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Dans la polyarthrite rhumatoïde et tout autre rhumatisme inflammatoire chronique ou maladie auto-immune traitée par immunosuppresseurs ou immunomodulateurs, il est indispensable d'envisager le souhait de grossesse du couple et d'assurer, au mieux dans une consultation préconceptionnelle, une modification des traitements avant toute grossesse pour éviter de se trouver en situation de grossesse (ou de paternité) exposée. Certains traitements de fond de la polyarthrite ou immunosuppresseurs sont clairement à risque comme le cyclophosphamide tant chez la femme que l'homme ; ils sont interdits ou doivent faire prendre des mesures de protection des gamètes. Sont interdits durant la grossesse le méthotrexate et le leflunomide. Il est possible de poursuivre chez la femme sans inquiétude la salazopyrine, l'hydroxychloroquine et l'azathioprine pour les plus courants. En revanche, chez l'homme, la salazopyrine peut donner lieu à une oligoasthénospermie ou une azoospermie réversible. L'allaitement est une autre situation où l'exposition au csDMARD chez la mère doit être vérifiée grâce au site du Centre de référence sur les agents tératogènes (CRAT, Paris). In rheumatoid arthritis and any other chronic inflammatory rheumatism or autoimmune disease treated with immunosuppressants or immunomodulators, it is essential to consider the couple's desire to become pregnant and to ensure, at best in a pre-conception consultation, a modification of the treatments before any pregnancy to avoid being in a situation of exposed pregnancy (or paternity). Certain basic treatments for polyarthritis or immunosuppressants are clearly at risk, such as cyclophosphamide, for both women and men; they are prohibited or must have measures taken to protect gametes. Methotrexate and leflunomide are prohibited during pregnancy. Salazopyrine, hydroxychloroquine and azathioprine for the most common ones can be continued in women without concern. In men, salazopyrine may cause oligo-asthenospermia or reversible azoospermia. Breastfeeding is another situation where maternal exposure to csDMARD should be verified through the Teratogen Reference Centre (CRAT, Paris, equivalent to OTIS) site. [ABSTRACT FROM AUTHOR]

Les spondyloarthrites sont des rhumatismes inflammatoires touchant les sujets jeunes. Les formes non radiologiques de spondyloarthrite prédominant chez la femme mettent en évidence la problématique de la gestion de grossesses dans ces rhumatismes inflammatoires. Nous aborderons dans cette revue, les données de la littérature concernant la fertilité dans la spondyloarthrite. Nous détaillerons les complications observées pendant la grossesse des patientes avec une spondyloarthrite et notamment le risque accru d'accouchement par césarienne dans cette population. Nous présenterons également les données de l'impact de la grossesse sur l'activité du rhumatisme, et notamment le risque de poussée. De plus nous développerons l'effet de la grossesse sur l'imagerie des articulations sacro-iliaques, pierre angulaire du diagnostic de spondyloarthrite. Spondyloarthritis is a chronic inflammatory rheumatic disease of the young subject. Non-radiological forms have a much more balanced sex-ratio than ankylosing spondylitis, so the issue of pregnancy management in spondyloarthritis arises more and more frequently. In this review, we will discuss data from the literature regarding fertility and pregnancy complications of patient with spondyloarthritis. We will also present data on the impact of pregnancy on disease activity, including the odds of relapse. Finally, we develop the effect of pregnancy on the imaging of sacroiliac joints, a cornerstone, of spondyloarthritis diagnosis. [ABSTRACT FROM AUTHOR]

La polyarthrite rhumatoïde (PR) est le rhumatisme inflammatoire chronique le plus fréquent chez la femme en âge de procréer. La fécondité et la fertilité de ces jeunes femmes peuvent être impactées par les conséquences de la maladie (fatigue, douleur, handicap) mais également par une activité de la maladie persistante ainsi que par les traitements utilisés. En effet, les patientes atteintes de PR ont un délai de conception plus long que la population générale et bien que la grossesse ait classiquement été rapportée comme une période « lune de miel » dans la polyarthrite rhumatoïde, des données récentes montrent que le nombre de patientes améliorées pendant la grossesse ne serait pas si important. La grossesse dans la polyarthrite rhumatoïde est à risque de complications. Elle doit être programmée afin d'adapter au mieux les stratégies thérapeutiques à la fois pour la période préconceptionnelle et la grossesse, tout en gardant l'objectif d'une rémission de la maladie. Une consultation préconceptionnelle peut être prévue dès que le désir de grossesse est évoqué par les patientes et le désir de grossesse devrait être abordé de manière systématique chez toute patiente atteinte de polyarthrite rhumatoïde en âge de procréer. La prise en charge pendant la période préconceptionnelle et tout au long de la grossesse doit être multidisciplinaire, en étroite collaboration avec les équipes de gynéco-obstétrique. Rheumatoid arthritis (RA) is the most common chronic inflammatory rheumatic disease in women of childbearing age. The fertility of these young women can be impacted by the consequences of the disease (fatigue, pain, disability) but also by disease activity and the treatments. Indeed, RA patients have a longer time to conceive than the general population and although pregnancy has traditionally been reported as a "honeymoon" period in rheumatoid arthritis, recent data show that the number of patients improved during pregnancy is not so important. Pregnancy in rheumatoid arthritis is at risk of complications. It must be programmed to best adapt treatment strategies for both the pre-conception period and pregnancy, while keeping the goal of remission of the disease in mind. Pre-conception consultation can be scheduled as soon as the desire of pregnancy is raised by patients, and the desire for pregnancy should be addressed routinely in all patients with rheumatoid arthritis of childbearing age. Management during the preconception period and throughout pregnancy should be multidisciplinary, in close collaboration with gynecological-obstetrical teams. [ABSTRACT FROM AUTHOR]

Les douleurs musculaires et ligamentaires sont des plaintes fréquentes au cours de la grossesse. Les atteintes générées lors de cet état sont en lien avec les modifications hormonales : sécrétion importante d'œstrogène et de relaxine, prise de poids, positionnement du fœtus... Les trois principales étiologies trouvées sont : les douleurs pelviennes incluant les symphysites, les syndromes canalaires par atteinte des tissus mous adjacents, les ténosynovites. Leur diagnostic est essentiellement clinique. Dans la plupart des cas, les signes cliniques sont régressifs après l'accouchement, leur chronicité est très rare. Muscle, ligament and tendon pains and discomfort are commonly observed during pregnancy. These musculoskeletal disorders are due to changes related to pregnancy, such as increased secretion of some hormones like estrogen or relaxin, weight gain or the position of the fetus...The three principal etiologies found are: pelvic pain, including osteitis pubis, acquired compressive nerve in relation with soft tissue changes, and tenosynovitis. The diagnosis is done thanks to symptoms. Most of the time, these pregnancy musculoskeletal disorders are regressive during the post-partum. Chronic pain is rare. [ABSTRACT FROM AUTHOR]

