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Objective. To estimate the impact of obesity on cervical ripening with prostaglandin E2 (PGE2). Materials and method. A retrospective study compared the cervical ripening efficiency of PGE2 on patients with BMI above 30 kg/m2 and normal weight patients with BMI between 20 kg/m2 and 25 kg/m2. In case of a Bishop score (≤3), a dinoprostone tampon was used over 12 h. In case of a Bishop score (4;6), a dinoprostone gel was used over 6 h. Failure of first cervical ripening attempt was defined, as the persistence of a Bishop score <6, 12 h after dinoprostone tampon or 6 h after dinoprostone gel. Results. Ninety-five obese patients were matched according to parity to 190 non-obese patients. The failure rate of the first attempt at cervical ripening was significantly higher ( P == 0.0016) among obese patients (53.7%%) as compared to patients with a BMI in between 20 and 25 (34.2%%). After multivariate analysis BMI ≥ 30 (OR == 2.32 (1.47-4.00), P == 0.0019), parity ≤2 (OR == 2.50 (1.20-5.26) P == 0.0137), and the Bishop score ≤3 (OR == 2.62 (1.45-4.72), P == 0.0014) were significantly and independently associated to prostaglandin ripening failure. Conclusion. Obesity seems to be associated to lower E2 prostaglandin sensitivity. [ABSTRACT FROM AUTHOR]

Simple Summary: After the results of many trials, it is now accepted to omit axillary dissection in selected patients with limited axillary involvement. However, the external validity of these trials is questionable. Our study aimed to evaluate the accuracy of the real French population representativity in the SERC (Sentinelle Envahi et Randomisation du Curage) trial population for patients with breast cancer (BC) associated with sentinel node (SN) micro-metastasis and the differences between the studied population and the real French population. The secondary aim was to compare the French and the Swedish populations of patients with SN micro-metastasis. The findings of our study in addition to the previously demonstrated concordance between the SENOMIC (Sentinelle node Micrometastasis) trial and the Swedish National Breast Cancer Registry (NKBC) populations implied that the results of both the SERC and the SENOMIC trials can be applied to both the French and Swedish real populations. Many trials confirmed the safety of omitting axillary dissection in the selected patients treated for early breast cancer. The external validity of these trials is questionable. Our study aimed to evaluate the accuracy of the French population representativity in the SERC trial and the differences between these two populations as well as comparing the French and the Swedish populations (the SENOMIC trial population and the Swedish National Breast Cancer Registry (NKBC) cohort) of patients with sentinel node (SN) micro-metastasis. A higher rate of smaller tumors and grade 1 tumors was observed in the French cohort when compared to the SERC population. Our findings conclude that both French populations show similar characteristics. Positive non-sentinel node (NSN) rates at completion axillary lymph node dissection (ALND) were 10.28 % and 11.3 % in the SERC trial and French cohort, respectively (p = 0.5). The rate of grade 1 tumors was lower in the SENOMIC trial (16.2%) and in the NKBC cohort (17.4%) compared to the SERC trial population (27.3%) and the French cohort (34.4%). Our findings in addition to the previously demonstrated concordance between the SENOMIC trial and the NKBC populations imply that the results of both the SERC and the SENOMIC trials can be applied to both French and Swedish real populations. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the health status and recovery of women after mid-urethral sling (MUS) revision in response to complications., Design: Cross-sectional study using a questionnaire sent to women from a registry., Setting: Twenty-two French surgical centres., Population: A total of 287 women from the VIGI-MESH registry responded, having undergone MUS revision for complications., Methods: Our sample of women were compared against a representative set of French women taken from the Eurostat database. Multivariate analysis was performed to identify clinical predictors for successful MUS revision. A qualitative analysis was carried out on free-text comments., Main Outcome Measures: Health status, defined by the Minimum European Health Module, and recovery, assessed by Patient Global Impression of Improvement., Results: The response rate was 76% (287/378), with 49% of the women (141/287, 95% CI 43%-55%) reporting good health status, which was 8 points lower than that expected from the comparator French set (57%, 95% CI 55%-58%). Overall, 53% (147/275, 95% CI 47%-59%) of the women reported feeling much better after MUS revision. Just over one-third (35%, 95/275, 95% CI 29%-40%) of respondents reported poor health with little or no improvement. Multivariate analysis showed that being operated on for pain at revision was associated with worse self-perceived health than being operated on for exposure (OR 0.36, 95% CI 0.14-0.95); women with pre-existing comorbidity reported a poorer health status following MUS revision (OR 0.22, 95% CI 0.13-0.38)., Conclusions: Our results suggest that half of the women recovered good health status after MUS revision, whereas a proportion appeared to be seriously affected by an MUS complication despite the revision., (© 2024 John Wiley & Sons Ltd.)

