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1. Cartographie de la prise en charge du nouveau-né dans les maternités de l’Assistance Publique des Hôpitaux de Paris et de la place de la sage-femme dans cette prise en charge

Author

Mallet, Marion, Université de Paris - École de sages-femmes Baudelocque (UP ESF Baudelocque), Université de Paris (UP), and Claire Boithias

Subjects
MESH: Illegitimacy, Organization of Care, Organisation des soins, MESH: Infant, Newborn, Midwife, Légitimité, MESH: Midwifery, Compétence, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Nouveau-né, Comprehensive Care, Sage-femme, MESH: Postpartum Period, Obstacles, MESH: Patient Care Management, Postpartum, MESH: Competence, Skill, MESH: Professional, Prise en charge globale, Legitimacy, Freins, Suites de couches
Abstract

Background: comprehensive care is more and more popular in the nursing of mother-child couples. However, we can notice a multiplication of protagonists with this couple in the postpartum. Midwives are health professionals with skills in taking care of healthy infants and the mother. In this way, the midwife is at the center of this overall nursing. Objective: the objective of this study is to track the care of the healthy newborns in the maternities of the Assistance Publique Hôpitaux de Paris (APHP) and to show how the midwife in an integral part of this care. Population and method: this is about a descriptive multicenter observational study. To achieve this, we carried out two questionnaires: the first one to the coordinators of childbirth and the second to the midwives of the 13 maternities of the APHP. In these questionnaires, we inquire them regarding the organization of cares provided to the newborns in their maternity unit. We also asked the midwives about their competence and legitimacy feelings with newborns. Results: we obtained 181 responses from midwives in 13 APHP maternities (being 24.69% of APHP midwives) and 11 responses from coordinators (84.61%). According to the different questionnaires, the midwife is the professional who, for the most part, guides the newborns in feeding. Midwives are rarely named in the management of systematic screenings and pathologies. These results vary according to the different maternities, and we can notice a real disparity in the skills used. Midwives evaluate themselves positively regarding their abilities with newborns with an average of 13.84 / 20. Regarding their legitimacy, the self-assessment is 14.95 / 20. Disincentives to investment in newborns are variable. However, the main impediment quoted by 60.77% of the midwives is due to a lack of time.; Contexte : la prise en charge globale reste privilégiée dans l’accompagnement des couples mère-enfants. Toutefois, nous pouvons remarquer une multiplication des intervenants auprès de ce couple en suites de couches. Les sages-femmes sont des professionnels de santé ayant les compétences pour s’occuper des nouveau-nés bien portants ainsi que de la mère. La sage-femme est donc au centre de cette prise en charge globale. Objectif : l’objectif de cette étude est de cartographier la prise en charge des nouveau-nés bien portant dans les maternités de l’Assistance Publique Hôpitaux de Paris et de montrer comment la sage-femme s’inscrit dans cette prise en charge. Population et méthode : il s’agit d’une étude observationnelle descriptive multicentrique. Pour cela, nous avons réalisé deux questionnaires : le premier à l’intention des coordinatrices de suites de couches et le second à l’intention des sages-femmes des 13 maternités de l’APHP. Dans ces questionnaires, nous les avons interrogées sur l’organisation des soins réalisés auprès des nouveau-nés dans leur maternité. Nous avons également interrogé les sages-femmes sur leurs sentiments de compétence et de légitimité auprès du nouveau-né. Résultats : nous avons obtenu 181 réponses de sages-femmes réparties dans les 13 maternités de l’APHP (soit 24,69% des sages-femmes de l’APHP) et 11 réponses des coordinatrices (soit 84,61%). D’après les différents questionnaires, la sage-femme est le professionnel qui accompagne majoritairement les nouveau-nés dans leur alimentation. Elle n’est que peu citée lors de la prise en charge des dépistages systématiques, ainsi que des pathologies. Ces résultats varient en fonction des maternités, et nous pouvons observer une réelle disparité des compétences utilisées. Les sages-femmes s’autoévaluent de manière positive en ce qui concerne leurs aptitudes auprès des nouveau-nés avec une moyenne de 13,84/20. En ce qui concerne leur légitimité, elles se notent à hauteur de 14,95/20. Les freins à l’investissement auprès des nouveau-nés sont variables. Toutefois, le frein majoritaire cité par 60,77% des sages-femmes est un manque de temps.

Published
2020

2. Satisfaction des femmes à travers l’expérience vécue en maternité autour de l’accompagnement de l’allaitement maternel

Author

Bassot, Sarah, Université de Paris - École de sages-femmes Baudelocque (UP ESF Baudelocque), Université de Paris (UP), and Hélène Guillaume

Subjects
MESH: Counseling, Satisfaction, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Nuit, MESH: Night Care, MESH: Postpartum Period, Postpartum, Expérience vécue, MESH: Life Change Events, Maternité, MESH: Breast Feeding, MESH: Personal Satisfaction, MESH: Hospitals, Maternity, Allaitement, Lived Experience, Accompagnement
Abstract

