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Objectif : Le dépistage combiné de la trisomie 21 au premier trimestre est la méthode de référence depuis les recommandations de la HAS de 2007. Sa réalisation est soumise à l’obtention d’un numéro d’identification par le biais d’une évaluation des pratiques professionnelles (EPP) depuis 2009. L’objectif était d’évaluer les pratiques de dépistage en Basse-Normandie, les freins à la validation d’EPP, les habitudes d’autoévaluation acquises par les praticiens ayant validé une EPP et l’information remise aux patientes sur le dépistage. Matériel et méthodes : Étude descriptive de mai à août 2016, fondée sur un questionnaire envoyé aux échographistes exerçant en Basse-Normandie, leur nombre étant évalué à 78. Résultats : Quarante-sept questionnaires ont été analysés. Trente-six praticiens bénéficiaient d’un numéro d’identification, 35 d’entre eux adhéraient au réseau périnatal basnormand, et 29 évaluaient systématiquement le score de Herman de leur cliché de clarté nucale. Onze praticiens, dont huit n’adhéraient pas au réseau, ne réalisaient pas de dépistage combiné, justifiant cela par un manque de pratique de l’échographie et un manque de temps pour valider une EPP. Une information sur les modalités de dépistage était délivrée dans 76,6 % des cas. Conclusion : Sept ans après l’arrêté de 2009, on ne parvient pas à une adhésion totale aux programmes d’EPP pour un dépistage optimal et uniforme. L’inscription des praticiens aux réseaux périnataux semble favoriser la validation d’EPP. Cette démarche de contrôle qualité permet l’apprentissage d’une autoévaluation par les praticiens dans la suite de leur exercice et ainsi une amélioration durable de la qualité du dépistage.

The aim of this study was to review the perioperative complication rates and neonatal outcomes after fetoscopic release of amniotic bands that caused bilateral limb constrictions. We present 5 cases of limb constriction by amniotic bands occurring spontaneously or following fetoscopic surgery and also include a review of 21 previously published cases. The cases were analyzed for indication, surgical technique, and postoperative follow-up. In our population and the literature, the majority of the children acquired a functional limb (75%), with few perioperative complications (15%). Fetal morbidity was mainly linked to the consequences of preterm premature rupture of the membranes (38.4%) and preterm birth (34.7 GW). The mortality rate was low (7.7%). This review only describes amniotic bands causing limb constriction, and illustrates that fetoscopic surgery for their release is technically feasible with an acceptable perioperative complication rate. However, the 75% success rate is very likely to be an overestimation of the true success rate. In view of these observations we cannot recommend treatment for cases where the fetus has been extensively affected by the bands. We believe, however, that we could consider this technique for a fraction of amniotic band syndrome cases isolated to the limb constrictions. This kind of surgery should be proposed as a potential treatment for amniotic band syndrome.

Introduction Pseudoamniotic Bands Syndrome (PABS) was described as iatrogenic complication from in utero procedure as fetoscopy. Objective The aim of our study was to identify the ultrasound findings in PABS diagnosed prenatally Methods First, we reported cases of PABS following fetoscopic surgery that were diagnosed prenatally in our institution. We collected all ultrasound data with fetal and neonatal issues. Then, a literature review was conducted by searching the Medline and Cochrane Library computer databases until 2020 to find publications that involve PABS diagnosed prenatally or postnatally. The following keywords were selected and combined: “pseudoamniotic bands syndrome”, “fetoscopy”, “fetal surgery”. Results We collected three cases of PABS diagnosed prenatally in our center following fetoscopic procedures for complicated monochorionic pregnancies. Among these cases, we reported the following ultrasound findings: floating membrane, amniotic bands, striction of limbs, perilesional edema, reduced member size and anomalies of Doppler flow. Including our cases, we reported 23 published PABS of which eight (35%) were prenatally diagnosed. When it was diagnosed, mean GA at PABS diagnosis was 23 weeks (mean interval from fetoscopic to diagnosis was 4 weeks). Three fetoscopic release of amniotic bands were described. The principal parts affected were the limbs, more particularly the extremities. Conclusion PABS was accessible to an antenatal diagnosis, as well as ABS. Although it is a rare complication of fetoscopic surgery, ultrasound examinations after procedure should focus on PABS signs to improve prognosis of the neonates.

