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Background: The effect on neonatal mortality of mode of delivery of a fetus in breech presentation at an extremely preterm gestational age remains controversial., Objective: To compare mortality associated with planned vaginal delivery (PVD) of fetuses in breech presentation with that of fetuses in breech presentation with a planned cesarean delivery (PCD)., Material and Methods: Retrospective study reviewing records over a 19-year period in a level 3 university referral center of singleton infants born between 25+0 and 27+6 weeks of gestation, alive on arrival in the delivery room, and weighing at least 500 grams at birth. Infants in the first group were in breech presentation with PVD and the second in breech presentation with PCD. The principal endpoint was neonatal death., Results: During the study period, we observed 113 breech presentations with PVD, and 80 breech presentations with PCD. Although not significant after adjustment, neonatal mortality in the breech PVD group was more than twice that of the breech PCD group (19.5 vs 7.8%, P = 0.031, ORa = 2.6, 95% CI 0.8-9.3, NNT = 8). This higher neonatal mortality in the breech PVD group was exclusively associated with a higher risk of death in the delivery room (12.4 vs 0.0% P = 0.001, OR not calculable, NNT = 8). In these extremely preterm breech presentations with PVD, neonatal mortality in the delivery room was associated with entrapment of the aftercoming head, cord prolapse, and a short duration of labor., Conclusion: For deliveries between 25+0 and 27+6 weeks' gestation, vaginal delivery in breech presentation is associated with a higher risk of death in the delivery room., Competing Interests: The authors have declared that no competing interests exist.

Background: Although its role in the prognosis for delivery remains controversial, the type of breech is sometimes taken into account in the decision about mode of delivery. Objective of our study was to compare maternal and neonatal morbidity for trial of vaginal delivery according to the type of breech (complete or frank)., Material and Method: Single-center retrospective study of women with trials of vaginal delivery of a singleton fetus in breech presentation at of after 37 weeks of gestation. Neonatal status was assessed by the composite variable of the Term Breech Trial, first considered alone, and then with the addition of a 5-min Apgar score < 7 or a neonatal arterial pH<7.0., Results: Of the 495 trials of vaginal delivery during the study period, approximately one third of them were complete breech (35.8 %) and two thirds frank (64.2 %). The frequency of cesareans during labor was similar regardless of the type of breech (16.4 for complete vs 12.6 % for frank, p=0.24), nor did neonatal morbidity differ (1.7 for complete vs 4.1 % for frank, p=0.15). On the other hand, cord prolapse occurred almost exclusively in complete breech presentations (4.5 vs 0.3 %, p<0.01), and prognosis was good in all cases. Complete breech presentations were also associated with more frequent use of forceps to the after-coming head (16.2 vs 9.7 %, p<0.05). Finally, there were non significant difference between the two types of breech concerning severe acidosis but it seemed to have it more in frank breech (2.3 vs 1.2 %, p=0.34)., Conclusion: Among women eligible for vaginal delivery, the type of breech presentation (complete or frank) has little influence on delivery maternal and neonatal morbidity. The type of breech need not be taken into account in deciding the route of delivery., Competing Interests: Declaration of Competing Interest All authors have no conflict of interest, (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Introduction: Evaluating the fertility and pregnancy outcomes in systemic sclerosis (SSc) women is challenging. Studies are still limited or subject to potential methodological biases. Areas covered: This work is a comprehensive review of the literature. We discuss the potential impact of SSc on women's pregnancy outcomes and the effects of pregnancy on SSc. We summarize the physiological changes during pregnancy and describe our experience. Expert commentary: Although the miscarriage rate does not appear increased in SSc, women are exposed to a higher risk of premature birth and intrauterine growth restriction compared with the general population. Early diffuse cutaneous SSc and use of corticosteroids are risk factors, whereas folic acid use prevents against premature birth. All SSc women wishing to conceive should be counselled during a preconception visit. Physiological changes arising during pregnancy may be the source of clinical problems in SSc women with organs with limited capacities.