Breastfeeding is a choice that is often made antenatally, but which is rooted into the experience of the first postpartum days. The way it is implemented at the early beginning determines whether it is pursued in the long term or not. The aim of this study is to evaluate women's satisfaction about the support provided about breastfeeding in the maternity ward during day and night. The secondary objectives are: to collect the women's stories during the first few days, to evaluate what happens more specifically at night and to highlight elements influencing their satisfaction. A qualitative study based on semi-directed interviews with 15 women in the postpartum period was conducted. The results show that the quality of interactions with the staff is needed for a good experience of the immediate postpartum. Particularly, the essential elements for a good breastfeeding experience in the first days are: the availability and time given by the teams to the women, advice, and some reassurance and encouragement. Night at the maternity ward is described as a period that exacerbates difficulties, feelings of loneliness and anxiety and therefore requires special attention. Women's initial motivations do not seem to have an impact on their expectations during the first few days. As a conclusion let’s say that the interactions with the maternity staff and the provided support influence women's satisfaction level concerning the way breastfeeding is implemented. In the maternity ward, professionals are at the heart of the construction of the mother/newborn diad, and it is therefore necessary to think about the best way to contribute to the satisfaction of the needs and expectations of women in the postpartum period.; L’allaitement maternel est un choix souvent fait en anténatal mais qui s’ancre dans l’expérience des premiers jours du post-partum. Sa mise en place détermine sa poursuite à plus long terme. L’étude réalisée a pour objectif d’évaluer la satisfaction des femmes sur l’accompagnement de l’allaitement à la maternité le jour, comme la nuit. Les objectifs secondaires étant de : recueillir le récit des femmes les premiers jours, évaluer ce qui se passe plus spécifiquement la nuit et mettre en évidence des éléments influant sur leur satisfaction. Une étude qualitative basée sur des entretiens semi-dirigés avec 15 femmes dans le post-partum a été menée. Les résultats permettent de mettre en évidence que la qualité des interactions avec le personnel est nécessaire à un bon vécu du post-partum immédiat. Plus particulièrement, les éléments indispensables à une bonne expérience vécue autour de l’allaitement les premiers jours sont : la disponibilité et le temps accordé par les équipes aux femmes, les conseils, les paroles de réassurance et l’encouragement. La nuit à la maternité est décrite comme une période exacerbant les difficultés et les sentiments de solitude, d’angoisse, nécessitant donc un accompagnement particulier. La motivation initiale des femmes ne semble pas avoir d’impact sur leurs attentes les premiers jours. En conclusion, les interactions avec le personnel de la maternité et l’accompagnement proposé influencent la satisfaction des femmes sur l’accompagnement de la mise en place de l’allaitement maternel. À la maternité, les professionnels se trouvent au cœur de la construction de la dyade mère/nouveau-né, et il est donc nécessaire de réfléchir à la meilleure manière de concourir à la satisfaction des besoins et attentes des femmes en post-partum.

Published
2020

3. Long-Term Outcomes After Reversible Cerebral Vasoconstriction Syndrome

Author

Grégory Marin, Marie-Germaine Bousser, Jérôme Mawet, Claire Duflos, Caroline Roos, Anne Ducros, Solene De Gaalon, Cécilia Burcin, Rosalie Boitet, Ursula Fiedler, Département de neurologie [Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier]-Université de Montpellier (UM), Service de neurologie [Nantes], Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Hôpital Guillaume-et-René-Laennec [Saint-Herblain], Département d'Information Médicale [CHRU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital Lariboisière-Fernand-Widal [APHP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)

Subjects
Male, Headache Disorders, Primary, MESH: Vasospasm, Intracranial, Cerebral arteries, 030204 cardiovascular system & hematology, 0302 clinical medicine, Pregnancy, Recurrence, Long term outcomes, Vasospasm, Intracranial, Thunderclap headaches, MESH: Middle Aged, MESH: Time, Postpartum Period, MESH: Headache Disorders, Primary, Headache, MESH: Follow-Up Studies, Middle Aged, MESH: Migraine Disorders, Reversible cerebral vasoconstriction syndrome, Cardiology, Female, MESH: Cerebrovascular Disorders, MESH: Vasoconstriction, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], medicine.symptom, Cardiology and Cardiovascular Medicine, Adult, medicine.medical_specialty, Migraine Disorders, Time, MESH: Postpartum Period, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, medicine, Humans, Advanced and Specialized Nursing, MESH: Humans, business.industry, MESH: Adult, medicine.disease, MESH: Male, Cerebrovascular Disorders, Migraine, Vasoconstriction, Neurology (clinical), business, MESH: Female, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract

Background and Purpose— We aimed to further investigate the long-term outcomes after reversible cerebral vasoconstriction syndrome (RCVS). Methods— A longitudinal follow-up study was conducted in 173 RCVS patients. Results— Of the 172 patients who completed a mean follow-up of 9.2±3.3 years, 10 had a recurrent RCVS that was benign in all. Independent predictors of relapse were having a history of migraine and having exercise as a trigger for thunderclap headache during initial RCVS. After new delivery, the rate of postpartum RCVS was 9%. Conclusions— Overall, long-term outcome after RCVS is excellent.

Published
2020
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4. Idiopathic granulomatous mastitis responding to oral prednisone

Author

Phi Do Trinh, Radjiv Goulabchand, Emilie Aubert‐Bringer, Philippe Guilpain, Hélène Perrochia, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Gynepole, Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), and Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)

Subjects
Adult, medicine.medical_specialty, Cutaneous Fistula, MEDLINE, Granulomatous mastitis, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, MESH: Cutaneous Fistula, MESH: Postpartum Period, 03 medical and health sciences, 0302 clinical medicine, MESH: Pregnancy, Prednisone, Pregnancy, Internal Medicine, medicine, Humans, 030212 general & internal medicine, Granulomatous Mastitis, skin and connective tissue diseases, Glucocorticoids, MESH: Granulomatous Mastitis, Wound Healing, 030219 obstetrics & reproductive medicine, MESH: Humans, business.industry, Postpartum Period, MESH: Adult, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, medicine.disease, Dermatology, 3. Good health, Pregnancy Complications, MESH: Wound Healing, Breast Feeding, Oncology, MESH: Pregnancy Complications, MESH: Breast Feeding, Disease Progression, Surgery, Female, MESH: Disease Progression, business, MESH: Glucocorticoids, MESH: Female, MESH: Prednisone, medicine.drug
Abstract

International audience; A 33-year-old woman presented with left breast chronic wound. Her past medical history was unremarkable, except tobacco use (

Published
2019
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5. Neuraxial analgesia is not associated with an increased risk of post-partum relapses in MS