The purpose of this study was two-fold: (1) To determine how the number of ultrasound scans a trainee has completed predicts the trainee's diagnostic accuracy when performing transvaginal ultrasound examinations, and (2) to examine the utility of simulation-based assessment of ultrasound competence for determining readiness for independently performing examinations. 101 OB/GYN trainees were surveyed regarding their clinical experience and the number of scans they had completed. All participants completed five different cases on a transvaginal virtual-reality ultrasound simulator (Scantrainer, Medaphor). The participants' diagnostic accuracy was recorded and expert raters evaluated their performance using the Objective Structured Assessment of Ultrasound Skills (OSAUS) scale. The utility of simulation-based assessments was assessed with respect to reliability, validity, acceptability, and costs. The main outcome was diagnostic accuracy for five different ultrasound cases. Although the number of scans was associated with diagnostic accuracy (p = 0.006), it was a poor predictor (AUC 0.69) of diagnostic accuracy. Only 56.6 % (n = 34) of participants who had more than 100 transvaginal scans demonstrated a diagnostic accuracy of 0.80 or above. The reliability of the OSAUS assessments was high (ICC 0.82) and the majority of participants supported the use of simulation-based assessments for future licensing exams (70.3 %). The running costs of simulation-based assessments (154 EUR per participant) were lower than for practical examinations using real patients. The number of completed ultrasound scans was a poor predictor of the trainees' diagnostic accuracy. Instead, simulation-based assessments can be used to ensure that trainees are ready for independently performing future scans.ZIEL: Diese Studie verfolgte zweierlei: (1) Die Feststellung, ob sich durch die Anzahl der von einem Trainee absolvierten Ultraschall-Scans die diagnostische Genauigkeit seiner transvaginalen Ultraschalluntersuchungen vorhersagen lässt und (2) die Untersuchung des Werts simulationsbasierter Assessments der Ultraschallkompetenz, um die Fähigkeit zur selbstständigen Durchführung von Untersuchungen zu ermitteln. 101 Trainees im Fach Gynäkologie/Geburtshilfe wurden hinsichtlich ihrer klinischen Erfahrung und der Anzahl der von ihnen durchgeführten Scans befragt. Alle Teilnehmer mussten 5 unterschiedliche Fälle auf einem transvaginalen Virtual-Reality-Ultraschallsimulator (Scantrainer, Medaphor) absolvieren. Die diagnostische Genauigkeit der Teilnehmer wurde aufgezeichnet und Experten bewerteten ihre Leistung anhand der OSAUS-Skala (Objective Structured Assessment of Ultrasound Skills). Der Nutzen simulationsbasierter Assessments wurde in Bezug auf Zuverlässigkeit, Validität, Akzeptanz und Kosten bewertet. Das Hauptergebnis war die diagnostische Genauigkeit bei den 5 verschiedenen Ultraschallfällen. Obwohl die Anzahl der Scans mit der diagnostischen Genauigkeit assoziiert war (p = 0,006), war diese ein schlechter Prädiktor (AUC 0,69) für die Genauigkeit. Nur 56,6 % (n = 34) der Teilnehmer mit über 100 transvaginalen Scans zeigten eine diagnostische Genauigkeit von 0,80 oder höher. Die Zuverlässigkeit der OSAUS-Bewertungen war hoch (ICC 0,82) und die Mehrheit der Teilnehmer unterstützte die Verwendung simulationsbasierter Assessments für zukünftige Lizenzprüfungen (70,3 %). Die laufenden Kosten simulationsbasierter Assessments (154 EUR pro Teilnehmer) waren niedriger als bei praktischen Untersuchungen am echten Patienten. Die Anzahl der Ultraschall-Scans war ein schlechter Prädiktor für die diagnostische Genauigkeit der Trainees. Stattdessen können simulationsbasierte Assessments verwendet werden, um sicherzustellen, dass Trainees in der Lage sind, künftige Scans unabhängig durchzuführen.