Près d'un tiers des femmes enceintes ressent des douleurs inguinales, mais il faut d'abord s'assurer que celles-ci proviennent bien des coxo-fémorales, et ne soient pas des douleurs projetées d'origine rachidienne, sacro-iliaque, pubienne, pelvienne, trochantérienne, ou dues à des souffrances tendineuses (dont du petit glutéal). Les syndromes canalaires des nerfs cutanés latéraux/fémoro-cutanés et obturateurs doivent aussi être éliminés. Une fois l'origine coxo-fémorale établie, l'étiologie la plus difficile à certifier, mais peut-être la plus fréquente, est une souffrance du labrum à l'origine d'un grand nombre de faux négatifs en imagerie. Les coxites septiques sont rares, mais peuvent être dues à des germes inusuels comme les streptocoques B. Une IRM doit être proposée quand les signes se précisent pour ne pas méconnaître une fissure osseuse compliquant une ostéopénie de hanche liée à la grossesse, ces fissures pouvant rarement se compliquer de fractures déplacées, ou d'ostéonécroses, imposant ensuite la pose d'une prothèse. Le mécanisme de ces ostéopénies n'est pas univoque, et plusieurs causes pourraient se cumuler : 1-ostéoporoses de la grossesse, bien plus souvent à l'origine de fractures vertébrales multiples que de fissures/fractures du col ; 2-algoydystrophie (plus souvent unilatérale que les deux autres étiologies) ; 3-œdéme du col fémoral et ostéonécroses, possiblement liées à la gêne au retour veineux induite par l'utérus gravide. Les grossesses ne sont en général pas plus compliquées chez les femmes porteuses de prothèses de hanche, et, même si un passage de Chrome et de Cobalt survient chez le fœtus, sa toxicité chez les enfants n'a pas été établie. One third of pregnant women can complain of the hip, but other sources of pain must first be ruled out: spine, sacroiliac, pubis, pelvis, trochanter, and tendons (including gluteus minus). Entrapment of lateral cutaneous and obturator nerves should not be forgotten. Once a coxo-femoral origin is ascertained, the most frequent diagnosis might be labral stresses or tears, although a high percentage of false negative on imaging often preclude a firm diagnosis. Septic arthritis are very rare but unusual bacteria like streptococcus B can be noticed. MRI must be requested each time hip pain or limping is lasting enough, first to seek for stress fractures with or without underlying osteopenia, since they can progress to displaced fractures or osteonecrosis leading to hip prosthesis following delivery. Several mechanisms could co-exist to account for the underlying hip osteopenia: 1-pregnancy-related transient osteoporosis (which mainly induces multiple vertebral fractures); 2-algodystrophy (more often unilateral as compared to other explanations of hip osteopenia); oedema of the femoral neck and/or epiphysis, or full-blown osteonecrosis, possibly fostered by venous stasis secondary to compression by the foetus of maternal large veins in the pelvis. Previous hip prostheses have no influence on pregnancy outcome, and later children health, although abnormal levels of cobalt and chromium are usually found in their cord blood. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Actualités Pharmaceutiques is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Les condylomes acuminés ano-génitaux externes liés à l´infection à papillomavirus sont fréquents pendant la grossesse avec un risque de transmission faible au moment de l´accouchement. Nous rapportons un cas de condylome acuminé géant surinfecté au cours de la grossesse. Il s´agissait d´une patiente de 28 ans enceinte à 36 SA, primigeste sans aucun antécédent, ayant consulté pour tuméfaction vulvaire avec leucorrhées malodorantes et douleur à type de tension évaluée à 4 sur l´échelle visuelle analogique. A l´examen, on objectivait une énorme masse prenant toute la vulve, ne permettant pas d´individualiser les grandes ni les petites lèvres et le clitoris. L´orifice vaginal était accessible et les parois vaginales étaient sans particularité au toucher vaginal. L´examen au spéculum était difficile. La patiente a été mise sous antibiotiques par voie parentérale, antalgiques pallier 1 et des soins locaux. Les suites étaient favorables après traitement antibiotique avec une discrète régression de la taille de la masse. La biopsie était revenue en faveur d´un condylome acuminé. A 39 semaines d´aménorrhée et 4 jours, la patiente a accouché à son domicile par voie basse malgré l´indication d´une césarienne programmée. Aucune complication périnéale n´était objectivée à l´examen et les suites du post partum étaient simples. La patiente a été adressée en dermatologie avec éventuelle prise en charge chirurgicale avec des plasticiens. Les lésions condylomateuses peuvent régresser spontanément après l´accouchement comme elles peuvent persister et nécessiter une prise en charge spécifique. La césarienne n´est pas systématique mais la taille et le siège peuvent l´imposer.

INTRODUCTION: L´objectif de cette étude était de déterminer la fréquence et d´évaluer le pronostic maternel et périnatal lors de la grossesse suivi de l´accouchement chez les élèves mineures mariées, dans la ville de Niamey. METHODES: c´était une étude cas-témoin des gestantes et parturientes de janvier 2018 au 31 d écembre 2018 à la Maternité Issaka Gazobi de Niamey. Les élèves mineures (18 ans) ont été comparées aux élèves âgées de 18-27 ans. Les paramètres sociodémographiques maternels, la morbi-mortalité maternelle et périnatale ont été analysées. Les statistiques usuelles et la régression logistique ont été utilisées pour analyser les résultats. Le seuil de signification a été fixé à une valeur de P-value (p=0,05). RESULTATS: la fréquence d´accouchement chez les élèves mineures était de 3,06%. Les mineures étaient plus assidues au suivi prénatal (46,7% vs 41,9%). La césarienne (ORa=2 [1,0-3,0]) l´éclampsie (ORa=2 [1,0-4,4]), l´épisiotomie (ORa=2[1,2-1,8]) et la dépression néonatale (P=0,05 (10,6% vs 5,8%)) étaient plus élevés chez les mineures que chez les adultes. La mortalité périnatale était élevée dans le deux groupes. CONCLUSION: nos résultats sont proches de ceux décrits dans d´autres études Européennes et Africaines. Les différences retrouvées pour les risques obstétricaux et périnatals semblent être liées aux facteurs sociodémographiques entourant ces gestantes mineures. Ces derniers devraient être pris en compte dans toute démarche de prévention des complications des grossesses chez les mineures.

