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Objectives:The presenting symptoms of leiomyosarcoma (LMS) are the same as those of leiomyoma. The diagnosis of LMS is usually achieved retrospectively after pathological analysis of hysterectomy specimens. The aim of surgery in uterine sarcomas being resection without tumor morcellation, LMS poses the problem of the choice of surgical route because it is more likely to occur in relatively young women. This study was undertaken to determine, firstly, the frequency of LMS in a series of hysterectomies performed for presumed leiomyomas, secondly, if there exist any particular context in which LMS should be considered and how this may modify the choice of surgical route, thirdly, to discuss about the therapeutical aspects of those cases of LMS diagnosed incidentally after uterine morcellation. Patients and methods: A retrospective review, from 1996 to 2005, of cases of LMS diagnosed retrospectively in patients having benefited from hysterectomy for presumed leiomyomas, at the department of Obstetrics-Gynaecology, Belfort Hospital. Results: From 1996 to 2005, 1297 hysterectomies have been performed for presumed leiomyomas in our department. Patients’ mean age was 48 years (34 to 77 years). Menometrorraghia was the most common symptom having motivated surgery (57%), followed by pelvic pain (31%) and the notion of a rapidly growing uterine mass (12%). The distribution of surgical route was as follows: laparotomic route, n =393 (30%); vaginal route, n =855 (66%) and laparoscopic assisted vaginal route, n =49 (4%). Pathological analysis had revealed LMS in three patients (0.23%). Discussion and conclusion: LMS is usually diagnosed incidentally on hysterectomy specimen analysis. Indeed, the surgeon may find himself in a therapeutic dilemma in cases where vaginal extraction has required tumor morcellation with an increased risk of peritoneal and/or vaginal dissemination. However, given the extremely low incidence of LMS in series of hysterectomies performed for presumed leiomyomas and the lack of specific preoperative context to clearly evoke this diagnosis, the fear of leiomyosarcoma should not make us apprehend nonlaparotomic surgical routes. [Copyright &y& Elsevier]

Abstract: The study was aimed to evaluate the feasibility of detecting human papillomavirus (HPV) in women with normal or abnormal cervical smears using the Roche Amplicor MWP HPV Test. We compared by AMPLICOR® Test and Hybrid Capture II® (HCII®) Test, the prevalence of HR-HPV in 470 cervical samples including 55 samples with WNL cytology, 208 ASC-US, 193 LGSIL and 14 HGSIL. Samples with discordant results were retested with INNO-LiPA Genotyping HPV Test v2. The HR-HPV positivity in WNL cytology samples was similar (21.8%) by AMPLICOR® and HCII®. In ASC-US, the HPV positivity was 42.3% by both tests. In LGSIL, HPV positivity was 66.3% and 66.8% by AMPLICOR® and HCII®, respectively. In HGSIL, 92.8% of samples were positive by AMPLICOR® and 85.7% by HCII®. The agreement of both tests was 96.2% with a Kappa value of 0.92. Eighteen cases were discordant: 9 HCII® positive/AMPLICOR® negative and 9 HCII® negative/AMPLICOR® positive. The INNO-LiPA test revealed HPV positivity in every case. Interestingly, all HCII®+/AMPLICOR®− samples were found to harbour HPV53. As for the HCII®−/AMPLICOR®+ samples, 8 demonstrated a multiple infection with HR 16- and/or 18- and/or 56-phylogenetically related HPV types. Moreover, two of these samples were co-infected with HPV6 and two other with HPV54. By using consensus HR-HPV as our reference HPV positivity, the sensitivity (96.6%) and specificity (100%) of AMPLICOR® was similar to that of HCII® Test. The AMPLICOR® HPV Test is sensitive, specific, feasible and appropriate for routine HPV detection. [Copyright &y& Elsevier]

The article presents a case study of a 30-year-old woman, who was referred for a second-trimester ultrasound examination. The patient had undergone medical termination of pregnancy at 26 weeks of amenorrhea for pulmonary agenesis, but there was no further relevant family history and no consanguinity with her husband.

Introduction La conférence internationale de Sydney en 2006 [1] , a établi une définition clinique et biologique du syndrome des antiphospholipides (SAPL). Les 3 anticorps antiphospholipides (aPL) retenus dans la définition sont l’anticoagulant lupique, l’anticardiolipine et l’antiβ2-glycoprotéine I. Dans la littérature, d’autres cibles antigéniques ont été associées aux manifestations du SAPL parmi lesquels l’annexine V, le groupe des phospholipides anioniques et neutres et la prothrombine. Nous proposons dans cette étude de comparer deux populations de femmes enceintes : celles porteuses d’aPLs identifiés « non pathogènes » et celles porteuses d’aPLs « pathogènes » (aPLs correspondants aux critères de Sydney). Patients et méthodes Il s’agit d’une étude rétrospective réalisée entre 2006 et 2013 au CHRU. Les femmes inclues dans l’étude étaient âgées de 15 à 45 ans et ont mené une grossesse alors que leur statut anti-phospholipides était déjà connu. Les données recueillies ont concerné, les éléments démographiques, les traitements prophylactiques proposés, le terme atteint par la grossesse, l’issue néonatale et les complications obstétricales. Résultats Quatre-vingt-onze dossiers ont été identifiés. La population était composée de 44 femmes (âge moyen de 30,55 ans ± 5,49) dans le groupe 1 (femmes porteuses d’un antiphospholipide non pathogène) et de 47 femmes (âge moyen 30,93 ans ± 4,9) dans le groupe 2 (femmes porteuses d’un antiphospholipide pathogène). Au terme de cette étude, aucune différence de prise en charge médicamenteuse du SAPL n’a été constatée entre les deux groupes étudiés : le traitement de première ligne c’est-à-dire l’association aspirine et héparine de bas poids moléculaire (HBPM) a été administré aux deux groupes sans différence de taux de prescription ( p = 0,22 pour l’aspirine, p = 0,52 pour le HBPM à doses préventive et 0,17 pour les HBPM à dose curative). L’aspirine a été prescrite aux mêmes doses ( p = 0,65). D’autre part, aucune différence de résultat n’a été montrée que ce soit pour les complications obstétricales (RCIU, perte fœtale, éclampsie et HELLP syndrome), l’accouchement (terme, instrumentalisation, etc.) ou l’issue néonatale (poids, taille, périmètre crânien et APGAR). Discussion Certaines publications ont fait état d’un lien entre plusieurs anticorps antiphospholipides non pathogènes et les formes obstétricales du SAPL [1,2] . Cependant, aucune publication ou conférence de consensus n’a proposé une analogie de traitement avec celui des SAPL « classiques ». L’évaluation des pratiques au CHRU montrerait que les praticiens ont tendance à traiter par précaution en présence d’une antériorité obstétricale et d’une sérologie antiphospholipides positive quel que soit le type d’anticorps identifié. Conclusion D’un point de vue statistique, l’issue materno-fœtale est équivalente entre les deux groupes étudiés mais sans pouvoir prouver que cela est dû à l’égalité de traitement. Il serait utile de déterminer par la suite, grâce à une étude prospective, la nécessité de traiter de la même manière les femmes porteuses d’aPLs non pathogènes que celles porteuses d’aPLs reconnus pathogènes dans la définition inte [ABSTRACT FROM AUTHOR]