Author

Caroline Lavie, Fabien Rollot, Françoise Durand-Dubief, Romain Marignier, Iuliana Ionescu, Romain Casey, Thibault Moreau, Patricia Tourniaire, Michael Hutchinson, Marie Béatrice D’Hooghe, David-Axel Laplaud, Pierre Clavelou, Jérôme De Sèze, Marc Debouverie, David Brassat, Jean Pelletier, Christine Lebrun-Frenay, Emmanuelle Le Page, Giovanni Castelnovo, Eric Berger, Patrick Hautecoeur, Olivier Heinzlef, Luca Durelli, Marinella Clerico, Maria Trojano, Francesco Patti, Sandra Vukusic, A. Alpérovitch, H. Carton, M.B. d’Hooghe, O. Hommes, M. Hutchinson, P. Adeleine, A. Biron, P. Cortinovis-Tourniaire, J. Grimaud, M. Hours, T. Moreau, S. Vukusic, C. Confavreux, G. Chauplannaz, D. Latombe, M. Clanet, G. Lau, L. Rumbach, J.Y. Goas, F. Rouhart, A. Mazingue, E. Roullet, M. Madigand, P. Hautecoeur, P. Brunet, G. Edan, C. Allaire, G. Riffault, J. Leche, T. Benoit, C. Simonin, F. Ziegler, J.C. Baron, Y. Rivrain, R. Dumas, D. Loche, J.C. Bourrin, B. Huttin, B. Delisse, I. Gibert, C. Boulay, M. Verceletto, G. Durand, G. Bonneviot, R. Gil, M.A. Hedreville, C. Belair, R.J. Poitevin, J.L. Devoize, P. Wyremblewski, F. Delestre, A. Setiey, G. Comi, M. Filippi, A. Ghezzi, V. Martinelli, P. Rossi, M. Zaffaroni, M.R. Tola, M.P. Amato, C. Fioretti, G. Meucci, M. Inglese, G.L. Mancardi, D. Gambi, A. Thomas, M. Cavazzuti, A. Citterio, A. Heltberg, H.J. Hansen, O. Fernandez, F. Romero, T. Arbizu, J.J. Hernandez, C. De Andres de Frutos, D. Geffner Sclarky, Y. Aladro Benito, P. Reyes Yanes, M Aguilar, J.A. Burguera, R. Yaya, W. Bonakim Dib, D. Arzua-Mouronte, C.J.M. Sindic, R. Medaer, H. Roose, K.M.J. Geens, D. Guillaume, M. Van Zandycke, J. Janssens, M. Cornette, L. Mol, F. Weilbach, P. Flachenecker, H.P. Hartung, J. Haas, I. Tendolkar, E. Sindrn, H.W. Kölmel, D. Reichel, M. Rauch, S. Preuss, S. Poser, E. Mauch, S. Strausser-Fuchs, H. Kolleger, S. Hawkins, S.J.L. Howell, J.E. Rees, A. Thompson, M. Johnson, M. Boggild, R.P. Gregory, D. Bates, I. Bone, C. Polman, S. Frequin, P. Jongen, J. Correia de Sa, M.E. Rio, S. Huber, J. Lechner-Scott, L. Kappos, I. Ionescu, C. Cornu, M. El-Etr, E.E. Baulieu, M Schumacher, D.H. Miller, M. Pugeat, C. d’Archangues, J. Conard, J. Ménard, R. Sitruk-Ware, C. Pelissier, S. Dat, J. Belaïsch-Allard, N. Athéa, D. Büschsenschutz, O. Lyon-Caen, R. Gonsette, J.P. Boissel, P. Ffrench, F. Durand-Dubief, F. Cotton, C. Pachai, L. Bracoud, G. Androdias, R. Marignier, D.A. Laplaud, S. Wiertlewski, C. Lanctin-Garcia, G. Couvreur, G. Madinier, P. Clavelou, F. Taithe, D. Aufauvre, N. Guy, A. Ferrier, J. De Sèze, N. Collongues, M. Debouverie, F. Viala, D. Brassat, A. Gerdelat-Mas, P. Henry, J. Pelletier, A. Rico-Lamy, C. Lebrun-Frenay, E. Lepage, V. Deburghraeve, G. Castelnovo, E. Berger, M. Blondiau, O. Heinzlef, M. Coustans, C. Clerc, L. Rieu, M. Lauxerois, G. Hinzelin, J.C. Ouallet, D. Minier, P. Vion, N. Gromaire-Fayolle, N. Derache, E. Thouvenot, M. Sallansonnet-Froment, P. Tourniaire, L. Toureille, F. Borgel, B. Stankoff, C. Moroianu, A.M. Guennoc, C.L. Tournier-Gervason, S. Peysson, M. Trojano, F. Patti, E. D’Amico, L. Motti, L. Durelli, A. Tavella, Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL), Observatoire Français de la Sclérose En Plaques [Lyon] (OFSEP), Service de neurologie fonctionnelle et d'épileptologie [Hôpital Pierre Wertheimer-HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center (CRNL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de Neurologie générale, vasculaire et dégénérative (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier Henri Duffaut (Avignon), National MS Center Melsbroek, Vrije Universiteit Brussel [Bruxelles] (VUB), Vrije Universiteit Brussel (VUB), Centre de Recherche en Transplantation et Immunologie (U1064 Inserm - CRTI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Service de Neurologie [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand-CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, Neuro-Dol (Neuro-Dol), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne (UCA), Laboratoire de Neuroimagerie in Vivo (LNV), CHU Strasbourg-Centre National de la Recherche Scientifique (CNRS), Les Hôpitaux Universitaires de Strasbourg (HUS), Service de neurologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), Neurologie vasculaire, pathologie neuro-dégénérative et explorations fonctionnelles du système nerveux [Toulouse], Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse], Centre de Physiopathologie Toulouse Purpan (CPTP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre de résonance magnétique biologique et médicale (CRMBM), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS), Hôpital de la Timone [CHU - APHM] (TIMONE), Centre Hospitalier Universitaire de Nice (CHU Nice), Université Côte d'Azur (UCA), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service de Neurologie [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Groupe Hospitalier de l'Institut Catholique de Lille (GHICL), Université catholique de Lille (UCL), centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy], Università degli studi di Torino = University of Turin (UNITO), University of Catania [Italy], Hospices Civils de Lyon, Departement de Neurologie (HCL), Biostatistiques santé, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), CHU Toulouse [Toulouse], Protéines membranaires transductrices d'énergie (PMTE), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Centre National de la Recherche Scientifique (CNRS), Institut des Géosciences de l’Environnement (IGE), Institut de Recherche pour le Développement (IRD)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Centre de Recherches sur les Macromolécules Végétales (CERMAV ), Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Environnement Ville Société (EVS), École normale supérieure - Lyon (ENS Lyon)-École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université Lumière - Lyon 2 (UL2)-Université Jean Moulin - Lyon 3 (UJML), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet [Saint-Étienne] (UJM)-École Nationale des Travaux Publics de l'État (ENTPE)-École nationale supérieure d'architecture de Lyon (ENSAL)-Centre National de la Recherche Scientifique (CNRS), Solvay (France), Laboratoire des Mécanismes et Transfert en Géologie (LMTG), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Observatoire Midi-Pyrénées (OMP), Institut de Recherche pour le Développement (IRD)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS)-Université Fédérale Toulouse Midi-Pyrénées-Météo-France -Institut de Recherche pour le Développement (IRD)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS)-Météo-France -Centre National de la Recherche Scientifique (CNRS), Institute of Evolutionary Biology, University of Edinburgh, Université de Lille, Sciences et Technologies, Service de Génétique Médicale [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Différenciation, interaction, activation et migration des sous-populations lymphocitaires humaines, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Motricité, interactions, performance EA 4334 / Movement - Interactions - Performance (MIP), Le Mans Université (UM)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université de Nantes - UFR des Sciences et Techniques des Activités Physiques et Sportives (UFR STAPS), Laboratoire Ecologie Fonctionnelle et Environnement (ECOLAB), Institut Ecologie et Environnement (INEE), Centre National de la Recherche Scientifique (CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université Toulouse III - Paul Sabatier (UT3), Institut de Recherche pour le Développement (IRD)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS)-Université Fédérale Toulouse Midi-Pyrénées-Météo-France -Institut de Recherche pour le Développement (IRD)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS)-Météo-France -Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées, Laboratoire de Chimie Physique D'Orsay (LCPO), Université Paris-Sud - Paris 11 (UP11)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), RMN et optique : De la mesure au biomarqueur, Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Department of Neurology, CHU Lyon, Institut de Recherche de Chimie Paris (IRCP), Ecole Nationale Supérieure de Chimie de Paris - Chimie ParisTech-PSL (ENSCP), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Ministère de la Culture (MC), Hôpital de Hautepierre [Strasbourg], Laboratoire de Réactivité des Surfaces et des Interfaces (LRSI), Département de Physico-Chimie (DPC), CEA-Direction des Energies (ex-Direction de l'Energie Nucléaire) (CEA-DES (ex-DEN)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay-CEA-Direction des Energies (ex-Direction de l'Energie Nucléaire) (CEA-DES (ex-DEN)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay, Empenn, Institut National de la Santé et de la Recherche Médicale (INSERM)-Inria Rennes – Bretagne Atlantique, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-SIGNAUX ET IMAGES NUMÉRIQUES, ROBOTIQUE (IRISA-D5), Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Institut National de Recherche en Informatique et en Automatique (Inria)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université de Rennes 1 (UR1), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Institut de Recherche en Informatique et Systèmes Aléatoires (IRISA), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT), Service de Neurologie [Rennes] = Neurology [Rennes], CHU Pontchaillou [Rennes], Biologie des Interactions Neurones / Glie, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Fondation pour l'Aide à la Recherche sur la Sclérose en Plaques, European Leukodystrophies Association, PHRC National, Lipides - Nutrition - Cancer (U866) (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon (ENSBANA), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Pierre Wertheimer, Département de Neurologie, Laboratoire de Mathématiques (LAMA), Centre National de la Recherche Scientifique (CNRS)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry]), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Nottingham Scientific Limited, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], Assistance Publique - Hôpitaux de Marseille (APHM)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Service de neurologie [Rennes], Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Turin, Università degli studi di Torino (UNITO), University of Bari Aldo Moro (UNIBA), Department of Neurosciences, Università degli studi di Catania [Catania], Centre de recherche en neurosciences de Lyon (CRNL), Neuroépidémiologie, Institut de Physique du Globe de Paris (IPGP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut national des sciences de l'Univers (INSU - CNRS)-IPG PARIS-Université Paris Diderot - Paris 7 (UPD7)-Université de La Réunion (UR)-Centre National de la Recherche Scientifique (CNRS), Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut de Recherche pour le Développement (IRD)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Centre National de la Recherche Scientifique (CNRS)-École nationale supérieure d'architecture de Lyon (ENSAL)-École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-École Nationale des Travaux Publics de l'État (ENTPE)-Université Jean Monnet [Saint-Étienne] (UJM)-Université Jean Moulin - Lyon 3 (UJML), Université de Lyon-Université Lumière - Lyon 2 (UL2)-École normale supérieure - Lyon (ENS Lyon), Météo France-Centre National d'Études Spatiales [Toulouse] (CNES)-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Météo France-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Centre National de la Recherche Scientifique (CNRS), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut Ecologie et Environnement (INEE), Centre National de la Recherche Scientifique (CNRS)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Observatoire Midi-Pyrénées (OMP), Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Ecole Nationale Supérieure de Chimie de Paris - Chimie ParisTech-PSL (ENSCP), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Ministère de la Culture (MC), Université de Bretagne Sud (UBS)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National de Recherche en Informatique et en Automatique (Inria)-École normale supérieure - Rennes (ENS Rennes)-Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-CentraleSupélec-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université de Bretagne Sud (UBS)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-École normale supérieure - Rennes (ENS Rennes)-Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Lavie, Caroline, Rollot, Fabien, Durand-Dubief, Françoise, Marignier, Romain, Ionescu, Iuliana, Casey, Romain, Moreau, Thibault, Tourniaire, Patricia, Hutchinson, Michael, D’Hooghe, Marie Béatrice, Laplaud, David-Axel, Clavelou, Pierre, De Sèze, Jérôme, Debouverie, Marc, Brassat, David, Pelletier, Jean, Lebrun-Frenay, Christine, Le Page, Emmanuelle, Castelnovo, Giovanni, Berger, Eric, Hautecoeur, Patrick, Heinzlef, Olivier, Durelli, Luca, Clerico, Marinella, Trojano, Maria, Patti, Francesco, Vukusic, Sandra, on behalf of PRIMS and POPARTMUS, Investigator, Filippi, Massimo, Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy], Environnement, Ville, Société (EVS), École normale supérieure de Lyon (ENS de Lyon)-École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-École Nationale des Travaux Publics de l'État (ENTPE)-École nationale supérieure d'architecture de Lyon (ENSAL)-Centre National de la Recherche Scientifique (CNRS), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Neuroimagerie: méthodes et applications (Empenn), Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-Institut National de Recherche en Informatique et en Automatique (Inria)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université de Rennes (UR)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Bretagne Sud (UBS)-École normale supérieure - Rennes (ENS Rennes)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS)-IMT Atlantique (IMT Atlantique), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Laboratoire de glaciologie et géophysique de l'environnement (LGGE), Observatoire des Sciences de l'Univers de Grenoble (OSUG), Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Centre National de la Recherche Scientifique (CNRS), Centre de Recherches sur les Macromolécules Végétales (CERMAV), Université Joseph Fourier - Grenoble 1 (UJF)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Necker - Enfants Malades [AP-HP], Laboratoire Motricité, Interactions, Performance, Université de Nantes (UN), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Paris-Sud - Paris 11 (UP11)-Centre National de la Recherche Scientifique (CNRS), Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS), Ecole Nationale Supérieure de Chimie de Paris- Chimie ParisTech-PSL (ENSCP)-Centre National de la Recherche Scientifique (CNRS)-Ministère de la Culture (MC), Centre Hospitalier Universitaire de Strasbourg (CHU de Strasbourg ), CEA-Direction de l'Energie Nucléaire (CEA-DEN), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay-CEA-Direction de l'Energie Nucléaire (CEA-DEN), Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes), Service de neurologie [Besançon], Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Hôpital Jean Minjoz, Service de Neurologie [CHU Besançon], Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon), Service de Neurologie [Rennes], Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Clinical sciences, Neuroprotection & Neuromodulation, and Neurology