This article presents the results of a small pilot study examining links between Hostile/Helpless (HH) representations of caregiving in pregnancy and later child removal by child protective services. The sample was drawn from a replication study of the Minding the Baby® attachment‐based home‐visiting intervention conducted in the United Kingdom, serving young first‐time mothers in under resourced communities. The HH classification system (Lyons‐Ruth et al.) was adapted for use with the Pregnancy Interview (PI) (Slade); 26 PIs were assessed (coders blinded) in a sample that included 13 mothers whose infants were removed from custody due to anticipated or documented maltreatment within 2 years of childbirth, and 13 mothers who did not have their infants removed. Mothers whose infants were removed from their custody had significantly higher HH scores than mothers of infants who were not removed from their care (F(1, 24) = 14.500, p <.001), and the relation between overall HH classification and infant removal status was also significant (χ2(1, N = 26) = 12.462, p <.001). Results suggest that prenatal maternal caregiving representations may predict postnatal relationship disruptions, and indicate the need for larger studies further testing this prenatal approach to maltreatment risk assessment in at‐risk populations. [ABSTRACT FROM AUTHOR]

The first cases of infection caused by new SARS-CoV- 2 coronavirus were reported in China in December 2019. This disease is called COVID-19 and has been declared as a pandemic by the WHO three months after its outbreak (in March 2020). In most cases it results in non-severe infectious syndrome associated with different degrees of benign symptoms (fever, cough, myalgia, headache and potential digestive disorders). SARS-CoV-2 can cause severe lung diseased and, sometimes, it results in death. Data on its consequences during pregnancy are limited. Currently, data on SARS-CoV-2 infection are reassuring and don ́t indicate a higher risk of infection or a superimposed risk of complications in pregnant women compared to the general population. A few exceptional cases of maternal mortality have been reported, but they occur, most often, in patients with other diseases, in particular pre-eclampsia. This retrospective study highlights the clinical, biological and evolutionary materno-fetal data collected in the COVID-19 Military Field Hospital of Benslimane, Morocco, over a period of 3 months, from 21st July to 21 October 2020. [ABSTRACT FROM AUTHOR]

despite the need for chemotherapy. This study reports the case of a 37-year old multiparous woman at 20 weeks and 4 days of amenorrhea (WA). She was hospitalized for dyspnoea (stage IV according to New York Heart Association (NYHA) classification). The patient had a syndrome of heavy left pleural effusion and bilateral mastitis. The diagnosis of metastatic breast cancer was retained based on cytological examination of pleural fluid and breast cytoponction revealing galactophoric carcinoma. The patient underwent pleural drainage with improvement of dyspnea but pleural fluid continued. After multidisciplinary consultation (MC), specific treatment of cancer was necessary. Five cycles of epirubicin- cyclophosphamide-5-FUbased chemotherapy was performed after the couple provided consent. Pleural fluid diminished significantly after the second cycle of treatment. After consultation with the obstetrician, chemotherapy was interrupted one month before the 37th week of amenorrhea. Pregnancy evolved favorable, vaginal birth was managed following rupture of membranes at term with good neonatal adaptation. After one-year follow-up, the mother was still on chemotherapy and the baby was in good health. Several parameters should be considered before the administration of antineoplastic agents, hence the role of early fetal and maternal monitoring. Multidisciplinary approach is recommended to support therapeutic decision and follow-up. [ABSTRACT FROM AUTHOR]

Examine the association between news media use frequency during the COVID-19 pandemic and the scale of psychological distress in pregnant women, considering this distress known harmful effects on the fetus development. Pregnant women living in Quebec province (N = 1014) have been recruited in April 2020 through social media, while a state of health emergency was declared. Participants were divided in 4 groups, according to self-reported frequency of news media consulting (little or none; one time a day; several times a day; constant). They filled measures of depressive symptoms, negative affects, post-traumatic stress symptoms and anxiety specific to COVID-19. Instrument scores were grouped under a unique factor of psychological distress. An ANCOVA controlling for age, gestational age, education level, household annual revenue and a diagnosed mental disorder present at the time of participation in study shows that news media exposure frequency is significantly associated with psychological distress severity in pregnant women, during COVID-19 pandemic, F(3,998) = 27.02, p < 0.001, η2 partial = 0.08. Given the mean comparisons a posteriori, higher psychological distress rates are found as soon as news media exposure exceeds once a day (effect sizes between 0.38 and 0.81). The more pregnant women report consulting the news media during the COVID-19 pandemic, the more likely they are to exhibit psychological distress. Results provide one of the first empirical supports to recommendations of World Health Organization, Canada government and psychiatric associations that encourage population to limit their news media consulting during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Copyright of Recherches Feministes is the property of Groupe de Recherche et d'Echange Multidisciplinaires Feministes and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Anti-Interleukin-1 (Anti-IL-1) drugs are used to treat some chronic rheumatic diseases that can affect young people, including women of childbearing age. Two anti-IL-1 drugs are available in France: anakinra and canakinumab. Data on their use during pregnancy are still limited. Based on the published literature, we carried out a review of the use of these anti-IL-1 therapies during pregnancy: therapeutic indications, pharmacological profiles and assessment of embryonic, fetal and neonatal risks. Based on this analysis, and given the absence of any reported concern, it is possible to consider the use of these two treatments during pregnancy if the clinical situation so requires and under certain conditions. Based on the data available to date, anakinra should be preferred to canakinumab whenever possible., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