TRAP sequence is a rare and severe complication of monozygotic pregnancies. We present the case of a 35 years old woman, diagnosed with a TRAP sequence for her second pregnancy, whose delivery was complicated of a severe hemorrhage from an unknown placenta accreta, making a hysterectomy necessary. If abnormal placentation is more frequent in multiple pregnancies, the physiopathology of TRAP sequence could explain the association with accreta placentation. One should keep in mind that a rare pathology can hide another., 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 Elsevier B.V. All rights reserved.)

The natural history of cervical cancer is closely linked to that of high-risk human papillomaviruses (HPV) infection. It is recognized that upon HPV DNA integration, partial or complete loss of the E2 open reading frame precludes expression of the corresponding protein, resulting in upregulation of the E6 and E7 viral oncoproteins. To better characterize HPV16 infection at the cervical level, viral load, viral DNA integration, and viral early transcript expression (E2, E5, and E6) were analyzed in a series of 158 cervical specimens representative of the full spectrum of cervical disease. Overall, the frequency of early transcript detection varied from 45% to 90% and tended to increase with lesion severity. In addition, the levels of E2, E5, and E6 transcript expression were slightly higher in high-grade lesions than in cervical specimens without abnormalities. Notably, early transcript expression was clearly associated with viral load, and no inverse correlation was found between the expression of E2 and E6 transcripts. No clear association was found between early transcript expression and HPV16 DNA integration, with the exception that samples with a fully integrated HPV16 genome did not harbor E2 or E5 transcripts. In conclusion, early HPV16 transcript expression appears to be associated with viral load rather than lesion grade. From a practical point of view, quantification of HPV16 early transcripts is difficult to translate into a relevant biomarker for cervical cancer screening., (© 2024 Wiley Periodicals LLC.)

Background and Objectives: Aneurysmal surgery is technically complex, and surgeon experience is an important factor in therapeutic success, but training young vascular neurosurgeons has become a complex paradigm. Despite new technologies and simulation models, cadaveric studies still offer an incomparable training tool with perfect anatomic accuracy, especially in neurosurgery. The use of human placenta for learning and improving microsurgical skills has been previously described. In this article, we present a comprehensive simulation model with both realistic craniotomy exposure and vascular handling consisting of a previously prepared and perfused human placenta encased in a human cadaveric specimen., Methods: Humans' placentas from the maternity and cadaveric heads from the body donation program of the anatomy laboratory were used. Placentas were prepared according to the established protocol, and aneurysms were created by catheterization of a placental artery. Ten participants, including senior residents or young attendees, completed an evaluation questionnaire after completing the simulation of conventional unruptured middle artery aneurysm clipping surgery from opening to closure., Results: The skin incision, muscle dissection, and craniotomy were assessed as very similar to reality. Brain tissue emulation and dissection of the lateral fissure were judged to be less realistic. Vascular management was evaluated as similar to reality as closure. Participants uniformly agreed that this method could be implemented as a standard part of their training., Conclusion: This model could provide a good model for unruptured aneurysm clipping training., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Introduction: Acute fetal leukemia is rare and characterized by a very poor prognosis. The aims of this study were to identify cases of acute fetal leukemia and to describe ultrasound and fetopathological findings that should lead to a suspicion of this diagnosis, as well as the investigations required to confirm it., Methods: A national retrospective study was conducted. Clinical data, prenatal ultrasounds and postmortem findings of fetal acute leukemia cases were collected and analyzed., Results: We collected seven cases: four in utero fetal deaths, two neonatal deaths and one termination of pregnancy. Prenatal ultrasounds showed fetal hydrops (42.9%) associated with hepatosplenomegaly (100%). In addition, post-mortem examination (n = 6) suggested a Down syndrome in one case and showed other organomegaly (83.3%) due to blastic infiltration, mainly in the liver, along with extrahepatic multivisceral hematopoiesis. Immunostainings allowed to specify the type of leukemia (71.4%). In one case, diagnosis was made on blood smear and flow cytometry was performed on fresh blood samples. All cases corresponded to acute myeloid leukemia. Karyotype was abnormal in 4 cases (66.7%), including one free trisomy 21, two mosaic trisomy 21 and one chromosome 15 deletion. GATA1 gene mutations were identified in two cases: one mosaic trisomy 21 and one with normal karyotype., Conclusion: Any hepatosplenomegaly associated with fetal hydrops and a negative immune, infectious, and metabolic work-up, should suggest acute fetal leukemia and prompt additional investigations., (© 2024 John Wiley & Sons Ltd.)

Background: Instrumental vaginal birth, a very common intervention in obstetrics, concerns nearly one in eight women in France. Instrumentally assisted vaginal childbirth can be for maternal and/or fetal indications. Although it reduces recourse to caesarean section, it is subject to risks. Practices concerning instrumental birth are disparate, varying among different practitioners, maternity units and countries, and it is essential to be able to evaluate them. Our objective was to create a classification tool of women requiring instrumental birth to facilitate the analysis of practices within our maternity unit as well as to enable temporal and geographical comparisons., Materials and Methods: We propose a simple and robust classification based on the same principles as Robson's classification. It is made up of seven totally inclusive and mutually exclusive groups. Our classification was refined and validated using the Delphi method by a panel of 14 experts from throughout France, and tested in our maternity unit using data from throughout 2021., Results: The seven clinically relevant groups are based on five obstetric criteria (multiplicity, presentation, gestational age, previous type of birth, induction of labor). To classify each woman in a group, five successive questions are posed in a predefined order. The classification has been validated by the experts with highly satisfactory overall agreement., Conclusion: In order to improve the quality of care, we propose a tool to standardize the evaluation of instrumental vaginal birth practice (called the "Isère classification", after the county where we work in south-eastern France). It will also facilitate the comparison the practices among different maternity units in a network, a country or even among different countries., (© 2024. The Author(s).)