Subjects
relapses, Neurology, [SDV]Life Sciences [q-bio], MESH: Pregnancy Complications / physiopathology, 0302 clinical medicine, MESH: Pregnancy, Anesthesia, Conduction, Recurrence, MESH: Anesthesia, Conduction / adverse effects, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, reproductive and urinary physiology, relapse, Postpartum Period, post-partum, MESH: Follow-Up Studies, MESH: Multiple Sclerosis / physiopathology, Obstetrical Analgesia, MESH: Multiple Sclerosis / chemically induced, Anesthesia, Female, pregnancy, Adult, medicine.medical_specialty, Clinical Neurology, Multiple sclerosis, MESH: Postpartum Period, 03 medical and health sciences, medicine, Humans, Multiple sclerosi, Post partum, Retrospective Studies, Pregnancy, MESH: Humans, MESH: Pregnancy Complications / chemically induced, business.industry, Neurotoxicity, MESH: Adult, MESH: Retrospective Studies, neuraxial analgesia, medicine.disease, MESH: Recurrence, Multiple sclerosis, neuraxial analgesia, post-partum, pregnancy, Pregnancy Complications, Increased risk, Neurology (clinical), [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Follow-Up Studies
Abstract

Background: Obstetrical analgesia remains a matter of controversy because of the fear of neurotoxicity of local anesthetics on demyelinated fibers or their potential relationship with subsequent relapses. Objective: To assess the impact of neuraxial analgesia on the risk of relapse during the first 3 months post-partum, with a focus on women who experienced relapses during pregnancy. Methods: We analyzed data of women followed-up prospectively during their pregnancies and at least 3 months post-partum, collected in the Pregnancy in Multiple Sclerosis (PRIMS) and Prevention of Post-Partum Relapses with Progestin and Estradiol in Multiple Sclerosis (POPARTMUS) studies between 1992–1995 and 2005–2012, respectively. The association of neuraxial analgesia with the occurrence of a post-partum relapse was estimated by logistic regression analysis. Results: A total of 389 women were included, 215 from PRIMS and 174 from POPARTMUS. In total, 156 women (40%) had neuraxial analgesia. Overall, 24% experienced a relapse during pregnancy and 25% in the 3 months post-partum. Women with a pregnancy relapse were more likely to have a post-partum relapse (odds ratio (OR) = 1.83, p = 0.02), independently of the use of neuraxial analgesia. There was no association between neuraxial analgesia and post-partum relapse (OR = 1.08, p = 0.78). Conclusion: Neuraxial analgesia was not associated with an increased risk of post-partum relapses, whatever multiple sclerosis (MS) activity during pregnancy.

Published
2019
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6. Efficacy of tenofovir in preventing perinatal transmission of HBV infection in pregnant women with high viral loads

Author

Yongzheng Wu, Lhousseine Touqui, Ya-Yun Lin, Dunjin Chen, Guifeng Ding, Guiqin Bai, Wei-Min Wang, Keying Liu, Na Xu, Lingyan Zhang, Yan Liu, Wu, Yongzheng, Xi'an Jiaotong University (Xjtu), Research Center for Clinical and Translational Medicine / Institute of Infectious Diseases [Beijing, China], Maternal and Child Health Care Hospital of Xinjiang Uygur Autonomous Region [Urumqi, China], Mucoviscidose et bronchopathies chroniques : biopathologie et phénotype cliniques - Cystic Fibrosis and Bronchial Diseases, Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), ShaanXi Provincial People Hospital [Xi’an, China], Guangzhou Medical University, Biologie cellulaire de l'Infection microbienne - Cellular Biology of Microbial Infection, Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), The authors acknowledge funding from the National Natural Science Foundation of China (National Science Foundation of China) - 81771615 and The General Program of Innovation of Science & Technology of Shaanxi Province (N°2016KTCL03-01)., CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur [Paris], and Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS)

Subjects
HBsAg, lcsh:Medicine, 0302 clinical medicine, MESH: Pregnancy, MESH: Tenofovir, Pregnancy, 030212 general & internal medicine, lcsh:Science, MESH: Treatment Outcome, [SDV.MP.VIR] Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Multidisciplinary, Obstetrics, Transmission (medicine), MESH: Infant, Newborn, Postpartum Period, virus diseases, Viral Load, MESH: Case-Control Studies, 3. Good health, MESH: Infectious Disease Transmission, Vertical, MESH: Hepatitis B virus, Treatment Outcome, HBeAg, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Gestation, 030211 gastroenterology & hepatology, Female, MESH: Viral Load, Viral load, medicine.drug, Adult, medicine.medical_specialty, Hepatitis B virus, Tenofovir, MESH: Hepatitis B, Chronic, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Virus, Article, MESH: Postpartum Period, 03 medical and health sciences, Hepatitis B, Chronic, medicine, Humans, Adverse effect, MESH: Humans, business.industry, lcsh:R, Infant, Newborn, MESH: Adult, digestive system diseases, Infectious Disease Transmission, Vertical, MESH: DNA, Viral, [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Case-Control Studies, DNA, Viral, lcsh:Q, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female
Abstract