Objective: The aim of this study was to assess perinatal morbidity associated with spatulas or forceps assisted delivery in preterm birth., Study Design: This is a retrospective cohort study including all women with assisted deliveries on singleton pregnancy in cephalic presentation, before 37 weeks of gestation, in two tertiary care centers. We compared forceps-assisted deliveries with spatula-assisted deliveries. The main outcome was the rate of neonatal birth trauma. Secondary outcomes included other neonatal parameters, maternal outcomes and obstetric anal sphincter injuries., Results: Out of 37 002 deliveries, 59 (0.2 %) preterm assisted deliveries with forceps and 111 (0.3%) preterm spatulas deliveries were included. The rate of neonatal birth trauma was low for both devices, without significant difference (3.4% in Forceps group vs 0.9% in Spatulas group, p = 0.28). The rate of episiotomy was 79.7% after forceps-assisted delivery and 48.6% for spatulas (p < 0.001). The rate of obstetric anal sphincter injuries was 1.7% and 2.7% respectively (p = 0,9)., Conclusion: The rate of birth trauma was low in both forceps-assisted deliveries and spatula-assisted deliveries and was not significantly different between the two groups., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Aim: 18 F-Fluorodeoxyglucose positron-emission tomography integrated with computed tomography ( 18 FDG PET-CT) is a non-invasive examination that could be helpful for the management of endometrial cancer. This study investigated the performance of 18 FDG PET-CT in assessing para-aortic (PA) lymph-node involvement in high-risk endometrial cancer., Materials and Methods: This was a retrospective, single-center study carried out between 2009 and 2018. The inclusion criteria were high-risk and locally advanced type 1 or 2 endometrial cancer with 18 FDG PET-CT before PA lymphadenectomy., Results: During the study period, among 142 patients with high-risk endometrial cancer, 35 patients (24.6%) underwent 18 FDG PET-CT followed by PA lymphadenectomy. In 25% of cases, PA lymphadenectomy was not performed due to the discovery of metastasis. 18 FDG PET-CT had a sensitivity of 50%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 75%, accuracy of 80% and an area under the curve of 0.75 for the evaluation of PA involvement., Conclusion: According to its high specificity in PA lymph-node evaluation, a positive PET scan might allow PA lymphadenectomy to be avoided., (Copyright© 2019, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Aim: To assess the impact of the surgical case volume on the accuracy of preoperative staging and compliance with the European Society of Medical Oncology (ESMO) guidelines for the management of endometrial cancer (EC)., Patients and Methods: Centers were divided into those taking care of 20 or fewer EC cases, and those with more than 20 per year., Results: Seventeen university teaching hospitals fully responded to the questionnaire. The differences between the preoperative assessment and postoperative risk groups were significant for all centers (p=0.001). However, this difference was not due to the volume of patients of centers (p=1.00). Lymphadenectomy was performed in 21% and 82% of patients in the ESMO low-risk and high-risk groups, respectively, without differences between centers overall and centers managing more or fewer than 20 ECs per year. For the ESMO intermediate-risk group, the difference was significant when taking all groups into account (p=0.02), but it was not significant between centers managing fewer than 20 ECs (85%) or more than 20 ECs (59%) per year (p=0.12)., Conclusion: The accuracy of preoperative staging in EC is not improved in centers managing more than 20 ECs per year. Lymphadenectomy practice in the presumed low- and high-risk groups was homogenous. In the presumed intermediate-risk group, lymphadenectomy practice is heterogeneous and centers managing more than 20 ECs tend to perform lymphadenectomy more frequently., (Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Available data on appropriate follow-up in endometrial cancer highlight the need of well-conducted studies. Most recurrences tend to occur within three years and involve symptoms. Routine tests are not advocated without symptoms. In case of suspicious recurrence, TEP/CT seems to be the most sensitive and specific method. There is limited evidence to decide whether follow-up schedules with multiple visits result in survival benefits. An appropriate follow-up should be discussed based upon the risk of recurrence. Counselling on the potential symptoms of recurrence should be a major aim.

The objective of this study was to provide guidelines for clinical practice from the French College of Obstetrics and Gynecology (CNGOF), based on the best evidence available, concerning hysteroscopy. Vaginoscopy should be the standard technique for diagnostic hysteroscopy (Grade A) using a miniature (≤3.5mm sheath) (Grade A) rigid hysteroscope (Grade C), using normal saline solution distension medium (Grade C), without any anaesthesia (conscious sedation should not be routinely used), without cervical preparation (Grade B), without vaginal disinfection and without antibiotic prophylaxy (Grade B). Misoprostol (Grade A), vaginal oestrogens (Grade C), or GnRH agonist routine administration is not recommended before operative hysteroscopy. Before performing hysteroscopy, it is important to purge the air out of the system (Grade A). The uterine cavity distention pressure should be maintained below the mean arterial pressure and below 120mm Hg. The maximum fluid deficit of 2000ml is suggested when using normal saline solution and 1000ml is suggested when using hypotonic solution. When uterine perforation is recognized during operative hysteroscopy using monopolar or bipolar loop, the procedure should be stopped and a laparoscopy should be performed in order to eliminate a bowel injury. Diagnostic or operative hysteroscopy is allowed when an endometrial cancer is suspected (Grade B). Implementation of this guideline should decrease the prevalence of complications related to hysteroscopy., (Copyright © 2014. Published by Elsevier Ireland Ltd.)

Agressive chemotherapy can lead to premature ovarian failure and loss of fertility in women and children. Embryo cryopreservation is an established clinical procedure of fertility preservation but with several limitations. Others options are available. Cryopreservation ovarian cortex tissu have to be suggested in case of high gonadotoxic treatment. It doesn't require puberty and delay in initiation of chemotherapy. The first birth in France after orthotopic graft of ovarian tissu thawed have been recently described with a promising process. Oocyte cryopreservation is available for women without partner but the experience is limited. Gonadotrophin-releasing hormone (GnRH) agonist therapy as ovarian protectants seem interesting. Follicular growth and maturation in vitro are still experimental., (Copyright 2010 Elsevier Masson SAS. All rights reserved.)