Background: The first feasibility study of the OdonAssist inflatable device for use in clinically indicated assisted vaginal birth reported a success rate of 48% with no significant safety concerns. Additional studies exploring the device performance in other clinical settings are warranted before definitive conclusions can be drawn about its safety and efficacy in current practice., Objective: This study aimed to investigate the safety and efficacy of the OdonAssist before conducting a randomized controlled trial., Study Design: This was an open-label, nonrandomized study of 104 women with a clinically indicated assisted vaginal birth using the OdonAssist at the Besancon University Hospital, France. Data, including those of a nested cohort group of women who had an assisted vaginal birth using vacuum or spatulas because a trained OdonAssist device operator was not available at the time of delivery, were collected. The primary outcome measure was the proportion of successful assisted vaginal births using the OdonAssist. Neonatal outcome data were reviewed at days 1 and 28, and maternal outcomes were investigated up to day 90., Results: Between December 2019 and May 2021, 2191 pregnant women were approached, and 83% (1636/1973) of them consented to participate in the study. Among them, 10.7% (176/1636) required an assisted vaginal birth owing to a vertex presentation at +1 and below. The OdonAssist was used in 59% of births (104/176), and 41.1% (72/176) of the participants were included in the nested cohort group. The rate of successful assisted vaginal births using the OdonAssist was 88.5% (92/104). No emergency cesarean deliveries were performed in the OdonAssist group. There were no serious adverse maternal or neonatal reactions related to the use of the device. The rate of third- and fourth-degree perineal tears with the OdonAssist was 3.8% (4/104). The maternal perception ratings of the birth experience with the OdonAssist (collected on days 1, 7, and 28 using a 15-point scale) were high. In addition, the operators reported a positive perception of the device, with ease of use across the different steps of the procedure. One single technique was used for all vertex fetal head positions., Conclusion: The OdonAssist is a safe and effective alternative to other current devices for assisted vaginal births. The high acceptance rate (83%) among pregnant women and the high rate of successful assisted vaginal births using the OdonAssist confirm the feasibility of a future randomized controlled trial., (Crown Copyright © 2023. Published by Elsevier Inc. All rights reserved.)

To quantify transplacental transmission of SARS-CoV-2 virus and antibody transfer in pregnant women and their newborns according to the gestational age at maternal infection. A prospective observational multicenter study including pregnant women with a positive RT-PCR or a positive serology for SARS-CoV-2 and compatible symptoms, from April to December 2020, in 11 French maternities. The study was designed to obtain a systematic collection of mother-infant dyad's samples at birth. SARS-CoV-2 viral load was measured by RT-PCR. IgG and IgM antibodies against the SARS-CoV-2 spike protein were measured by enzyme-linked immunosorbent assay. Antibody concentrations and transplacental transfer ratios were analyzed according to the gestational age at maternal infection. The primary outcome was the rate of SARS CoV-2 materno-fetal transmission at birth. The secondary outcome was the quantification of materno-fetal antibody transfer. Maternal and neonatal outcomes at birth were additionally assessed. Among 165 dyads enrolled, one congenital infection was confirmed {n = 1 (0.63%) IC 95% [0.02%; 3.48%]}. The average placental IgG antibody transfer ratio was 1.27 (IC 95% [0.69-2.89]). The transfer ratio increased with increasing time between the onset of maternal infection and delivery (P Value = 0.0001). Maternal and neonatal outcomes were reassuring. We confirmed the very low rate of SARS-CoV-2 transplacental transmission (< 1%). Maternal antibody transfer to the fetus was more efficient when the infection occurred during the first and second trimester of pregnancy., (© 2024. The Author(s).)

Background: The objective of this study was to assess the preliminary efficacy and safety of conservative management compared with systematic suture in isolated vaginal or first-degree perineal tears after birth., Methods: We conducted a preliminary efficacy, open-label, randomized, controlled, and prospective trial. This study implemented Simon's 2-step plan (interim analysis and final analysis) to test the success rate of the digital compression strategy group. Primiparous women aged ≥18 years with isolated vaginal or first-degree perineal tears after spontaneous vaginal birth of a cephalic presenting term (≥37 weeks) neonate were randomly allocated to the conservative management (CM) group (digital compression if bleeding followed by suture if persistent bleeding) or a systematic suture (SS) group. The primary outcome was the success of the intervention 10 days after delivery, defined by pain as evaluated using a visual analog scale < 3, satisfactory healing defined by a REEDA score ≤ 2, and no bleeding or infection. Sexual well-being was assessed at 2 and 6 months postpartum., Results: Among 861/2209 eligible women, 143 consenting women with a superficial perineal tear were randomized: 72 in the systematic suture group and 71 in the conservative management group. Success rate was 87.8% (90% CI [70.5-93.54]) (42/55) in the systematic suture group vs 90% (90% CI [78.3-93.8]) (53/61) in the conservative management group. The REEDA score was significantly higher in the systematic suture group (1.4 vs 0.9; P = 0.036). Perineal pain was significantly higher at day 1 in the systematic suture group (2.38 vs 1.69; P = 0.034). For the Female Sexual Functional Index score, no significant difference was found between the two groups at inclusion or at 2 and 6 months postpartum., Conclusions: Conservative management of superficial perineal tears shows an efficacy rate ≥90%. Women in the conservative management group had less pain at the 1st day follow-up and lower REEDA scores at the 10th day follow-up., (© 2022 Wiley Periodicals LLC.)