Mother-to-child transmission is the major cause of chronic hepatitis B virus (HBV) infection. This double-blind trial tested the effect of tenofovir disoproxil fumarate (TDF) in preventing vertical transmission. Pregnant women who were HBsAg/HBeAg-positive with a HBV DNA titer ≥ 2×106 IU/mL were randomly assigned to the control (n = 60) and TDF-treated (n = 60) groups. TDF treatment (oral dose 300 mg/day) was initiated at 24 weeks of gestation and continued to 4 weeks after delivery. The subjects were followed up to 28 weeks postpartum. The effects of TDF on vertical transmission, outcomes of the mothers and infants and virological changes were monitored. TDF dynamically reduced the serum HBV DNA level of the mothers, particularly during the first 4 weeks of treatment. The lower viral loads were maintained in the pregnancies until delivery. Approximately 90% and 33.9% of the TDF-treated mothers had viral loads ≤2000 IU/mL after delivery and at 28 weeks postpartum, respectively. No cervical transmission or adverse effects were observed in the TDF-treated individuals, whereas 13.5% of the infants were infected with HBV in the control group. We conclude that TDF treatment initiated at 24 weeks of gestation in high-viremia, HBsAg/HBeAg-positive mothers efficiently prevents mother-to-child HBV transmission without adverse events in mothers and infants.

Published
2018
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7. Impact de la précarité sur la prescription de la contraception en suites de couches : étude qualitative dans une maternité de la petite couronne parisienne

Author

Blondeau, Cléo, Université Paris Descartes - École de sages-femmes Baudelocque (UPD ESF Baudelocque), Université Paris Descartes - Paris 5 (UPD5), Priscille Sauvegrain, and Sylvie Duquenois

Subjects
Sage-femme, MESH: Contraception, MESH: Postpartum Period, Contraception, Precariousness, MESH: Midwifery, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, Précarité, Post-partum
Abstract

The literature related unfavorable socio-economic contexts with a higher risk of unwanted and closely-spaced pregnancies. After-birth contraception interviews are carried at a singular moment in the gynecological women’s life, they usually are conducted by midwives and precarious living situations can be an obstacle to a contraception routine use. The main objective was to study the impact of precarious living situations on after-birth contraception prescription, while the secondary objectives were to describe interviews about postpartum contraception and to study which expectations are common to all women. A qualitative study based on non-participant observations of 20 interviews about post-partum birth control - including 10 among women in precarious situations - was conducted following a preliminary quantitative study including 102 women. The results showed no difference in the postpartum contraception prescription, neither in the formulated women’s expectations. However, it appeared that early implant placements before leaving the hospital, by women wishing implant, were more likely to be seen with precarious women, whose gynecological follow-up continuity is uncertain. A quantitative study on a larger scale could allow us to confirm this point.; La littérature met en lien les contextes socio-économiques défavorables et le risque de grossesses non souhaitées et rapprochées. L’entretien de contraception en suites de couches est réalisé à un moment singulier de la vie gynécologique des femmes, il est majoritairement réalisé par les sages-femmes et les situations de vie précaires peuvent rendre difficile la gestion d’une contraception. L’étude réalisée a pour objectif principal d’étudier l’impact des situations de précarité traversées par les patientes sur la prescription de la contraception en suites de couches, les objectifs secondaires étant de décrire les entretiens de contraception et d’étudier quelles attentes sont communes à toutes les femmes. Une étude qualitative basée sur l’observation non participante de 20 entretiens de contraception dont 10 auprès de femmes en situation de précarité a été réalisée suite à une étude quantitative préalable auprès de 102 femmes. Les résultats obtenus ne montrent pas de différence dans la prescription de contraception en suites de couches ni dans les attentes formulées des femmes. Il apparait cependant que la pose d’implant précoce avant la sortie de la maternité chez les femmes souhaitant l’implant concerne davantage celles en situation de précarité dont la continuité du suivi gynécologique est incertaine. Une étude quantitative à plus grande échelle pourrait permettre de confirmer ce résultat de la recherche.

Published
2018

8. Dépistage du diabète de type 2 après un diabète gestationnel : évaluation du taux de participation en post-partum et motifs de non-observance

Author

Minatchy, Aurélie, Université Paris Descartes - Faculté de Médecine (UPD5 Médecine), Université Paris Descartes - Paris 5 (UPD5), and Pierre Chedin

Subjects
MESH: Diabetes, Gestational, MESH: Diagnosis, Communication, Glycémie, Diabète gestationnel, Diabète de type 2, MESH: Primary Health Care, MESH: Postpartum Period, Dépistage, MESH: General Practice, MESH: Blood Glucose, Médecin généraliste, MESH: Communication, Premier recours, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Post-partum, MESH: Diabetes Mellitus, Type 2
Abstract