In preparation for a new version of the CRAT (Centre de référence sur les agents tératogènes) website, an evaluation of user satisfaction was carried out. An invitation to complete an online questionnaire covering the various dimensions of the website (appearance, content, interactivity, ease of use, technical performance) was sent in April 2022 to healthcare professionals who referred to CRAT for clinical expertise over the previous two years. After sending out 3224 individual e-mail invitations, 758 evaluators completed the questionnaire in full (response rate: 23.5%). The evaluation revealed a high-level of overall satisfaction among site users (98.0% very satisfied or satisfied). Satisfaction with the site's appearance was also high, although comments were made about the site's lack of a modern web design. Health professionals recognized in their responses the reliable, relevant and up-to-date nature of the content of this free, public online resource, independent of the pharmaceutical industry. On the basis of these highly favorable assessments, with content that has been widely acclaimed and areas for improvement that have caught the attention of site users (evolution of its appearance, of the search tool, implementation of a mobile site), a new version of www.lecrat.fr was launched in the fall of 2023., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Between 2016 and 2018, 13 maternal deaths were due to hypertensive disorders. During this period, the maternal mortality ratio was 0.6/100 000 live births. Hypertensive disorders were responsible for 4.8% of maternal deaths during the first year, 5.1% up to 42 days postpartum and for 13.5% of direct maternal mortality. Maternal deaths due to hypertensive disorders increased close to signification (p=0.09) compared to the last triennium (MMR=0.2/100.000). Classification of the hypertensive disorders was: 5 severe preeclampsia, 3 eclampsia, 4 HELLP syndromes et 1 undefined hypertension. In five cases, a stroke was associated. Mode of delivery was a cesarean section when the hypertensive disorder started before the labour (8/13, 62%). Six women were older than 35years old and 5/12 were nulliparous. Among the 12 cases where place of birth was known, 5 were born foreigners. BMI was over 30 for 46%. Medical care were estimated non optimal in 11/13 of the cases. Among these deaths, 66% (8/12) seemed to be preventable versus 82% for the last period 2013-2015. The main causal factor of suboptimal management was inappropriate management by the obstetrical or anesthetist/intensive care squads, respectively: 3 lack of diagnosis, 8 delays for diagnosis and 5 underestimated severity. Four cases corresponded to inappropriate health care organization. This study offers the opportunity to stress major points to optimize medical management and health care organization facing hypertensive disorders during pregnancy., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Between 2016 and 2018, twenty maternal deaths were associated with a stroke. The 20 deaths whose main cause was stroke represent 7.4% of all maternal deaths, i.e. a maternal mortality ratio (MMR) of 0.9 per 100,000 live births (95%CI 0.6-1.3). Among the 20 stroke deaths, it was hemorrhagic in 17 cases (85%), ischemic in 2 cases, and due to thrombophlebitis in 1 case. Stroke occurred during pregnancy in 8 women (40%) - one case before 12 weeks, 3 cases between 28 and 32 weeks, and 4 cases between 34 and 40 weeks; in 3 cases the stroke occurred intrapartum, and for the other 9 cases (45%) the stroke occurred postpartum between Day 1 and Day 15. Care was assessed as non-optimal in 10/19 (56%) of cases but mortality as possibly avoidable in 24% of cases (4/17 cases with conclusion established by the CNEMM) and not established in two cases. The potentially improvable elements identified were a delay in carrying out initial brain imaging in three cases (one case antepartum, two cases postpartum) and insufficient hemodynamic monitoring in intensive care in one case., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

This report, covering the period 2016-2018, confirms that psychiatric causes (largely dominated by suicides) are the leading cause of maternal mortality up to 1year after childbirth, a finding already made in the previous 2013-2015 report. There were 47 deaths from psychiatric causes in 3years, including 45 maternal suicides, giving a maternal mortality ratio (MMR) of 2.1 per 100,000 live births (NV) (95% CI: 1.4-2.6). The median time to suicide was 138days postpartum. This group represents 17.3% (16.5% for suicides) of all maternal deaths for the period. Maternal suicide is linked to an interaction of several risk factors, including a history of personal and family psychiatric disorders not always known to the obstetric team (53% of women), socioeconomic disparities (29% present social vulnerability, and 14% domestic violence), stressful events, and inadequate access to healthcare services. Psychiatric causes are among those in which the proportion of sub-optimal care and preventable deaths, i.e. 79% of cases, are the highest. An analysis of all the women who died in France of psychiatric causes during pregnancy reveals a number of recurring elements that point to the need for improvement, both in terms of the quality and organization of care, and in terms of women's interaction with the healthcare system. Screening for a history of psychiatric disorders and ongoing psychiatric pathologies must be carried out systematically at all stages of pregnancy and postpartum by all those involved, with communication with future parents on the not inconsiderable risk of perinatal depression. Finally, it is important to develop an adapted and graduated response across the country, according to resources, and to strengthen city-hospital collaboration and training for all those involved., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

As pregnant women are constantly exposed to drugs during pregnancy, either to treat long-term conditions or acute illnesses, drug safety is a major concern for the fetus and the mother. Clinical trials are rarely made in this population due to strict regulation and ethical reasons. However, drug pharmacokinetic (PK) parameters vary during pregnancy with an increase in distribution volume, renal clearance and more. In addition, the fetal distribution should be evaluated with the importance of placental diffusion, both active and passive. Therefore, there is a recent interest in the use of physiologically-based pharmacokinetic (PBPK) modeling to characterize these changes and complete the sparse data available on drug PK during pregnancy. Indeed, PBPK models integrate drug physicochemical and physiological parameters corresponding to each compartment of the body to estimate drug concentrations. This review establishes an overview on the current use of PBPK models in drug dosage determination for the pregnant woman, fetal exposure and drug interactions in the fetal compartment., (Copyright © 2023 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

Olo nutritional follow-up care offers vulnerable pregnant women food vouchers, multivitamin supplements, tools, and nutritional counselling to support healthy pregnancy outcomes. Purpose: To evaluate the contribution of Olo follow-up care to nutritional intakes and eating practices, as well as to assess the programme-related experience of participants. Methods: Participants (n = 30) responded to questionnaires and web-based 24-hour dietary recalls and participated in a semi-structured interview (n = 10). Results: Olo follow-up care reduced the proportion of participants below the recommended intake for groups for many micronutrients, with the greatest reduction for folate (by 96.7%), vitamin D (by 93.3%), iron (by 70.0%), calcium (by 50.0%), and zinc (by 30.0%), mainly due to the prenatal multivitamin supplements. Most participants (96.7%) did not follow Olo's typical recommendations but, if they had, hypothetically they would have consumed an average of 746 additional calories per day and be above the recommendations for excessive intakes of folic acid and iron (100% and 33.3%, respectively). More than half of the participants were moderately to severely food insecure. Olo contributed to reducing the impact of isolation and increased food accessibility and budget flexibility among participants. Conclusion: Olo follow-up care helped reduce the proportion of women below the recommended intake for micronutrients, but revising the food offered and strategies to address food insecurity may be necessary.

Endometriosis does not always mean infertility, and treatment depends on the couple's prognosis and their wishes. Spontaneous pregnancy remains possible, all the more so if endometriosis treatment is initiated early in the patient's life. Surgery and assisted reproduction are available to couples who wish to have a child., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Previous systematic reviews have reported on the relationship between eating disorders (EDs) and birth outcomes, but there are no existing meta-analyses on this topic. This systematic review and meta-analysis examines the association between lifetime maternal EDs, including anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) with low birth weight (LBW), preterm birth (PTB), small for gestational age (SGA), large for gestational age (LGA), and miscarriage. Four databases were systematically searched for quantitative literature on maternal EDs that preceded birth outcomes. Eighteen studies met the inclusion criteria and were included in the review. The meta-analyses included 6 studies on miscarriage, 11 on PTB, 4 on LBW, 9 on SGA, and 4 on LGA. The Mantel-Haenszel random effects model was used to test the associations between EDs and birth outcomes. The results showed significant positive associations between AN and LBW (OR 1.74, 95% confidence interval (CI) 1.49, 2.03), AN and SGA (OR 1.39, 95% CI 1.17, 1.65), BN and PTB (OR 1.19, 95% CI 1.04, 1.36), and BED and LGA (OR 1.43 95% CI 1.18, 1.72). EDs were not significantly correlated with miscarriage. These findings reveal the importance of screening for and treating EDs in pregnant women.