Misinformation regarding HPV vaccine safety and benefits has resulted in low coverage within the eligible French population. HPV vaccination is safe and efficacious in preventing HPV infections in adolescents. However, reaching optimal coverage in countries such as France is challenging due to misinformation, among other factors. Moreover, disparities exist in cervical cancer screening programs. To support the government health promotion policy aimed at improving prevention and control of HPV-related cancers in France, the Human Papillomavirus Prevention and Control Board (HPV-PCB), in collaboration with local experts, held a meeting in Annecy, France (December 2021).HPV-PCB is an independent, multidisciplinary board of international experts that disseminates relevant information on HPV to a broad array of stakeholders and provides guidance on strategic, technical and policy issues in the implementation of HPV control programs.After a one-and-a-half-day meeting, participants concluded that multi-pronged strategies are required to expand vaccination coverage and screening. Vaccine acceptance could be improved by: 1) strenghtening existing trust in clinicians by continuous training of current and upcoming/pre-service healthcare professionals (HCPs), 2) improving health literacy among adolescents and the public through school and social media platforms, and 3) providing full reimbursement of the gender-neutral HPV vaccine, as a strong signal that this vaccination is essential.The discussions on HPV infections control focused on the need to: 1) encourage HCPs to facilitate patient data collection to support performance assessment of the national cervical cancer screening program, 2) advance the transition from cytology to HPV-based screening, 3) improve cancer prevention training and awareness for all HCPs involved in screening, including midwives, 4) identifying patient barriers to invitation acceptance, and 5) promoting urine or vaginal self-sampling screening techniques to improve acceptability, while establishing appropriate follow-up strategies for HPV-positive women. This report covers some critical findings, key challenges, and future steps to improve the status of HPV prevention and control measures in the country., (© 2023. The Author(s).)

Objective: In France, C-sections are classified through a color code according to their degree of urgency. A red-classified C-section is triggered when life of mother or fetus is immediately threatened These cases happen very rarely and represent less than 1% of total deliveries. Many French maternity hospitals are above this rate. This risky procedure should remain an exception. The main purpose of this study is to develop a new tool enabling to determine the relevance of red C-sections in order to improve obstetrical practices., Methods: Eleven national obstetrical experts were submitted with relevant-estimated indications of red C-sections. A two-round Delphi methodology was then used to reach a consensus on a new table of relevance., Results: Five different groups of indications were proposed to the panel of experts. After two rounds, four groups achieved a consensus by being qualified "very relevant" or "relevant" by more than 80% of the 11 experts., Conclusion: The aim of this new consensual table of relevance is to improve quality of care. It allows to evaluate the relevance of red C-sections and determine when red C-sections are non-relevant but it particularly helps teams to identify ways of improvements. Finally, this tool enables a reproductible analysis that can be further intra- or inter-hospitals developed towards harmonization of practices., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

The idea of using an instrument to assist natural childbirth is not new and it was in the 18th and 19th centuries that the forceps was developed. It is only after the Second World War that the suction cup provides an alternative to instrumental childbirth, but still based on prehension and traction. In 1950, Emile Thierry, in France, presented his spatulas based on the then original principle of propulsion. The diffusion of spatulas is almost non-existent in the Anglo-Saxon world but is not limited to France since its use was real by the Iberians and Latin Americans. There are currently three types of spatula, two of which are French and one Colombian. This review takes up the saga of this instrument for more than 70 years, develops its particularities and describes the present literature., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Background: During the second stage of labor, in case of a need for a fetal extraction at midcavity, the choice of attempting the procedure between operative vaginal delivery and cesarean delivery is difficult. Moreover, guidelines on this subject are not clear., Objective: This study aimed to identify antenatal and intrapartum parameters associated with a failed midcavity vacuum-assisted delivery and its association with maternal and neonatal adverse outcomes., Study Design: This was a single-center, retrospective, cohort study conducted at a tertiary maternity hospital in France from January 2010 to December 2020. Women with singleton pregnancies under epidural analgesia with nonanomalous cephalic presenting fetuses and gestational ages at ≥37 weeks of gestation, who were submitted to midcavity vacuum-assisted delivery, were included. Following the American College of Obstetricians and Gynecologists definition, midcavity was defined as the presenting part of the fetus (ie, the fetal head) found at stations 0 and +1. For research purposes, all patients were submitted to transperineal ultrasound to evaluate the head-to-perineum distance, however, this measurement did not affect the decision to perform a midcavity vacuum-assisted delivery. The primary outcome of the study was failed midcavity vacuum-assisted delivery leading to cesarean delivery or the use of a different instrument to achieve vaginal delivery., Results: Overall, 951 cases of midcavity vacuum-assisted delivery were included in this study. Failed midcavity vacuum-assisted delivery occurred in 242 patients (25.4%). Factors independently associated with failed midcavity vacuum-assisted delivery included maternal height (adjusted odds ratio, 0.96; 95% confidence interval, 0.94-0.99; P=.002), duration of the active phase of the first stage of labor (adjusted odds ratio, 1.11; 95% confidence interval, 1.05-1.17; P<.001), nonocciput anterior fetal head position (adjusted odds ratio, 1.47; 95% confidence interval, 1.06-2.04; P=.02), z score of the head-to-perineum distance (adjusted odds ratio, 1.23; 95% confidence interval, 1.05-1.43; P=.01), and birthweight of >4000 g (adjusted odds ratio, 2.04; 95% confidence interval, 1.28-3.26; P=.003). Women submitted to a failed midcavity vacuum-assisted delivery were more likely to have a major postpartum hemorrhage (7.1% vs 2.0%; P<.001), whereas neonates were more likely to have an umbilical artery pH of <7.1 (30.5% vs 19.8%; P=.001), be admitted to the neonatal intensive care unit (9.6% vs 4.7%; P=.005), and have a severe caput succedaneum (14.9% vs 0.7%; P<.001). Subgroup analysis on all patients with a fetal head station of 0 found that the head-to-perineum distance was the only independent variable associated with failed midcavity vacuum-assisted delivery (adjusted odds ratio, 1.66; 95% confidence interval, 1.29-2.12; P<.001). The area under the receiving operating characteristic curve of the head-to-perineum distance in this subgroup population was 0.67 (95% confidence interval, 0.60-0.73; P<.001), and the optimal cutoff point of the head-to-perineum distance measurement discriminating between failed and successful midcavity vacuum-assisted deliveries was 55 mm. It was associated with a 0.90 (95% confidence interval, 0.83-0.95) sensitivity, 0.19 (95% confidence interval, 0.14-0.25) specificity, 0.36 (95% confidence interval, 0.30-0.42) positive predictive value, and 0.80 (95% confidence interval, 0.66-0.90) negative predictive value., Conclusion: Study data showed that a high fetal head station, measured using the head-to-perineum distance, and a nonocciput anterior position of the fetal head are independently associated with failed midcavity vacuum-assisted delivery. The result supported the systematic assessment of the sonographic head station and position before performing a midcavity vacuum-assisted delivery., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The Odon Device TM is an innovative investigational device for assisted vaginal birth (AVB) and has not yet been granted regulatory approval for sale in any country. It is the first innovation in AVB since the introduction of the vacuum extractor in the 1950's and the device is designed for use by different level of trained health care providers. Efficacy studies are presently in progress in two centers: The ASSIST II Study, Bristol, England, and The BESANCON ASSIST Study, Besançon, France. The device consists of an applicator, sleeve and cuff. This original paper illustrates the operating process in real conditions.