Background: gestational diabetes mellitus (GDM) is a common risk factor for post-partum type 2 diabetes mellitus (T2DM). Before the publication of national guidelines in 2010, screening rate was unsatisfying. Aim: to evaluate testing rates for abnormal postpartum glucose level and reasons why it is not performed. To determine testing results, and factors associated with a better screening rate. Methods: retrospective study of 139 GDM patients followed in a diabetology day care center in Val d’Oise between September 2014 and December 2014. Data were collected at least 3 months after delivery, by phone interview with patients, general practitioners (GPs) and/or laboratories, and from hospital medical files. Results: 127 patients were analyzed. 73.2% of them declared they had been tested for abnormal postpartum glucose level, but data obtained from GPs and laboratories showed only 58.3% underwent screening. 62% of GPs were informed of their patient’s GDM, 33% had received a discharge summary. 50% of all women knew their risk for later postpartum T2DM. Factors associated with better screening were GPs information (p=.0009), sending the discharge summary (p=.025), number of visits with a diabetologist (p=.025), and extent of postpartum weight loss (p=.011). Conclusion: type 2 diabetes mellitus screening after gestational diabetes mellitus remains low despite the publication of new recommendations. A better communication with the patients and their GPs is necessary to improve postpartum GDM management.; Introduction : le diabète gestationnel (DG) est un facteur de risque de diabète de type 2 (DT2) en post-partum. Son dépistage était insuffisant avant la diffusion des recommandations du CNGOF et de la SFD en 2010. Objectifs : évaluer le taux de réalisation des glycémies en post-partum et les motifs de non réalisation du dépistage. Déterminer le résultat du dépistage et rechercher les facteurs améliorant le dépistage. Méthodes : étude rétrospective incluant 139 patientes suivies pour DG en hôpital de jour de Diabétologie entre septembre 2014 et décembre 2014 dans un hôpital du Val d’Oise. Recueil des données au minimum 3 mois après l’accouchement, par entretien téléphonique avec les patientes, les médecins traitants (MT) et/ou les laboratoires, et consultation des dossiers médicaux. Résultats : 127 patientes ont été analysées. 73,2% ont déclaré avoir réalisé le dépistage en post-partum, mais seuls 58,3% des résultats ont été retrouvés après appel des médecins et des laboratoires. 62% des MT avaient été informés du DG, 33% avaient reçu un compte-rendu. 50% de notre population connaissait le risque de DT2 ultérieur. Les facteurs associés à l’amélioration du dépistage étaient l’information du MT (p=0,0009) et l’envoi d’un compte-rendu d’hospitalisation (p=0,025), le nombre de consultations en diabétologie (p=0,025), et l’importance de la perte de poids en post-partum (p=0,011). Conclusion : le dépistage du diabète de type 2 après un diabète gestationnel reste insuffisant malgré la diffusion des nouvelles recommandations. Une meilleure communication avec la patiente et avec son médecin traitant sont nécessaires pour améliorer la prise en charge en post-partum du DG.

Published
2016

9. Diagnostic value of a negative single complete compression ultrasound of the lower limbs to exclude the diagnosis of deep venous thrombosis in pregnant or postpartum women: A retrospective hospital-based study

Author

M. Collet, Caroline Bohec, Karine Lacut, Marc Philip Righini, Jean-Claude Vergos, Anne-Marije Prins, Pierre Germain, Emmanuel Oger, Raymond Kaczmarek, Grégoire Le Gal, Bruno Guias, Luc Bressollette, Dominique Mottier, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, Service de Gynécologie (CHIC - Gynécologie), CHIC Quimper, Service de Radiologie (CHIC - Radiologie), CHIC, Service de Gynécologie (CHPM - Gynécologie), CHPM - Morlaix, and Service de Gynécologie-Obstétrique (BREST - Gynéco-Obs)

Subjects
Adult, medicine.medical_specialty, Adolescent, Pregnancy Complications, Cardiovascular, MESH: Lower Extremity, MESH: Pregnancy Complications, Cardiovascular, 030204 cardiovascular system & hematology, MESH: Postpartum Period, 03 medical and health sciences, MESH: Pregnancy, 0302 clinical medicine, Predictive Value of Tests, Pregnancy, medicine, Humans, 030212 general & internal medicine, Risk factor, Retrospective Studies, Ultrasonography, MESH: Adolescent, Venous Thrombosis, MESH: Humans, Vascular disease, business.industry, Obstetrics, Medical record, Postpartum Period, MESH: Adult, MESH: Retrospective Studies, Retrospective cohort study, MESH: Follow-Up Studies, Hematology, medicine.disease, MESH: Predictive Value of Tests, 3. Good health, Surgery, Venous thrombosis, Lower Extremity, Embolism, Predictive value of tests, MESH: Venous Thrombosis, Female, business, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Postpartum period, Follow-Up Studies
Abstract

Objective We aimed at determining whether a negative single complete compression ultrasonography (CUS) of the lower limbs veins is a safe and accurate diagnostic method to rule out the diagnosis of deep venous thrombosis in pregnant and early postpartum women. Design Hospital-based retrospective study. Setting The gynaecology and vascular ultrasound units of three general hospitals in western France. Patients We identified from the hospitals databases all pregnant or up to three months postpartum women who underwent CUS for a suspicion of deep venous thrombosis between January 2002 and December 2004. Methods Questionnaires were sent to all women with a negative CUS. Their medical records were also checked. Main outcome measures We assessed the three-month thromboembolic risk and its 95% percent confidence interval in women left untreated on the basis of a negative single complete CUS of the lower limbs. Results During the study period, 162 pregnant or postpartum women underwent CUS for a suspicion of deep venous thrombosis. It was positive in 44 (27%). The 118 women who had a negative CUS were sent the questionnaire. Information about the three-month follow-up was found for 107 patients (91%). None of them experienced a thromboembolic event during follow-up: 0.0% (95% CI: 0.0–3.6). Conclusions Single complete CUS of lower limbs veins appears to be a safe method to rule out the diagnosis of deep venous thrombosis in pregnant or early postpartum women. This has to be confirmed by a prospective management study with a formal follow-up.

Published
2006
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10. Diagnostic value of single complete compression ultrasonography in pregnant and postpartum women with suspected deep vein thrombosis: prospective study

Author

Le Gal, Grégoire, Kercret, Geneviève, Ben Yahmed, Khalil, Bressollette, Luc, Robert-Ebadi, Helia, Riberdy, Louise, Louis, Patrick, Delluc, Aurélien, Labalette, Marie-Luce, Baba-Ahmed, Mohamed, Bounameaux, Henri, Mottier, Dominique, Righini, Marc, Renseigné, Non, Calvez, Ghislaine, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Cabinet KERCRET, Ville, Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service d'angiologie et d'hémostase (MR), Hôpital Universitaire de Genève, Cabinet LOUIS, and Cabinet LABALETTE

