6% assisted medical procreation. An exclusive public hospital position was desired by 51.6% of trainees, with 45.1% in academic hospitals and 54.9% in non academic hospitals. Exclusive private practice was desired by 8.9% of trainees and 47.7% wish a private practice with a part-time public hospital position., Conclusion: Actual trainees in obstetrics and gynaecology see their future practice as polyvalent, mostly in public hospitals and including for most at least obstetrics.

Introduction: Two major modifications have recently changed the training program of interns in obstetrics and gynecology in France. The first modification is an important increase in the number of interns in OBGYN, allowing more lower ranked medical students to enter this training. The second modification is the imposed subdivision of the pool of interns in two distinctive branches: obstetrics and gynecological surgery, and medical gynecology with a 2/1 ratio. These modifications were decided without consulting interns on the type of practice they intend to have later. This study tries to determine what type of practice French interns in OBGYN intend to have when they have finished their training., Material and Method: We distributed surveys to all French interns in OBGYN. The survey included questions on the type of practice they intend to have, and questions on their opinions on how OBGYN show be taught., Results: Two third of interns wanted to have a full practice in OBGYN. This proportion was the same considering only first year interns. Three quarters of interns wanted to have a future practice that includes at least medical gynecology, and only one intern wanted to do solely medical gynecology later. French interns in OBGYN wanted more medical gynecology teaching during their training, Conclusion: Despite recent modifications in the training program, French interns in OBGYN intend to have a full practice later. This choice is not influenced by the 5 years of training.

Objective: To compare the learning curves of inexperienced junior obstetrics/gynecology registrars for ultrasound-guided invasive procedures on a training model, with and without an electronic guidance system., Study Design: Four junior registrars performed their first 100 procedures on a training model with a new electronic guidance system, and four other junior registrars performed their first 100 procedures on the same training model without using the guidance system. All procedures were performed using a free-hand technique. We evaluated the quality of the procedure, which we defined as the time spent with the entire needle clearly visualized on the screen over the total duration of the procedure. We constructed learning curves for the eight junior registrars for comparative analysis., Results: Quality of the procedure increased over time for all trainees. The learning curves were significantly steeper for trainees using the electronic guidance system. Trainees using the electronic guidance system performed better in the middle of their learning curve (procedures 25-75). All trainees reached the same level of quality by the end of their 100 procedures., Conclusions: The automated electronic guidance system helps faster learning but, after 100 procedures on a training model, both groups reached the same level of quality.

In the recent past, the British and French health care systems have both undergone significant reforms, enveloped in a state of Urgency, resulting primarily in France from the increasing rate of growth in health expenditure and in England from malfunctioning procedures such as waiting lists. After describing current features of the National Health Service (NHS), this study extracts and considers the points of convergence and divergence in the respective policies of the two countries: similarities in the choice of priorities, decentralisation of decision-making, negotiation between actors at the local level, development of the quality concept, and the differences in formulating objectives and involving the system's users. The considerations provided here should allow for a better understanding of the developments of these respective health policies and their future evolution.

Patients and Methods: Shortly before their discharge from a rheumatology department, 100 patients with a mean age of 54 +/- 16 years completed a 20-item questionnaire on morphine therapy. Pain scale scores were 77.1 +/- 19 at admission and 44.2 +/- 24 at questionnaire completion., Results: Thirty-three patients, including 27 with spinal or nerve root disorders, received morphine during their stay. Five of these patients had a malignancy. Among patients who received morphine, 21% (6/29) were disappointed with the drug. Only four of the patients who did not receive morphine (4%) wished they had. Thirty-six percent of patients (30/83) reported previous morphine therapy given by a primary care physician (10/30) or a specialist (14/30) and/or in a hospital (22/30). Only five patients (5/100, 5%) said they regretted not having received morphine for past pain; however, 45% (35/78) of patients agreed with the suggestion that French physicians do not use morphine often enough. Most patients (82%, 65/77) agreed that morphine can be used to treat pain due to rheumatic disorders, although 92% (83/90) felt that morphine should be reserved for "intolerable" pain. Only 37% (34/92) of the patients were apprehensive about using morphine, 57% (45/79) were aware of the risk of dependency, 66% (44/79) of the risk of behavioral or attention disorders, and 53% (41/78) of the risk of tolerance., Conclusion: Expectations of French rheumatology department patients about morphine use were roughly satisfactory. The mean pain scale score above which the patients felt morphine should be given was 70.5 +/- 20.