Human papillomavirus (HPV) 16 exhibits different variants that may differ in their carcinogenic risk. To identify some high-risk variants, we sequenced and compared HPV16 whole genomes obtained from a longitudinal cohort of 34 HPV16-infected women who had either spontaneously cleared their infection (clearance group or "C"), or developed cervical high-grade lesions following a viral persistence (group persistence or "P"). Phylogenetic analysis of paired samples obtained at the beginning (C0 or P0) and at the end (C2 or P2) of the follow-up (median intervals between C0-C2 and between P0-P2 were 16 and 36.5 months, respectively) revealed a low genetic variability within the host compared to the genetic interhost diversity. By comparing our HPV16 sequences to a reference sequence, we observed 301 different substitutions, more often transitions (60.9%) than transversions (39.1%), that occurred throughout the viral genome, but with a low frequency in E6 and E7 oncogenes (10 and 9 substitutions), suggesting a high conservation of these genes. Deletions and insertions were mostly observed in intergenic regions of the virus. The only significant substitution found between the subgroups C2 and P2 was observed in the L2 gene (L330F), with an unclear biological relevance. Our results suggest a low longitudinal intrahost evolution of HPV16 sequences and no correlation between genetic variations and clinical evolution., (© 2022 Wiley Periodicals LLC.)

Purpose: To evaluate the effectiveness and safety of temporary proximal uterine artery embolization (UAE) for the treatment of highly vascularized retained products of conception (RPOCs)., Materials and Methods: This retrospective analysis included women who underwent treatment for vaginal bleeding after abortion, miscarriage, or delivery, with highly vascularized RPOCs detected by Doppler ultrasound (US) (ie, presence of an enhanced myometrial vascularity, a low resistance index of <0.5, and a peak systolic velocity of ≥0.7 m/s). A unilateral or bilateral embolization with torpedoes of gelatin foam was performed. From November 2017 to January 2021, 24 women with a median age of 30 years (interquartile range, 26.0-34.5 years) with symptomatic highly vascularized RPOCs were included. Clinical success was defined as bleeding arrest between the UAE and 1-month follow-up. Technical success was defined as the complete obstruction of at least 1 uterine artery supplying vascular abnormalities. The safety of the procedure according to the classification of the Society of Interventional Radiology and evolution of lesions on US were also reported., Results: Technical success was achieved in all 24 (100%) patients, with bilateral arterial embolization in 19 (79%) patients and unilateral embolization in 5 (21%) patients. Clinical success was achieved in all 24 (100%) patients. Five patients still had uterine retention at the 1-month follow-up, including 2 patients with highly vascularized RPOCs. Two patients benefited from hysteroscopy, and 3 had noninvasive management. Four minor adverse events were reported (1 patient had infectious endometritis and 3 patients had a postembolization syndrome)., Conclusions: Proximal UAE with torpedoes of gelatin foam is safe and effective for the management of symptomatic highly vascularized RPOCs., (Copyright © 2022 SIR. Published by Elsevier Inc. All rights reserved.)

Background: Fetal cardiac well-being is essential during labor as the delivery is at risk for fetal distress. Continuous monitoring by cardiotocography (CTG) is daily used to record the fetal heart rate (FHR) but this technique has important drawbacks in clinical use., Objectives: We propose to monitor FHR with a non-invasive technique, using multimodal recordings of the fetus cardiac activity, associating electrocardiographic (ECG) and phonocardiographic (PCG) sensors. The aim of this study is to evaluate the quality of these multimodal FHR estimations by comparison with CTG, based on clinical criteria., Methods: A clinical protocol was established and a prospective open label study was carried out in the University Hospital of Grenoble. The objective was to record thoracic and abdominal PCG and ECG signals on pregnant women over 37 WG (weeks of gestation), simultaneously with CTG recordings. Adapted signal processing algorithms were then applied on abdominal PCG and ECG signals to extract FHR. Quantitative evaluation was carried out on FHR estimations compared with FHR extracted from CTG., Results: A total of 40 recordings were performed. Due to technical mistakes the analysis was made possible for 38. 35 recordings allowed a FHR follow-up by ECG or PCG, 30 recordings allowed a FHR follow-up by PCG only, 25 recordings allowed a FHR follow-up by ECG only and 20 recordings allowed a FHR follow-up by both ECG and PCG., Conclusion: Reliable multimodal recording of FHR associating ECG and PCG sensors is possible during the last month of pregnancy. These positive results encourage the study of multimodal FHR recording during labor and delivery., (Copyright © 2022. Published by Elsevier Masson SAS.)