Maternal diet during pregnancy can have a significant impact on maternal and offspring health. As nutrition counselling is an important component of prenatal care, registered dietitians (RDs) are uniquely trained professionals who can provide personalized nutrition counselling customized to an individual's sociocultural needs. The objective of this systematic review was to determine if RD involvement during pregnancy is associated with a lower prevalence of adverse birth outcomes in the United States and Canada. The review was conducted through a search of four databases: PubMed, CINAHL, Embase, and Web of Science. A total of 14 studies were identified. Women had a lower prevalence of low birth weight and preterm infants when RDs were involved during prenatal care. While RD involvement during pregnancy was not associated with macrosomia, more research is needed to assess its relationship with small for gestational age, large for gestational age, and infant mortality. Future research should also investigate the specific dietary advice provided by RDs and the extent and timing of their involvement throughout pregnancy to better understand the mechanisms surrounding nutrition counselling, in utero development, and health outcomes.

Objectives: The aim of the study was to explore the structure of the Prenatal Attachment Inventory (PAI) on a French sample of pregnant women., Methods: Three hundred and nine pregnant women were recruited in gynecology-obstetrics departments and on social networks. To be included, women had to be pregnant, aged between 18 and 45 years old, and not have somatic complications of pregnancy. The women completed a questionnaire including questions on sociodemographic information, and the PAI. The structure of PAI was explored with an exploratory structural equation model (ESEM)., Results: Three factorial solutions were explored: two-, three- and four-factor. The 2-factor solution was excluded due to its CFI, TLI and RMSEA indexes, which were lower than the reference values. The choice between the 3- and 4-factor solutions was made according to the clinical meaning of the items included in the factors. The 3-factor solution was retained with the factors: "current and future representations of the baby", "maternal-fetal relationship", and "proprioceptive feeling". The scale had good internal consistency., Conclusions: The PAI is the first standardized multidimensional assessment tool for maternal-fetal attachment in the French language. In view of the results obtained, this tool can be disseminated and used by professionals in perinatal care., (Copyright © 2024. Published by Elsevier Masson SAS.)

Our team was confronted with a situation of stubborn refusal of care, including the indication of a cesarean section for an adult patient able to express her wishes. This refusal was formulated during pregnancy follow-up, during the discussion of the birth plan and during delivery, the patient having accepted the indication of a possible emergency cesarean section under general anesthesia only in the occurrence of severe fetal heart rate abnormalities. The impasse forced caregivers to violate the rules of good clinical practice, which indicated the performance of a cesarean section, and to wait for a complication to arise in order to be able to act, taking the risk of intervening too late. This situation has led to direct risks to the health of the mother and the unborn child, without putting the life of either of them in imminent danger. Finally, the time devoted to this patient in a tense organization was to the detriment of the care of other patients., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

La réactivation des représentations d'attachement au cours de la grossesse peut amener à une recherche de soutien alternatif, sur Internet par exemple. En effet, les spécificités des échanges en ligne facilitent cette recherche de soutien. L'état émotionnel (anxiété, dépression) de la femme enceinte pourrait aussi être lié à un usage d'Internet centré sur la grossesse. L'objectif de cette étude est d'explorer les associations entre l'usage d'Internet concernant la grossesse par les futures mères, leur style d'attachement, leur perception du soutien social et leur niveau d'anxiété et de dépression. Cette étude a été menée auprès de 28 femmes enceintes primipares, au dernier trimestre de grossesse. L'usage d'Internet en lien avec la grossesse, le style d'attachement, le soutien social perçu, le niveau d'anxiété et de dépression ont été évalués par autoquestionnaires. Des analyses de corrélation et de comparaisons de moyenne ont été réalisées. Les résultats montrent une association significative entre un style d'attachement craintif et l'usage d'Internet pour la recherche d'informations. Le score de dépression est significativement associé à l'usage d'Internet pour la recherche d'informations en lien avec la grossesse et pour des conseils et réduire les affects négatifs. Le besoin de réassurance caractérisant l'attachement craintif pourrait se traduire par une multiplication des recherches de sources d'informations pour gérer les questionnements liés à la grossesse. Le lien entre la dépression et l'usage d'Internet interroge néanmoins sur les effets de cet usage sur les symptômes dépressifs. The pregnancy of a first child is a life event with a strong emotional impact. Like any life event, pregnancy is a time when the need for comfort and support can be increased. The issues related to attachment will be reactivated in future parents and affect the experience of this transition period. Pregnant women with an insecure attachment style would be particularly vulnerable to experiencing pregnancy-specific anxiety. Furthermore, depending on their representations of attachment relationships, future mothers may perceive their partner as more or less supportive. Faced with a lack of perceived support, expectant mothers could turn to other people. Nevertheless, seeking help and support is not always simple. The Internet could be an alternative source of support and information. Indeed, the specificities of online exchanges can allow another mode of exchange and facilitate the search for support, making the Internet a potential source of support. To face anxiety and depression sometimes experienced during pregnancy, social support is essential. It may help pregnant women to grasp the changes related to her new life. Future mothers with a high level of anxiety and depression, or with anxiety-depressive disorders, could use the Internet to find people with whom to exchange and find answers to their questions. The aim of this study is to explore the Internet use related to pregnancy by expectant mothers in relation to their attachment style, perception of social support, and level of anxiety and depression. This study is cross-sectional and was conducted among a sample of 28 pregnant women (mean = 27.10 years; sd = 3.70). To recruit participants, advertisements with a link to the survey were posted and shared on social networks. All the women were expecting their first child and were in the last trimester of their pregnancy. The participants completed an anonymous online survey. The survey assessed Internet use related to pregnancy, attachment style, perceived social support level of anxiety and depression by autoquestionnaires. Partial correlation analyzes, controlled by time prior to conception, showed a significant relationship between fearful attachment and (1) Internet use for information seeking, (2) Internet use having a perceived effect on emotions. Data revealed that Internet use to exchange and share experiences and emotions is significantly and negatively related to satisfaction of perceived social support. Finally, depression was linked to both Internet use for information seeking and Internet use for counseling and reducing negative emotions. The results of this study suggest that pregnant women with fearful attachment use the Internet to search for information related to pregnancy. This use could be explained by the fact that the fearful attachment is often associated with a higher level of stress. The need for reinsurance could then result in a multiplication of sources of information to handle the issues raised by pregnancy. The link between the level of depression and the use of the Internet to reduce negative affects suggests that the Internet can be perceived as a source of support by expectant mothers. However, the link between the level of depression and the use of the Internet for information seeking questions about the effects of this use. Indeed, the information and testimonies collected on the Internet could also lead to depressive symptomatology in future mothers. [ABSTRACT FROM AUTHOR]