We reviewed data from a cohort of fetuses with ureterocele diagnosed and operated prenatally in four fetal therapy centers. Inclusion criteria were: (1)ureterocele confirmed on detailed fetal ultrasound examination, (2)absence of additional fetal malformations (3)fetal intervention to decompress the ureterocele with local institutional review boards’ approval. Data on sonographic follow-up, obstetrical, neonatal outcome and postnatal evaluation were collected. Ten cases of prenatally treated ureterocele are described. Six cases benefited from a fetoscopy for laser incision and decompression, two cases had an ultrasound guided puncture before resorting to a fetoscopy with laser incision, one case had a balloon catheterization under ultrasound guidance and one case had an ultrasound-guided opening of the ureterocele with a laser fiber passed through a 20G needle. Mean GA at diagnosis was 21.6GW. Two cases underwent TOP. The remaining eight cases recovered normal amniotic fluid volume, and delivered a live-born child at a mean GA of 38.6GW with normal creatinine levels during the first week of life. Prenatal incision provided complete treatment of severely obstructive ureteroceles in 80% of the cases and allowed improvement of urinary electrolytes, renal size and echogenicity, bladder filling in all survivors and recollection of normal amniotic fluid volume, in case of oligoanhydramnios.

Resume Objectif Au cours de leurs etudes, les sages-femmes doivent acquerir les competences echographiques necessaires pour realiser une estimation de la quantite de liquide amniotique, des biometries fœtales et localiser les positions fœtale et placentaire. Un stage clinique d’echographie est organise pendant leur cursus pour acquerir cette competence. L’objectif de cette etude est d’evaluer la contribution qu’une formation sur simulateur d’echographie obstetricale pourrait apporter aux competences des etudiants sages-femmes et l’evaluation du meilleur moment pour l’integrer dans leur cursus. Methode Quarante etudiants sages-femmes en 4e annee de formation ont ete randomises en 2 groupes. Le groupe A realisait, le parcours academique habituel avec un stage clinique d’echographie qui etait suivi d’une evaluation sur simulateur d’echographie obstetricale (E1A). Le groupe B etait evalue sur simulateur avant son stage clinique d’echographie (E1B). Apres ces premieres evaluations, les deux groupes beneficiaient d’une seance de formation et d’entrainement sur simulateur puis etaient reevalues de la meme facon (E2A et E2B). Le groupe B realisait alors son stage clinique d’echographie puis etait evalue a nouveau a 1 mois sur simulateur (E3B). L’evaluation consistait a noter les cliches biometriques obtenus selon les criteres de qualite etablis par le comite technique d’echographie, et d’evaluer leur competence selon un score d’evaluation structuree et objective des competences en echographie (OSAUS) cote sur 5. Resultat L’evaluation 1 retrouvait une moyenne OSAUS (2,375/5 vs 2,24/5 p = 0,52) comparables entre les deux groupes, mais un score de qualite des images significativement superieur pour le groupe A (p = 0,02). Lors de l’evaluation 2 une amelioration etaient notee pour les 2 groupes sans que les moyennes OSAUS entre les deux groupes ne different (p = 0,76). Par contre, apres une mise en pratique, le score OSAUS du groupe B ayant beneficie de seances de simulation avant leur stage clinique (E3B) etait meilleur que celui du groupe A (E1A) (3,45/5 vs 2,375/5 [p= 0,00017]). Il en etait de meme pour la qualite de leurs cliches (12,67/16 vs 9,95/16 [p= 0,003]). Conclusion L’apprentissage sur simulateur en complement d’un stage clinique d’echographie semble ameliorer de facon significative les competences en echographie obstetricale.