Background: An incarcerated uterus refers to the retroversion of a pregnant uterus within the pelvis due to the absence of a forward tilt at the end of the first trimester. An incarcerated uterus that is overlooked or only discovered perpartum can cause severe obstetrical complications. Several authors have shared their experience with uterine incarceration management at 12, 14, and 16 weeks of amenorrhea., Case: Our report concerns a case of uterine incarceration management at 21 weeks of amenorrhea, achieved by way of a specific anesthesia protocol and the positioning of the patient, which allowed the disimpaction of the uterus with the help of external maneuvers. No recurrence was observed., Conclusion: Uterine incarceration management is possible beyond 16 weeks of amenorrhea.

Objectives: To evaluate the benefits and risks of labor induction in patients previously delivered by at least one low transverse cesarean section. To define how labor should be managed in patients attempting a vaginal birth after cesarean section (VBAC)., Methods: A literature search was performed using the Pubmed(®) and Cochrane(®) databases. Foreign societies guidelines were also consulted., Results: Labor induction is associated with an increased risk of uterine rupture that could be estimated at 1% with oxytocine and 2% with vaginal prostaglandins (Level 2). Mechanical methods have been insufficiently studied. Misoprostol seems to dramatically increase the risk of uterine rupture (Level 3). The routine use of intrauterine pressure catheter does not prevent uterine rupture (Professional agreement). A moderate increase of uterine rupture was also found with augmentation (Level 3). The risk of uterine rupture increases when cervical dilatation is arrested for 3 hours or more when a good uterine dynamic is obtained (Professional agreement). The use of epidural analgesia should be encouraged (Grade C). Routine digital exploration of the uterine scare postpartum is not necessary (Grade C)., Conclusion: Women attempting a VBAC should be aware of the modalities of labor management. When labor induction is warranted, women should also be informed of the indication and the increased risk of uterine rupture. The choice of labor induction method should take into consideration maternal and obstetrical characteristics., (Copyright © 2012. Published by Elsevier Masson SAS.)

Objective: To compare the effectiveness of two single-use vacuum devices, the Kiwi Omnicup and the Mitysoft Bell., Material and Methods: This retrospective study was conducted during two different periods: from January 15th to March 14th to assess the Kiwi Omnicup and from March 15th to June 15th for the Mitysoft Bell. The primary outcome was the successful completion of delivery with the allocated instrument. Secondary outcomes were fetal scalp trauma and maternal perineal lesions. All deliveries were performed by similar teams., Results: Thirty-nine patients were included in the Kiwi Omnicup group and 48 in the Mitysoft Bell group. Compared to the Kiwi Omnicup, the Mitysoft Bell was associated with a greater number of cup detachments (41.7% vs. 10.3%; p<0.01) and a significantly higher rate of failure (31.3% vs. 12.8%). Rates of substantial scalp trauma and maternal trauma were similar in both groups., Conclusion: The Mitysoft Bell is not as successful at achieving a vaginal delivery as the Kiwi Omnicup. This could be explained by the shape of the cup.

Background: Cord blood transplantation is used to treat patients with malignant and nonmalignant hematopoietic diseases. This study assessed the feasibility of collecting cord blood for eventual transplantation to a sibling with such a disease., Methods: We studied the records of 47 infants from whom cord blood was collected for siblings from 1993 through 1999., Results: During the study, cord blood was collected for 47 potential recipients: 37 (80.4%) with malignant disease and 9 (19.6%) with nonmalignant disease. Delivery was induced before 39 weeks of gestation. The mean volume collected was 107+/-39 mL and the number of nucleated cells was 11.52 x 10(8). Problems making collection difficult included: impossibility of collecting cord blood because of spontaneous delivery (n=1), the cytomegalovirus-positive serologic status of donor (n=7), and an inadequate number of nucleated cells (n=16). Weekday collection was possible for 60% of the donors. To date, only 7 of these cord blood collections have been used for stem cell transplantations., Conclusion: This retrospective study demonstrates the practical difficulties in collecting cord blood for transplantation to siblings, difficulties that may decrease the likelihood of success.