Objective: To analyse the introduction of the Couder manoeuvre in our level 3 maternity unit shortly after its introduction in 2019. Then, to evaluate and compare the rate of perineal injuries between 2017, when the manoeuvre was not performed at all, and 2020., Materials and Method: A single-centre retrospective study of patients who delivered a singleton eutociously at term from 1 January to 31 December 2017 and 2020., Results: In total, 2930 records were analysed. The Couder manoeuvre rate was 32.12% in 2020. A change in the distribution of perineal lesions was observed: the rate of intact perineum increased (P<0.001), while 2nd degree lesions decreased between 2017 and 2020 (P<0.05). The 1st degree perineum and obstetric anal sphincter injuries remained stable. The rate of episiotomy decreased significantly by almost a factor of 7., Conclusion: The practice of the Couder manoeuvre can be implemented fairly quickly after training of the actors with nearly a third of normal deliveries at term concerned one year after its introduction. This manoeuvre seems, in our practice, to have contributed to the reduction, as previously reported, of the rate of second degree perineal injuries., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Objective: To evaluate and compare overall survival and progression-free survival in two groups of patients with advanced ovarian cancer, managed by neoadjuvant chemotherapy (3 cycles or more) followed by interval debulking surgery. Secondary objectives regarded surgical morbidity and extent of cytoreduction., Material and Methods: We conducted a retrospective study, in a referral center, evaluating the management of patients diagnosed with advanced ovarian cancer (FIGO IIIC-IV) beneficiating of interval surgery after neoadjuvant chemotherapy. We compared two groups, one in which patients underwent 3 cycles of chemotherapy before surgery, and a second group in which patients underwent more than 3 cycles., Results: 140 patients underwent interval surgery after neoadjuvant chemotherapy. Among these patients, 45 patients underwent 3 or less cycles (group 1) and 95 patients more than 3 cycles (group 2). There was no statistical difference for overall and progression free survival. The mean overall survival was 58,4 months for group 1 and 58,3 for group 2 (p.value = 0.56). The mean progression free survival was 30,5 months for group 1 and 23,8 months for group 2 (p.value = 0.17). More posterior pelvectomies were realized in group 1 compared to group 2 with a statistically significant difference (p=0,01). There was no difference regarding complete macroscopic difference during the surgery between the 2 groups (p=0,09)., Conclusion: Debulking surgery is an invasive and heavy procedure and is not always possible in first line. Neoadjuvant chemotherapy followed by interval debulking surgery is an accepted alternative. The number of administered cycles is questionable, and does not seem to have a significant impact on overall survival and progression free survival. However, surgical morbidity is significantly reduced by increased cycles of chemotherapy., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Background: Cervical dilatation curves are widely used to describe normal and abnormal labor progression for cephalic presentation. Labor curves for breech presentations have never been described., Objectives: The aims of this study were to examine the pattern of labor progression in women with a breech presentation and to determine whether the type of breech or parity can influence the speed of cervical dilatation., Study Design: We analyzed the labor data from 349 women with a term, singleton, and breech fetus after spontaneous onset of labor in 2010-2018. Cesarean deliveries were excluded. The patterns of labor progression were described by examining the relationship between the elapsed times from the full dilatation and cervical dilatation stages. Average labor curves were developed using repeated-measures analysis with 3rd degree polynomial modeling. The results were interpreted according to parity and the type of breech., Results: The first stage of labor progression was divided into a latency phase from 0 to 5 cm of dilatation and an active phase from 5 to 10 cm. In the active phase, the median speed of cervical dilatation was 1.67 cm/h [1.25, 2.61] (2 cm/h for multipara and 1.54 cm/h for nullipara). The difference by parity was significant in the active phase (p< 0.05). The cervical dilatation rate from 3 cm to 10 cm did not significantly differ between the complete and frank breeches (1.56 cm/h vs 1.75 cm/h, p = 0.48). However, the median cervical dilatation rate from 8 cm to complete dilatation was faster for complete breeches (1.92 cm/h versus 1.33 cm/h, p = 0.045)., Conclusion: As with cephalic presentation, the first stage of labor progression for breech presentation can be divided into a latent and active phase. Labor progression should be interpreted with respect to parity, and women should be informed that the type of breech does not seem to influence the cervical dilatation rate when there is adequate management., Competing Interests: The authors have declared that no competing interests exist.

Encephalocraniocutaneous lipomatosis (ECCL) or Haberland syndrome (MIM #613001) is a rare congenital neurocutaneous disorder. It is characterized by unilateral ocular, cutaneous and central nervous system anomalies. Key clinical features include hairless fatty tissue nevus of the scalp, choristoma of the eye and intraspinal and intracerebral lipomas. We report one of the first cases diagnosed after termination of pregnancy at 35 WG, including antenatal and post-mortem imaging, complete autopsy and genetic analysis. Prenatal ultrasound and MRI of the third trimester showed multifocal spinal lesions and left lateral cerebral ventriculomegaly with cerebral atrophy. Diagnosis of ECCL was suggested at complete autopsy which revealed nevus psiloliparus of the scalp, facial hamartomas and intracranial and spinal lipomas. In addition, our case also exhibited a cardiac rhabdomyoma and a multicystic dysplastic kidney, both never reported to date in this syndrome. ECCL was confirmed by the identification of a postzygotic FGFR1 mutation. We reviewed the literature and discuss the pathogenesis of this syndrome.

Background: Induction of labour, a very common obstetric procedure, affects about one in five pregnant women in most developed countries. Induction of labour is medically indicated, is subject to risks and additional costs, and is often poorly experienced by patients. The practices concerning induction vary widely from centre to centre and therefore need to be evaluated. Our aim was to develop a tool for evaluating induction of labour which would facilitate geographical and temporal comparisons., Methods: We have created a classification based on the principles of the internationally known Robson classification. It should be simple, robust, reproducible and require readily available data in each file. The groups are fully inclusive and mutually exclusive. This classification has been validated by a Delphi method., Results: Our classification includes 8 clinically relevant groups according to 5 obstetrical criteria. In order to classify each patient into a group, a simple system based on a maximum of 7 successive questions (from 1 to 7 questions) is used. Our classification has been validated by 13 national experts with satisfactory overall approval., Conclusions: With a view to improving the quality of care, our Grenoble classification would allow a standardization of the evaluation of practices of the induction of labour over time in the same maternity hospital. It would also allow the comparison of practices within different maternity hospitals in a network, a country or even different countries., (© 2022. The Author(s).)

Objectives: To evaluate Demelin's maneuver for arm entrapment's dystocia during vaginal breech deliveries after failure of the usual Lovset maneuver., Methods: We led a retrospective cohort study in two French maternities. Between January 2013 and June 2020, we included all vaginal breech deliveries of live newborns after 32 weeks of gestation requiring Demelin's maneuver for persistent arm entrapment despite the Lovset maneuver. The primary endpoint was the Demelin's maneuver success without the existence of a neonatal trauma related to the maneuver., Results: Among 1611 vaginal breech deliveries, 29 with Demelin's maneuver for an arm entrapment were enrolled (prevalence 0,02%). No failure of this maneuver was found. There was 10 nulliparous (34.5%). Mean gestational age was 38±2.4 weeks of gestation. The success of Demelin's maneuver without trauma related to it was estimated at 82.8%. No serious neonatal trauma was noticed. Five fractures (17.2%), one humeral and four clavicular, without sequelae were diagnosed. Mean weight of newborns was 2945.5 grams and the median arterial pH was 7.17. The median 5-minutes-Apgar score was 10. Maternal morbidity was low: one case (3.4%) of obstetric anal sphincter injuries (type III)., Conclusion: Demelin's maneuver seems to be an effective and safe method to treat an arm entrapment's dystocia during vaginal breech delivery after failure of the Lovset's maneuver., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