Les symptômes dépressifs concernent 10 à 15 % des femmes enceintes, avec un pic de fréquence au cours des deuxième et troisième trimestres de la grossesse. Une augmentation du risque de survenue de troubles psychiques, en particulier de l'humeur, est également observée dans les mois suivant la naissance de l'enfant. Le pharmacien d'officine doit être capable d'aborder la problématique avec la patiente et de lui apporter le soutien approprié. Depressive symptoms occur in 10–15% of pregnant women, with a peak in frequency in the second and third trimesters of pregnancy. An increase in the risk of psychiatric disorders, particularly mood disorders, is also observed in the months following the birth of the child. The dispensing pharmacist must be able to discuss the problem with the patient and provide appropriate support. [ABSTRACT FROM AUTHOR]

Les kystes paratubaires sont des lésions fréquentes, qui peuvent

La torsion de l´ovaire est une complication grave et constitue une urgence chirurgicale. Nous rapportons le cas d´une patiente qui a développé une torsion de l´ovaire en cours de grossesse. L´objectif est de montrer les difficultés de diagnostic et de prise en charge précoce en milieu à faibles ressources. Le diagnostic erroné de départ et le transfert tardif de la patiente a conduit à une ovarectomie. La tocolyse préventive post-opératoire aux progestatifs et antiprostaglandines a permis de maintenir la grossesse.

INTRODUCTION: la survenue de grossesse au cours de l´hémodialyse chronique est rare. Néanmoins, avec l´évolution des techniques de dialyse, une amélioration de la fertilité est possible. Le but de notre travail est de rapporter notre expérience concernant la survenue d´une grossesse chez les patientes dialysées et de dégager les facteurs impliqués dans sa réussite. METHODES: notre étude rétrospective a porté sur 25 grossesses spontanées survenues chez 19 patientes traitées par hémodialyse périodique dans différents centres d´hémodialyse du sud tunisien sur une période de 34 ans. RESULTATS: l´âge maternel de survenue de grossesse était en moyenne égal à 35,6 ans [23-44ans] avec une ancienneté moyenne en hémodialyse de 4,22 ans [1-17 ans]. Sept patientes (37%) avaient une diurèse résiduelle (500 ml/24h). Le volume horaire hebdomadaire de dialyse était 16 heures par semaine dans 7 cas et 20 heures dans 4 cas. Le succès de la grossesse (nouveau-né survivant au moins 28 jours) était estimé à 56%. L´âge gestationnel médian était de 34 semaines d´aménorrhée [28-38 SA]. Le poids néonatal moyen est égal 1970g [1500g-2300g]. L´étude analytique a montré une corrélation significative entre l´augmentation des heures de dialyse par semaine et la réussite de la grossesse (R= 0,59; p= 0,002). CONCLUSION: on souligne qu´avec une prise en charge adéquate et notamment la majoration du nombre de séances de dialyse, les complications materno-foetales peuvent être minimisées et la balance risque bénéfice vire vers donner la chance à une femme dialysée de devenir maman.

L´éclampsie représente l´une des principales causes de décès maternels dans le monde. Notre objectif était de déterminer le pronostic maternel et périnatal de l´éclampsie à l´hôpital de Tombouctou, Mali. L´étude a été descriptive, rétrospective du 1er janvier 2013 au 31 décembre 2017, incluant les cas d´éclampsies survenues au cours de la grossesse ou l´accouchement à l´hôpital de Tombouctou. Nous avons retrouvé 116 cas sur 4951 accouchements soit un taux d´incidence de 2,3%. Il s´agissait essentiellement de femmes de moins de 26 ans (85,3%), primipare (81%), admise en moyenne 8 heures après la première crise. La césarienne était pratiquée dans 77,6% des cas. Le Sulfate de magnésium a été utilisé dans 75% des cas. Les létalités maternelle et périnatale étaient respectivement à 4,3% et 21,5%. Le facteur de mauvais pronostic maternel était un score Glasgow 8 à l´admission (p: 0,004). Les facteurs de mauvais pronostic périnatal étaient la résidence hors de la ville de Tombouctou (p: 0,000), l´absence de consultation prénatale (p: 0,020) et l´accouchement par voie basse (p: 0,012). Ainsi, l´amélioration du pronostic maternel et périnatal nécessite un suivi correct des grossesses, la réduction des retards dans l´accès à des soins adéquats.

Nous rapportons le cas d'une patiente enceinte de 33 semaines d´aménorrhée qui consulte en urgence pour un syndrome douloureux abdominal aigu avec vomissements, chez qui un examen obstétrical avait objectivé une mort fœtale in utéro. Le bilan biologique montrait un taux de lipasémie augmenté avec une hypertriglycéridémie majeure : triglycérides à 35 g/l. Une pancréatite aiguë gestationnelle secondaire à l´hypertriglycéridémie a été évoquée, confirmée par la réalisation d'un scanner abdominal. La patiente est adressée en service de réanimation médicale où une héparinothérapie ainsi qu´un régime hypolipidique ont permis une diminution rapide des triglycérides quelques jours après avec une normalisation du taux des enzymes pancréatiques. Un déclenchement artificiel du travail a permis une expulsion fœtale 2 jours après. Dans cette observation nous reprenons les données de la littérature sur la pancréatite aiguë gestationnelle secondaire à une hypertriglycéridémie majeure ainsi que les différentes thérapies réalisées.

Dans le but de décrire les particularités cliniques, biologiques, radiologiques thérapeutiques et évolutives de l´appendicite aigüe pendant la grossesse, nous avons mené une étude rétrospective portant sur 7 cas d´appendicite aigüe diagnostiqués et pris en charge au Service de Gynécologie-Obstétrique II du CHU Hassan II de Fès. L´appendicite aigüe représente 0,1% de l´ensemble des consultations et 1,2% des grossesses à risque dans notre service. L´âge moyen des patientes était de 24,4 ans avec des extrêmes de 19 et 34 ans. Sur le plan clinique l´appendicite s´est manifestée par une douleur de la fosse iliaque droite chez 6 patientes (85,7%), la fièvre chez 5 patientes (71,4%) avec un examen physique mettant en évidence une défense localisée et une sensibilité à la Fosse iliaque droite (FID). La Protéine C-réactive (CRP) était positive chez toutes les patientes et l´hyperleucocytose dans 57,7% des cas. L´échographie a été d´un grand apport dans le diagnostic. La prise en charge a été pluridisciplinaire et médico-chirurgicale. L´évolution postopératoire a été favorable dans la majorité des cas. Une seule patiente a fait un accouchement prématuré à 32 SA soit un mois après l´appendicectomie. L´appendicite aigüe chez la femme enceinte est une affection rare. Son diagnostic souvent difficile requiert une échographie abdominale faite par un opérateur entrainé. Le pronostic maternel et fœtal dépendant de la précocité de la prise en charge médico-chirurgicale.