We relate the embolization of a hematoma of the broad ligament which developed suddenly in the post-partum period. The radiological intervention could be considered as an alternative treatment. The decision for embolization must be a multidisciplinary decision involving all the specialists concerned (interventional radiologist, intensive care specialist, and obstetrician).

Pregnancy and puerperium are well-known risk factors for venous thromboembolism, but the actual incidence of the disease is low (about 1/1,500 pregnancies). Pregnancy-associated venous thromboembolism is rare, though it is still the second cause of maternal death in France. Several types of prophylaxis are available, mainly clinical vigilance and aggressive investigation of women with symptoms of venous thromboembolism, or antithrombotic prophylaxis. Given the low incidence of the pathology, it seems desirable to select high-risk groups of women for such strategies. The most studied and identified risk factors are prior episodes of venous thromboembolism and biological thrombophilias. Prophylaxis through low molecular weight heparin during pregnancy and the puerperium should be considered mainly in these two groups. Noteworthy, no prospective and randomized study is available, and treatment recommendations are grade C.

If pregnancy is very frequently normal, severe complications can appear for fetus, mother or both. The etiologies are various but preeclampsia and its complications remain one of the leading causes. The management is discussed according to the etiology and the severity of the disease and also the level of maternity and neonatal unit which can accept the newborn. However, all situation is a case apart and any decision will not be taken without concertation between obstetricians and neonatologists. In France, a regionalization policy is taking place to improve the maternal and neonatanal management.

Preeclampsia complicating 3% of all births is an important cause of maternal death and is associated with an increased risks of neonatal morbidity and mortality. Among the numerous theories proposed to explain this syndrome, the concept of placental ischaemia resulting in a generalized disturbance of endothelial physiology is receiving increasing support. Maternal immunological systems is often solicited during normal pregnancy. Most likely the immunological system is implicated in preeclampsia. Its responsibility is protean. Trophoblastic antigens may not be properly recognized by maternal immunologic system, resulting in a defect of trophoblastic invasion of the myometrial segment of the spiral arteries. Preeclampsia does not seem to be accompanied with trophoblast immunological rejection by the mother. Some cases of preeclampsia are associated with autoimmune phenomena. The autoantibodies could be directed against phospholipids or/and trophoblastic membrane components. Activated neutrophils release a variety of substances, capable of mediating vascular damage. An imbalance between the protective antioxidant activity and aggressive oxidant mechanisms could initiate the endothelial lesions. Preeclampsia could be one presentation of immunodystrophism with local excess of harmful cytokines. The immunologic system is probably not the initiator of preeclampsia, but its role is ambiguous: either the protective immunologic mechanisms usually operating during pregnancy can be surpassed, or immunologic responses are inadequate and directly aggressive. A better understanding of the underlying immunologic anomalies will improve the nosologic classification of preeclampsia syndrome.

We report our personal experience with 35 laparoscopically prepared vaginal hysterectomies performed over a 3 year period, for January 1990 to January 1993. We give our indications for this new technique present our results. We compared our results with those reported in the literature evaluating indications, technique and complications and demonstrate the numerous advantages of this new technique. Finally, a decision protocol has been prepared in order to chose the optimal approach according to the preoperative work-up.

An antenatal echography performed at 32 weeks of amenorrhoea revealed a formation in the liver. Other tests during the antenatal period were unable to provide an exact diagnosis which was only established after exploratory laparotomy after birth. A review of the literature showed that this hepatic tumour has been diagnosed in 3 reported cases antenatally. Haemangioendothelioma occurring during the antenatal period is difficult to diagnose and the severe forms discovered by echography have a poor prognosis.

The authors present a case of partial trisomy 12q associated with chylothorax, diagnosed at 30 weeks of pregnancy. Cordocentesis for the karyotype as well as thoracocentesis were carried out. In spite of the administration of tocolytic drugs the patient delivered a girl with multiple clinical abnormalities, who died at 7 days of age. From this case, the authors report 6 other cases of partial trisomy 12q in the literature, and, in the discussion they suggest the management after the diagnosis of hydrothorax has been made by ultrasound.