The Caribbean ranks seventh among the world regions most affected by cervical cancer. HPV-prevalence and genotype distributions also differ from regions. Knowledge of HPV genotype profiles is important for patients care and HPV vaccination implementation. The objective of this study was to describe HPV genotype distribution and risk factors in a population-based cohort of women in Martinique. In this study, 1312 women were included and underwent cervical cancer screening with successful sample collection between 2009 and 2014. Sociodemographic and clinical variables were recorded. Cytological examination of cervical vaginal smear was performed and classified(Bethesda). Detection of HPV DNA was performed with the PapilloCheck© Kit from Greiner Bio-one. Genotypes were analyzed for18 high-risk HPV (hrHPV) and 6low-risk HPV(lrHPV) types. A total of 1075 women were included with a mean age of 49.1±10.5 years. HPV prevalence was 27.6% (297/1075) with 19.4% (209/1075) women with only hrHPV, 5.3% (57/1075) with only lrHPV. Multiple infections (hrHPV/lrHPV) were detected in 31/240 cases of hrHPV (12.9%). A total of 353 hrHPV genotypes were analyzed; the most common HPV types were HPV51 (11.0%), HPV68 (10.8%), HPV53 (9.1%) and HPV 52 (7.1%). HPV16 and HPV18 represented respectively 4.8% and 4.0% of hrHPV genotypes. Abnormal cytology was observed in 34 cases (3.2%), with 14 ASCUS (1.3%), 10 LSIL (0.9%), 5 HSIL (0.5%), 3 ASC-H (0.3%) and 2 AGC (0.2%). Fifteen (44.1%) were hrHPV and 4 (14.7%) lrHPV; 7 cases of hrPHV were in the age-group 25-34 years. Among 1041cases of normal cytology, 225 had positive hrHPV detection (21.6%). This is the first population-based study of HPV profiles in our country, and we found a high prevalence of hrHPV. The most common genotypes were HPV51, 68, 53. These results could serve for cancer vaccination strategies and HPV surveillance in Martinique., Competing Interests: The authors have declared that no competing interests exist.

Purpose: To evaluate the obstetrical prognosis of term breech delivery in case of asymmetric pelvis., Methods: An observational, comparative, retrospective, bi-centric study of 559 patients who had a computer tomography pelvimetry prior to delivery of a term breech presentation was conducted between August 2013 and August 2019. Patients with an attempted vaginal delivery were divided into two groups: a group of asymmetric pelvis (AP) when the difference between the lengths of both oblique diameters was ≥ 1 cm and a group of symmetric pelvis (SP) when the two oblique diameters differed by < 1 cm. The primary outcome was the rate of vaginal delivery. Secondary outcomes were a composite variable of neonatal and maternal morbidity and mortality., Results: Of the 370 patients who attempted a vaginal breech delivery, 8% (n = 29) had an AP and 92% (n = 341) had a SP. In the AP group, the vaginal delivery rate was higher (93% versus 78%, p = 0.05). There was no statistically significant difference in neonatal (3% versus 1% in the AP and SP groups, respectively, p = 0.4) and maternal (17% versus 23% in the AP and SP groups, respectively, p = 0.5) morbidity and mortality., Conclusion: When a pelvimetry is performed before an attempt of vaginal breech delivery, a difference of less than two centimetres between both oblique diameters does not seem to reduce the rate of vaginal birth and is not an indication for an elective caesarean section., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

High-risk HPV (hrHPV) testing has been implemented as a primary screening tool for cervical cancer in numerous countries. However, there is still a need for relevant triage strategies to manage hrHPV positive women to avoid excessive referral to colposcopy. The objective of this study was to assess, in women infected by hrHPV and presenting no or mild cytological abnormalities, HPV16 and HPV18 viral loads to predict the development of cervical high-grade lesion. Among 2102 women positive for hrHPV, 885 had no lesion or mild cytological abnormalities at baseline and had at least one follow-up (FU) visit. HPV16 and HPV18 prevalence was 25.9% and 8.4%, respectively. Of those women, 15% developed a high-grade lesion during the FU. An HPV16 viral load cut-off set at 3.2 log 10 GE/10 3 cells permitted to identify a subgroup of women at high risk of developing high-grade cervical lesion (HR = 2.67; 95% CI 1.80-3.97; p ≤ 0.0001). No specific HPV18 viral load threshold could have been defined in regard to the present study. In multivariate analysis, HPV16 load (absence/log 10 GE/10 3 cells < 3.2 vs. ≥3.2), RLU/PC 239 (1-100 pg/mL vs. >100 pg/mL) and cytology (normal vs abnormal) were independently associated with a significant increased risk of high-grade lesion development and were used to construct the prognostic score. In conclusion, HPV16 load is a relevant biomarker to identify women at high risk for developing cervical precancerous lesions.

This study aims to analyze, in a population of singletons, the potential confounding or modifying effect of noise on the relationship between fetal growth restriction (FGR) or small for gestational age (SGA) and environmental exposure to air pollution. All women with single pregnancies living in one of two medium-sized cities (Besançon, Dijon) and who delivered at a university hospital between 2005 and 2009 were included. FGR and SGA were obtained from medical records. Outdoor residential exposure to nitrogen dioxide (NO 2 ) and particulate matter (PM 10 ) was quantified at the mother's address at delivery over defined pregnancy periods; outdoor noise exposure was considered to be the annual average daily noise levels in the façade of building (L Aeq,24 h ). Adjusted odds ratios (OR a ) were estimated by multivariable logistic regressions. Among the 8994 included pregnancies, 587 presented FGR and 918 presented SGA. In the two-exposure models, for SGA, the OR a for a 10-µg/m 3 increase of PM 10 during the two last months before delivery was 1.18, 95%CI 1.00-1.41 and for FGR, these OR a were for the first and the third trimesters, and the two last months before delivery: 0.77 (0.61-0.97), 1.38 (1.12-1.70), and 1.35 (1.11-1.66), respectively. Noise was not associated with SGA or FGR and did not confound the relationship between air pollution and SGA or FGR. These results are in favor of an association between PM 10 exposure and fetal growth, independent of noise, particularly towards the end of pregnancy, and of a lack of association between noise and fetal growth.