Background: In utero therapeutic approaches for lower urinary tract obstruction (LUTO) have been developed to salvage the fetal kidney function. Objective: The aim of this work was to report the long-term survival, nephrological, and urological outcome of children treated prenatally for LUTO using operative fetal cystoscopy (FC) and vesicoamniotic shunting (VAS) or both. Methods: A retrospective study of 48 procedures (23 FC, 25 VAS) was performed on 33 patients (between 2008 and 2018). Reviewed data included prenatal management and clinical follow-up by a pediatric nephrologist and a pediatric urologist. Both intention-to-treat and per-protocol analyses were conducted. Results: The median follow-up was 3.6 years (0.5–7) for FC and 2.5 years (1.1–5.1) for VAS. There was no difference between FC and VAS in terms of survival (92 vs. 83%, p = 1), complication rate (74 vs. 92%, p = 0.88), or chronic kidney disease (58 vs. 50%, p = 1). The number of procedures was higher in the VAS group: 1.7 (1–3) versus 1.1 (1–2), p = 0.01. With a 30% rate of technical failure, FC added diagnostic value in 3 out of 21 cases. Conclusions: No difference was found between FC and VAS regarding survival, long-term kidney function, or urological outcome. Despite overly optimistic reports on FC, it lacks reproducibility due to posterior-urethra inadequate visualization and inappropriate instrumentation.

International audience; Background: Informing couples about the diagnosis of severe fetal pathologies is part of the daily routine in fetal medicine. This situation is usually complex and can put untrained professionals in an uncomfortable position. The aim of this study was to assess the perception of health care professionals when faced with the need to announce a fetal pathology in order to target their training gaps in this domain.Materials and methods: A questionnaire was created and disseminated on a national level among physicians practicing or collaborating with the multidisciplinary centers of prenatal diagnosis in France. The questionnaire focused on the difficulties encountered by practitioners when announcing fetal pathologies, and their potential interest in simulation sessions regarding the delivery of bad news.Results: 193 participants filled the questionnaire. 65 % report not receiving any theoretical courses in this field during their initial training, 49 % admit feeling uncomfortable when a fetal anomaly needs to be announced, 79.5 % think that role-play could help them, 87.5 % believe that training sessions in communication skills would help improve their methods and 73.1 % support teaching the delivery of bad news by simulation sessions.Conclusion: This survey illustrates the significance of announcing a fetal pathology for fetal medicine professionals. Many of them report not being properly trained to cope with this situation and would like to improve with a more practical way of teaching. Simulation would be the ideal educational tool to meet this demand.

Resume Objectif Comparer l’apprentissage de l’echographie obstetricale sur un simulateur a l’apprentissage traditionnel sur des patientes pour des novices. Methodes Vingt etudiants en medecine n’ayant jamais pratique l’echographie ont ete randomises en deux groupes A et B, de 10 etudiants chacun. Apres avoir recu un cours theorique sur les principes de base de l’echographie obstetricale, les groupes A et B ont beneficie d’une session d’apprentissage de l’echographie obstetricale avec entrainement individuel, respectivement sur un simulateur et sur vrai appareil d’echographie en presence d’une femme volontaire enceinte a 22 SA. Chaque etudiant a ensuite ete evalue sur une vraie patiente ou il lui a ete demande d’evaluer la position placentaire, la presentation fœtale et de mesurer le diametre biparietal (BIP), le perimetre crânien (PC), le perimetre abdominal (PA) et la longueur femorale (LF). Un score deja publie, evaluant la qualite de la mesure etait utilise pour cote chaque image, et donner un score global a chaque etudiant. Le temps necessaire pour completer l’examen a ete egalement mesure. Resultats Le score total moyen obtenu dans le groupe A (entrainement sur simulateur) (14,3 ± 1,4) etait significativement (p = 0,001) meilleur que celui du groupe B (10,3 ± 2,75) (entrainement sur vraie patiente). Le groupe B avait tendance a etre plus rapide a la realisation de l’echographie (479 ± 104 s) par rapport au groupe A (569 ± 174 s) sans difference significative (p = 0,18). Conclusions Le simulateur en echographie obstetricale semble etre un outil efficace dans l’enseignement destine aux novices. Il pourrait etre integre dans le processus de formation initiale pour permettre aux novices d’atteindre un niveau de base avant d’effectuer des examens sur de vraies patientes.

