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Resume But Comparer le nombre de consultation et le delai de consultation en lien avec un ressenti de diminution des MAF en cas de grossesse prolongee selon l’utilisation ou non du compte des mouvements actifs fœtaux (MAF). Materiels et methodes Nous avons compare dans une etude de cohorte, un groupe « Temoin » compose de 160 patientes ayant eu un suivi et une information classique (du 18 decembre 2013 au 28 fevrier 2014) versus un groupe « Informee » compose de 160 patientes ayant beneficie d’une education au compte des MAF (du 1 er mars 2014 au 12 aout 2014). Resultats Les consultations pour diminution des MAF etaient significativement plus frequentes dans le groupe « Temoin » par rapport au groupe « Informee » (36 versus 8, p = 0,0009). Les declenchements pour baisse des MAF n’etaient pas statistiquement differents entre les deux groupes (13 patientes dans le groupe « Informee» versus 7 patientes dans le groupe « Temoin », p = 0,97). Conclusion L’apprentissage d’une technique de compte des mouvements actifs fœtaux parait diminuer le nombre de consultation pour diminution des MAF sans augmenter la morbidite perinatale mais peut etre au prix d’une augmentation des interventions obstetricales.

Resume Objectif Evaluer l’etat des connaissances des patientes suivies pour grossesse prolongee sur les mouvements actifs fœtaux. Patientes et methode Enquete prospective, declarative par questionnaire, aupres de toutes les patientes volontaires lors de la consultation de terme a 41+0 SA dans les services de gynecologie obstetrique du CHU de Saint-Etienne, du CHU de Clermont-Ferrand, du centre hospitalier de Roanne et du centre hospitalier de Firminy entre le 22 juillet 2013 et le 14 septembre 2013. Resultats La baisse des MAF est un motif peu frequent de consultation en urgence (17 % des patientes). Bien souvent le delai de consultation reste tardif puisque 73,6 % des patientes attendent 24 heures pour consulter. Plus d’une femme sur deux n’avaient jamais ete informees avant leur terme sur ce sujet. A contrario, les patientes estiment qu’il serait interessant de vehiculer ce genre d’information en consultation a 86,84 %. Enfin, la methode la plus simple a adopter serait un compte de MAF 3 fois par jour sur une courte periode. Discussion et conclusion Il persiste un manque d’information sur les mouvements fœtaux. La difficulte reside dans le fait que cette notion reste une definition subjective et que l’information n’est pas protocolisee.

Objective Evaluate accuracy of prenatal ultrasound findings in predicting the risk of bowel atresia in patients with gastroschisis. Methods A retrospective study was conducted on 18 fetuses with a prenatal diagnostic of gastroschisis treated at University hospital of Saint Etienne France between 2002 and 2012. Ultrasound abnormalities were used to classify them into three groups: no ultrasound abnormality ( n = 4), oligohydramnios ( n = 9), intra-abdominal bowel dilatation ≥20.5 mm ( n = 5). Postnatal outcomes were compared between groups. The threshold value of 20.5 mm for the prediction of atresia was determined through the receiver operator characteristics curve. Results In the group with oligohydramnios, intra uterine growth restriction were significantly more frequent ( p = 0.015) and three newborns had serositis including two with secondary complications after the initial surgery. In the group with major intra-abdominal bowel dilatation, all had a narrow defect p = 0.002). Intra-abdominal bowel dilatation reaching 20.5 mm started at a mean gestational age significantly lower than that of the other fetuses (23.3 versus 29.7 weeks p = 0.02). On the five fetuses presented intra-abdominal bowel dilatation ≥20.5 mm, four showed atresia and no other newborn has this complication ( p = 0.0016). The threshold value of 20.5 mm has a sensitivity of 100% and a specificity of 92.9%. The area under the curve was equal to 96.4%. Conclusion Intra-abdominal bowel dilatation ≥20.5 mm seems to be associated with the risk of postnatal atresia. MRI could help to clarify a complicated or uncertain ultrasound aspect.

To evaluate the effectiveness of an interdisciplinary team training program based on simulated scenarios and focusing on two obstetrical emergency situations: shoulder dystocia and complicated breech vaginal delivery (CBVD). These situations are rare, so there are few opportunities for real-life training, yet their competent and efficient management is crucial to minimizing the risks to mother and child.The target population for training comprised the 450 professionals working in the French regional perinatal care network ELENA. An expert committee defined the topics for the training program, selected the simulated scenarios and developed the evaluation grids. The training sessions were conducted by two qualified and experienced professionals in each maternity unit. They comprised a theoretical introduction followed by practical exercises in management of simulated emergency situations by the participant teams, with the aid of a mannequin. Each team completed the exercises twice, their performances being filmed, reviewed and evaluated in each case.The training sessions took place over 9 months between September 2012 and June 2013. A total of 298 professionals (obstetricians, residents in obstetrics, midwives and nursery nurses) were trained, representing 75% of the staff working in the ELENA perinatal care network. The results showed substantial and significant increases in the overall scores for management of the two emergency situations (from 74.5% to 91.4% for shoulder dystocia [p0.0001], and from 67.2% to 88.4% [p0.0001] for CBVD) as well as in the scores for all the specific areas of expertise assessed: safety, know-how, technique, team communication and communication with the patient.This study demonstrated the value of multidisciplinary team training for obstetric emergencies, encouraging the ELENA perinatal care network to implement an annual training program for its staff. Over and above our experience, the future establishment of a national education program to optimize the management of obstetric emergencies seems to be essential.