The aim of this study was to evaluate an oocyte pick-up (OPU) simulation training program for residents using the high fidelity PickUpSim TM (Accurate, Cesena, Italy) simulator. The authors carried out an observational study during an OPU simulation workshop. A successful scenario was defined as an oocyte retrieval rate ≥70% without any complications. Forty-six residents affiliated to 23 different French university hospitals were included, and 37/46 (80.4%) of them successfully completed the scenario with a mean time of 3.4 ± 1.1 minutes. The oocyte retrieval rate was 442/561 (78.8%). All residents found training beneficial and 41/46 (87%) were in favour of having simulation-based training programs for OPU in their reproductive medicine departments. All residents who had previous experience with OPU (11/11) recommended the use of a simulator before performing OPU. This study confirms that high-fidelity OPU simulation is a simple and efficient method for training residents.Impact statement What is already known on this subject? Simulator-based training has been shown to be effective and useful for oocyte pick-up (OPU) training. What the results of this study add? All residents found the simulation program beneficial and formative, with 80% successfully completing their scenarios in a mean time of 3.4 ± 1.1 minutes. All residents who had previous experience with OPU recommended the use of a simulator before performing OPU. What the implications are of these findings for clinical practice and/or further research? Prospective studies are needed to confirm the short- and long-term positive clinical impact of OPU simulation training programs.

Background: We aimed at developing a core outcome and variables of interest set to investigate the effects of mediolateral episiotomy on Obstetric Anal Sphincter Injury (OASI) during and after operative delivery in nulliparous women in a large-scale one-year observational French study including 15,000 women (INSTRUMODA)., Methods: A list of outcomes and variables of interest was suggested to obstetricians participating in the INSTRUMODA study using online questionnaires divided into 7 categories: the woman's history and course of pregnancy, course of labor, modalities of operative delivery, episiotomy characteristics, immediate maternal morbidity, one-year maternal morbidity, immediate neonatal morbidity. We used a three-round DELPHI method to reach a consensus. In the first round, outcomes and variables considered as essential by 70% or more of obstetricians were included in the corpus whereas they were excluded when 70% rated them as "not important". In the second round, non-consensual outcomes and variables were reassessed and excluded or definitively included if considered as "not important" or essential by 50% or more of the obstetricians. During the first round, obstetricians were invited to suggest new outcomes and/or variables that were then assessed in the second and third round. We used the same method to develop a core outcome and variables of interest set in a population of women in the community recruited via an association of patients. At the end of the procedure the core outcome and variables of interest sets were merged to provide the final core outcome set for the INSTRUMODA study., Results: Fifty-three obstetricians and 16 women filled out questionnaires. After the 3 rounds of Delphi procedure in each population, 74 outcomes and variables were consensually reported by obstetricians and 92 by women in the community. By mixing these two consensual corpora we reported a final consensual list of 114 variables of interest and outcomes for both obstetricians and women., Conclusion: We established a core outcome and variables of interest set among obstetricians and women in the community to investigate the association between mediolateral episiotomy and OASI during operative delivery., Trial Registration: The INSTRUMODA study was registered on https://clinicaltrials.gov on June 25, 2020 ( NCT04446780 ).

Objectives: In 5 % of vaginal deliveries in case of cephalic presentation there is a persistent occipital posterior position known to be associated with a higher maternal and neonatal morbidity. In these situations, vacuum extractor seems to be the best choice for assisted delivery but it also has limits and contraindications, for example an important caput succadenum or premature birth. The aim of our study was to evaluate the rate of intra-pelvic rotation of persistent occipital posterior position without instrumental rotation in case of operative delivery with spatulas., Methods: This is a retrospective, monocentric and descriptive study evaluating the rate of spontaneous intra-pelvic rotation of persistent occipital posterior position in case of assisted delivery with spatulas among all live births at the Besançon University Medical Center between 2010 and 2017., Results: There were 20 205 births during the study and 81(0,4 %) operative deliveries by spatulas in case of persistent occipital posterior position. Delivery in occiput anterior (OA) position was obtained in 36 cases (44.4 %). There was no significant difference in maternal or neonatal morbidity between both groups and perineum injuries were less severe in case of OA delivery., Conclusion: Operative deliveries by spatulas without instrumental rotation in case of persistent occipital-posterior position seem to be a relevant alternative to vacuum extractor, especially in case of premature birth or important caput succedaneum without altering the maternal or neonatal prognostic., Competing Interests: Declaration of Competing Interest The authors report no declarations of interest., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

The Odon Device™ has been described in the literature since 2013 and the World Health Organization supports its development through the Human Reproduction Program. This innovative device could be easier to use than usual instruments and could be an alternative to caesarean section during the second stage of labor, especially in countries where access to obstetric care is limited. The aim of the Odon Device™ is to position an air cuff over the fetal head, past its widest point (around the level of the fetal mouth anteriorly and the nape of the fetal neck posteriorly). Three mechanical principles favor the progression of the fetal head with the Odon Device™: partial propulsion, limited flexion and traction. Preliminary clinical studies on animals and simulators are reassuring and show that an appropriate use is no more at risk than the vaccum or forceps. A phase 1 study was conducted in Argentina and South Africa between 2011 and 2017. The reported failure rate was 29%, of which 77% was secondary to a mechanical failure of one of the components of the device. Improvements concerning the applicator, the handles and the inflatable air cuff have been made to the device. Phase II of the clinical research program began in 2018 and includes two studies in two different centers: The ASSIST Study in Bristol, England, and The BESANCON ASSIST Study, Besançon, France., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Objective: Our purpose was to evaluate the impact of active delivery of the anterior arm with Couder's Maneuver (CM) during vacuum-assisted vaginal delivery (VAVD) on perineal tears. This maneuver can be beneficial because it has the advantage of reducing fetal biacromial diameter. Methods: This monocentric retrospective study compared two non-concurrent cohorts of nulliparous women before and after implementation of a systematic CM during VAVD: Cohort 1 from 1 January to 31 December 2006 without CM and Cohort 2 from 1 January to 31 December 2016 with systematic CM. This study reviewed all births during these two periods. All live-born singleton pregnancies where VAVD occurred after 37 weeks of gestation were included. The principal endpoint was the type of perineal tear. Results: In total, there were 179 VAVD in the Cohort 1 and 267 VAVD in the Cohort 2. In the Cohort 2, 233 VAVD (87.3%) were performed with systematic CM. No episiotomy was performed in both cohorts. There was a significant decrease in the rate of second-degree perineal tears between the two cohorts (42.4 versus 15%, p  < .001) and a significant increase in the rate of intact perineum (34.1 versus 54.7%, p  < .001). There was no influence of CM on the rate of obstetrical anal sphincter injury (3.9 versus 2.6%, p  = .44). Conclusions: Practicing this maneuver could improve the perineal prognosis during VAVD in nulliparous women.