We reviewed data from a cohort of fetuses with ureterocele diagnosed and operated prenatally in four fetal therapy centers. Inclusion criteria were (1) ureterocele confirmed on detailed fetal ultrasound examination, (2) absence of additional fetal malformations, and (3) fetal intervention to decompress the ureterocele with local institutional review boards' approval. Data on sonographic follow-up, obstetrical, neonatal outcome, and postnatal evaluation were collected. Ten cases of prenatally treated ureterocele are described. Six cases benefited from a fetoscopy for laser incision and decompression, two cases had an ultrasound guided puncture before resorting to a fetoscopy with laser incision, one case had a balloon catheterization under ultrasound guidance, and one case had an ultrasound-guided opening of the ureterocele with a laser fiber passed through a 20-gauge needle. Mean gestational age at diagnosis was 21.6 GW. Two cases underwent termination of pregnancy. The remaining eight cases recovered normal amniotic fluid volume and delivered a liveborn child at a mean gestational age of 38.6 GW with normal creatinine levels during the first week of life. Prenatal incision provided complete treatment of severely obstructive ureteroceles in 80% of the cases and allowed improvement of urinary electrolytes, renal size and echogenicity, bladder filling in all survivors, and recollection of normal amniotic fluid volume, in case of oligoanhydramnios. © 2017 John WileySons, Ltd.

In most tropical areas, pregnant women are at increased risk of malaria, as a consequence of the massive sequestration of parasitized red blood cells in the placenta. The placenta plays a key role in embryonic and fetal development as well as in maternal-fetal exchanges, and pregnancy-associated malaria may alter selected placenta functions that lead to stillbirth and low birth weight. Although there are several tools (blood smear examination, RDT, PCR) to diagnose malaria infection during pregnancy, there is currently no test to assess placenta dysfunction in the framework of pregnancy-associated malaria. Pregnancy-associated malaria shares many features with preeclampsia, an extensively studied disease. Various biomarkers associated with placental dysfunction have been identified as associated with preeclampsia. Several of these are inflammatory markers that lack of specificity. A few seem more specific of placenta dysfunction, including s-endoglin and sFlt1, increased in the peripheral blood during preeclampsia. The predictive value of these biomarkers should be studied in the context of pregnancy-associated malaria to evaluate their usefulness in identifying placental dysfunction during malaria. These biomarkers should be considered to improve the diagnosis of placental dysfunction during malaria and pregnant women monitoring.

Background Evaluation of trainee's ability in obstetrical ultrasound is a time-consuming process, which requires involving patients as volunteers. With the use of obstetrical ultrasound simulators, virtual reality could help in assessing competency and evaluating trainees in this field. Objective The objective of the study was to test the validity of an obstetrical ultrasound simulator as a tool for evaluating trainees following structured training by comparing scores obtained on obstetrical ultrasound simulator with those obtained on volunteers and by assessing correlations between scores of images and of dexterity given by 2 blinded examiners. Study Design Trainees, taking the 2013 French national examination for the practice of obstetrical ultrasound were asked to obtain standardized ultrasound planes both on volunteer pregnant women and on an obstetrical ultrasound simulator. These planes included measurements of biparietal diameter, abdominal circumference, and femur length as well as reference planes for cardiac 4-chamber and outflow tracts, kidneys, stomach/diaphragm, spine, and face. Images were stored and evaluated subsequently by 2 national examiners who scored each picture according to previously established quality criteria. Dexterity was also evaluated and subjectively scored between 0 and 10. The Raghunathan's modification of Pearson, Filon's z, Spearman's rank correlation, and analysis of variance tests were used to assess correlations between the scores by the 2 examiners and scores of dexterity and also to compare the final scores between the 2 different methods. Results We evaluated 29 trainees. The mean dexterity scores in simulation (6.5 ± 2.0) and real examination (5.9 ± 2.3) were comparable ( P = .31). Scores with an obstetrical ultrasound simulator were significantly higher than those obtained on volunteers ( P = .027). Nevertheless, there was a good correlation between the scores of the 2 examiners judging on simulation ( R = 0.888) and on volunteers ( R = 0.873) ( P = .81). Conclusion An obstetrical ultrasound simulator is as good a method as volunteer-based examination for evaluating practical skills in trainees following structured training in obstetrical ultrasound. The threshold for success/failure should, however, be adapted as candidates obtain higher scores on the simulator. Advantages of the obstetrical ultrasound simulator include the absence of location and time constraints without the need to involve volunteers or to interfere with the running of ultrasound clinics. However, an obstetrical ultrasound simulator still lacks the ability to evaluate the trainees' ability to interact with patients.