Le prolapsus est un trouble fréquent de la statique pelvienne chez la femme ménopausée. Sa survenue au cours de la grossesse est exceptionnelle. Nous rapportons deux cas exceptionnels de prolapsus au cours de la grossesse. Cas 1: une multipare âgée de 27 ans, a été admise pour prise en charge d´un prolapsus stade 4 de la classification POP (pelvic organ prolapse) après un accouchement à terme, dystocique dans un hôpital régional. Une attitude conservatrice a été décidée. Le post-partum a été marqué par la régression spontanée du prolapsus en 15 jours. La patiente a été revue en consultation à 6 mois du post-partum, le prolapsus n´a pas récidivé. Cas2:une multipare âgée de 30 ans, a été admise pour une rupture prématurée des membranes sur une grossesse de 39 semaines d´aménorrhée. A l´examen clinique, on notait la présence d´un prolapsus stade 3 de POP. L´accouchement s´est effectué par voie basse avec travail harmonieux et naissance d´un nouveau-né de sexe féminin dont le poids de naissance était 3,3kg. Le prolapsus a régressé spontanément en 10 jours, et n´a pas récidivé après 6 mois de suivi.Le prolapsus pelvien durant la grossesse pourrait être transitoire, relevant d´une surveillance simple.

Le déficit en facteur V est une pathologie héréditaire à transmission autosomique récessive très rare de la coagulation. L'accouchement, le post-partum et la césarienne programmée à terme sont des situations à haut risque hémorragique. Le mode d'accouchement dépend des conditions obstétricales ainsi que les préférences des obstétriciens après une évaluation rigoureuse. Nous rapportons l'observation d'une parturiente âgée de 38 ans, suivie pour un déficit en facteur V et qui a eu une grossesse menée à terme. La prise en charge a consisté à un traitement substitutif basé sur la transfusion de 20ml/kg de plasma frais congelé avant l'accouchement, suivie de 5ml/kg par 24 heures pendant 3 jours en post-partum. Les suites de couches étaient normales sans aucune complication hémorragique.

INTRODUCTION: le paludisme est un problème de santé publique majeur, responsable de nombreuses complications durant la grossesse parmi lesquelles le retard de croissance intra utérin et les hypotrophies. L'objectif de ce travail était de déterminer l'effet du respect des 3 doses du traitement préventif intermittent (TPI) à la sulfadoxine-pyrimétamine (SP) sur le poids de naissance des nouveau-nés de la zone sanitaire Cotonou II et III.Méthodes: il s'agit d'une étude transversale qui a porté sur 630 femmes en période post partum résidant dans la zone sanitaire Cotonou II-III et sélectionnées par une technique de sondage à deux degrés. Les données ont été recueillies par un questionnaire et une fiche de dépouillement. Pour l'analyse, les données ont été pondérées et nous avons utilisé l'analyse de variance pour la comparaison des moyennes et une comparaison de proportions avec le test de chi² assorti d'une estimation de la force de l'association par l'odds ratio (OR) et son intervalle de confiance à 95%.Résultats: le respect des 3 doses du TPI à la SP était de 34,08% (IC95%: [24,84% - 43,30%]). On note un gain significatif de poids de naissance de 264,5g (p = 0,001) chez les mères qui avaient reçu plus de 3 doses de SP et la probabilité d'avoir un bébé ayant un faible poids de naissance était plus faible (OR = 0,45; p = 0,001) chez ces mères comparativement à celles qui avaient reçu moins de 3 doses de sulfadoxine-pyriméthamine.Conclusion: cette étude révèle une faible observance de la nouvelle politique à 3 doses du traitement préventif intermittent à la sulfadoxine-pyriméthamine dans la zone sanitaire de Cotonou II et III, mais elle témoigne de son potentiel de contribution à la réduction du risque de faible poids de naissance. Des stratégies doivent donc être mises en œuvre pour renforcer son application en vue de la prévention du paludisme et de ses conséquences pour les cibles vulnérables.

Une patiente diabétique de type 2 est encouragée à planifier sa grossesse. Il est primordial qu'elle bénéficie ensuite d'un suivi et d'un traitement adaptés, ainsi que d'une éducation thérapeutique. L'objectif de cette prise en charge optimale est d'éviter de potentielles complications graves, fœtales ou maternelles. Le pharmacien d'officine fait partie de ses interlocuteurs privilégiés. [ABSTRACT FROM AUTHOR]

Pre-pregnancy obesity and excessive gestational weight are modifiable risk factors, associated with adverse gestational and fetal outcomes, as well as adverse health outcomes in childhood. In this narrative review, we summarize main findings from epidemiological studies on the associations of maternal obesity and excessive weight gain during pregnancy with offspring outcomes in utero and in childhood. We expose the nutritional mechanisms involved in maternal obesity, as well as genetic and epigenetic effects underlying observed cardiometabolic outcomes. In particular, we explain how disentangling maternal and fetal genetic effects on birth weight, and report main findings on DNA methylation and other epigenetic modifications identified in the cord blood and placenta. Finally, we suggest some perspectives for future research to gain more insight in the biological processes involved in the fetal programming related to obesity. [ABSTRACT FROM AUTHOR]

Aim: The aim was to compare the maternal-fetal prognosis of pregnancies in large multiparous with that of other parities. Materials and Methods: We conducted a case-control study from March 1st, 2014 to February 1st, 2015. It concerned all parturients admitted in our service during the study period. We have chosen 1 case for 2 witnesses. All the large multiparous were included as cases and as witnesses the primiparous, the pauciparous and the multiparous who gave birth just before and after the case. The statistical test was the Chi2 with a significance level at 5%. Results: The frequency of pregnancy in the large multiparous was 4.93%. They were housewives in 84% of cases, unschooled in 74.7% of cases. The maternal-fetal outcome was dominated by uterine rupture in 0.6% of cases, immediate postpartum hemorrhage in 9.8% of cases, vicious presentations in 5.5% of cases and cord prolapse in 6.8% of cases. Conclusion: Large multiparity is common in our practice. It is a high-risk pregnancy because of its many maternal-fetal complications. [ABSTRACT FROM AUTHOR]

Le tabagisme pré- et post-natal a des conséquences sur le développement pulmonaire, modifie la réponse immunitaire et augmente la prévalence des bronchites sifflantes durant l'enfance. Les nouveau-nés exposés ont un risque d'altération de leur fonction respiratoire et d'augmentation des symptômes d'asthme. Récemment, les progrès de la génomique et de l'épigénétique ont mis en évidence des altérations de la méthylation de l'ADN pouvant expliquer des conséquences à long terme. Cette revue analyse l'influence du tabagisme passif sur l'augmentation des risques infectieux, la déviation de la réponse immunitaire vers un profil lymphocytaire de type TH2 et l'évolution vers un phénotype allergique des manifestations asthmatiques. Le tabagisme passif peut également contribuer au développement d'allergie alimentaire via la progression de la marche atopique, l'IPFT étant un risque avéré d'eczéma et d'asthme. Fumer pendant la grossesse est la cause la plus commune de morbidité et mortalité infantile que l'on peut prévenir. Il existe un faisceau d'argument qui montre que l'enfant peut aussi bénéficier pour sa santé de l'implantation d'une législation restreignant le tabagisme dans les lieux publics. Exposure to second-hand tobacco smoke (SHS) and nicotine during the prenatal and post-natal periods can impair lung development and immune response, and can increase the prevalence of wheezing during childhood. Exposed neonates are at greater risk for diminished lung function and increased asthma symptoms throughout childhood. Recently, genomic and epigenetic risk factors, such as impaired DNA methylation, have been identified that may affect the risk of long-term disease. In addition, this review examines the role of SHS during the prenatal and post-natal periods and its association with increased risk of infection, skewing of the immune response toward a T-helper type 2 bias, and increasing the risk of developing an allergic phenotype and asthma-like symptoms during childhood. Passive smoking may also contribute to the development of food hypersensitivity via progression of the atopic march since SHS is a known risk factor for asthma and eczema. Smoking during pregnancy is the most common preventable cause of infant morbidity and mortality. There is an increasing body of evidence showing that children also reap health benefits following the introduction of legislation to restrict smoking in public places. [ABSTRACT FROM AUTHOR]

The fear of childbirth (FOC) and antenatal and parenthood education (APE) sessions were evaluated in pregnant women. One hundred and twenty women were included and 40 of them participated in APE sessions. The FOC assessment scale (EPA) was used. The average EPA score is 43.21. This score is significantly higher in primiparas (P = 0.043) rather than in multiparas. During the prenatal period, the 3rd trimester is the period where FOC score is significantly the highest (P = 0.02). Participating the APE sessions did not significantly reduce the level of FOC estimated with EPA. Perspectives between the FOC and perinatal stress are discussed. [ABSTRACT FROM AUTHOR]

Introduction: the purpose of this study was to determine the frequency and to evaluate maternal and perinatal prognosis during pregnancy and childbirth among married child students in the city of Niamey. Methods: we conducted a case-control study of gestants and parturients at the Issaka Gazobi Maternity Hospital in Niamey over the period January 2018-December 31, 2018. Child students (<18 years) were compared to students aged 18-27 years. Maternal sociodemographic parameters and maternal and perinatal mortality were analyzed. The usual statistics and logistic regression were used to analyze the results. The significance level was set at p <0.05. Results: the frequency of delivery among child students was 3.06%. Minors attended prenatal follow-up (46.7% vs 41.9%) more diligently than adults. Cesarean section (ORa=2 [1.0-3.0]) eclampsia (ORa=2 [1.0-4.4]), episiotomy (ORa=2[1.2-1.8]) and neonatal depression (p <0.05 (10.6% vs 5.8%)) were higher among minors than among adults. Perinatal mortality was high in both groups. Conclusion: our results are close to those described in other European and African studies. The differences in obstetric and perinatal risks seem to be related to socio-demographic factors of child mothers. These should be taken into account in any approach to the prevention of pregnancy complications in minors. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Sante Mentale au Quebec is the property of Revue Sante Mentale au Quebec and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Peu de recherches ont étudié la façon dont les couples se préparent à devenir parents dans le contexte d'un don d'ovocytes, et aucune étude ne s'est centrée sur le vécu des hommes. Il s'agit de s'intéresser aux particularités éventuelles introduites par le don d'ovocytes au sein des remaniements psychiques à l'œuvre chez les femmes et les hommes avant et pendant la grossesse. À 7–8 mois de grossesse, des entretiens s'inspirant de l'interview pour les représentations maternelles et paternelles pendant la grossesse ont été proposés à dix femmes infertiles et huit hommes, rencontrés séparément. Avant et pendant la grossesse, les femmes et les hommes s'engagent de façon variable dans un processus d'élaboration des implications liées au recours à une donneuse et à l'introduction d'une asymétrie au sein du couple sur le plan de la filiation génétique. Selon les sujets, la minimisation du rôle de la donneuse et de l'importance de la filiation génétique dans la conception de leur enfant est plus ou moins efficace pour mettre à distance la déception et les angoisses associées au don d'ovocytes. Il est nécessaire d'accorder une attention particulière au vécu des femmes, mais aussi à celui des hommes, lors des entretiens médicaux et de l'entretien psychologique obligatoire préalables au don d'ovocytes, ainsi que lors de la période périnatale. Few studies have investigated how couples prepare to become parents after receiving an oocyte donation, and no study has specifically focused on men's experiences. To interest in the possible special features introduced by the oocyte donation within the psychic rearrangements that are taking place within women and men before and during the pregnancy. At 7–8 months of pregnancy, interviews inspired by the interview for maternal and paternal representations during pregnancy were proposed to ten infertile women and eight men, met separately. Before and during pregnancy, women and men were variably engaged in an elaboration process of the implications of using a donor and introducing asymmetry in terms of genetic filiation within the couple. According to the individual, minimizing the donor's role and the importance of genetic filiation in their child's conception is more or less effective in keeping at distance the disappointment and anxieties associated with oocyte donation. It is necessary to pay attention to both the woman's and the man's experience during medical interviews and the obligatory psychological interview prior to oocyte donation as well as during the perinatal period. [ABSTRACT FROM AUTHOR]

From the implementation of a psychoanalytic device applied to the therapy in a hospital and through research in psychoanalysis, this paper examines the parental psychic ties and the enigmas that are established within those involved around the birth of a child or during pregnancy. At the same time, it describes the clinical device of accompaniment during conflictive situations in such hospital passage, contributing to the elaboration of the psychic manifestations associated with painful organic processes. The psychoanalytically documented casuistry on the trinomial –a form of denomination to the group formed by the newborn and their primary and secondary caretakers– in its journey with the hospital agents shows that parentality can be read from the psychic marks generated from the real order. [ABSTRACT FROM AUTHOR]