Subjects
Deep vein, MESH: Lower Extremity, MESH: Pregnancy Complications, Cardiovascular, 030204 cardiovascular system & hematology, MESH: Pregnancy, 0302 clinical medicine, Pregnancy, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Clinical Diagnostic Tests, reproductive and urinary physiology, Ultrasonography, Venous Thrombosis, ddc:616, education.field_of_study, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Postpartum Period, MESH: Follow-Up Studies, General Medicine, Venous Thromboembolism, Ultrasonography/methods, Thrombosis, MESH: Predictive Value of Tests, 3. Good health, Stroke, Venous Thrombosis/ultrasonography, Venous thrombosis, medicine.anatomical_structure, Lower Extremity, Radiology (Diagnostics), Predictive value of tests, MESH: Diagnostic Errors, Female, Radiology, Adult, medicine.medical_specialty, Population, Pregnancy Complications, Cardiovascular, MESH: Phlebography, MESH: Anticoagulants, Anticoagulants/administration & dosage/therapeutic use, MESH: Postpartum Period, 03 medical and health sciences, Lower Extremity/blood supply/ultrasonography, Drugs: Cardiovascular System, Predictive Value of Tests, medicine, Humans, Diagnostic Errors, education, Cardiovascular/ultrasonography, MESH: Humans, business.industry, Research, Anticoagulants, MESH: Adult, Phlebography, medicine.disease, MESH: Prospective Studies, Surgery, Pregnancy Complications, Reproductive Medicine, MESH: Venous Thrombosis, business, Pulmonary Embolism, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Postpartum period, MESH: Ultrasonography, Follow-Up Studies
Abstract

International audience; OBJECTIVE: To assess the safety of using single complete compression ultrasonography in pregnant and postpartum women to rule out deep vein thrombosis. DESIGN: Prospective outcome study. SETTING: Two tertiary care centres and 18 private practices specialising in vascular medicine in France and Switzerland. PARTICIPANTS: 226 pregnant and postpartum women referred for suspected deep vein thrombosis. METHODS: A single proximal and distal compression ultrasonography was performed. All women with a negative complete compression ultrasonography result did not receive anticoagulant therapy and were followed up for a three month period. MAIN OUTCOME MEASURES: Symptoms of venous thromboembolism, second compression ultrasonography or chest imaging, a thromboembolic event, and anticoagulant treatment. RESULTS: 16 women were excluded, mainly because of associated suspected pulmonary embolism. Deep vein thrombosis was diagnosed in 22 out of the 210 included women (10.5%). 10 patients received full dose anticoagulation despite a negative test result during follow-up. Of the 177 patients without deep vein thrombosis and who did not receive full dose anticoagulant therapy, two (1.1%, 95% confidence interval 0.3% to 4.0%) had an objectively confirmed deep vein thrombosis during follow-up. CONCLUSIONS: The rate of venous thromboembolic events after single complete compression ultrasonography in pregnant and postpartum women seems to be within the range of that observed in studies in the non-pregnant population. These data suggest that a negative single complete compression ultrasonography result may safely exclude the diagnosis of deep vein thrombosis in this setting. TRIAL REGISTRATION: clinicaltrials.gov NCT00740454.

Published
2012

11. Inpatient mother-and-child postpartum psychiatric care: factors associated with improvement in maternal mental health

Author

Christine Rainelli, Marie-Agathe Zimmermann, Anne-Claire Thieulin, Anne-Laure Sutter, Blanche Massari, Pierre-Yves Ancel, Odile Cazas, Nine M.-C. Glangeaud-Freudenthal, Alain Debourg, Michel Maron, Rafaële Cammas, Véronique Dagens-Lafont, Babak Khoshnood, Sylvie Nezelof, François Poinso, Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants ( UMR_S 953 ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Université Paris-Sud - Paris 11 ( UP11 ), Pôle Universitaire Psychiatrie Adulte, CHU Bordeaux [Bordeaux]-Hôpital Charles Perrens, Laboratoire de psychologie:Santé et qualité de vie, Université Bordeaux Segalen - Bordeaux 2, Centre Hospitalier Théophile Roussel, Département de Psychiatrie et de Santé mentale, CHU Strasbourg-Hopital Civil, Service de soins en périnatalité, Hôpital du vesinet, Unite Medico-Psychologique pour la Mère et l'Enfant, CHI Créteil, Service de psychiatrie, Université Paris-Sud - Paris 11 ( UP11 ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Paul Brousse, Unité d'hospitalisation mère-bébé, Hôpital de jour La pomme, Unité mère-bébé [Montesson], Unité d'Hospitalisation Parents-enfants, Assistance Publique - Hôpitaux de Marseille ( APHM ) -Hôpital Sainte-Marguerite [CHU - APHM] ( Hôpitaux Sud ), Hôpital Fontan-Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Service de psychiatrie infanto-juvénile, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants (UMR_S 953), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Descartes - Paris 5 (UPD5)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris-Sud - Paris 11 (UP11), Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse, Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital Sainte-Marguerite [CHU - APHM] (Hôpitaux Sud ), Hôpital Fontan-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Département de psychiatrie [CHRU de Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Debs, Nayla, Université Paris-Sud - Paris 11 (UP11)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), and CHU Bordeaux [Bordeaux]-Centre hospitalier Charles Perrens [Bordeaux]

Subjects
Male, Epidemiology, Social and Cross Cultural, MESH : Prospective Studies, Psychiatry in Europe, Disease, MESH : Mental Health, 0302 clinical medicine, MESH: Pregnancy, Pregnancy, Patient-Centered Care, Surveys and Questionnaires, Childbirth, MESH : Female, 030212 general & internal medicine, Prospective Studies, MESH: Inpatients, MESH: Postnatal Care, MESH: Treatment Outcome, MESH: Middle Aged, MESH: Mental Health, Mental Disorders, MESH: Infant, Newborn, Postpartum Period, MESH : Postnatal Care, MESH : Questionnaires, MESH : Infant, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, Middle Aged, MESH : Adult, MESH: Infant, MESH: Mothers, Postpartum disorders, MESH : Patient-Centered Care, MESH : Postpartum Period, 3. Good health, MESH: International Classification of Diseases, Psychiatry and Mental health, Mental Health, Treatment Outcome, Schizophrenia, MESH: Young Adult, MESH : Mothers, MESH : Inpatients, Female, Psychology, Clinical psychology, Adult, Postnatal Care, medicine.medical_specialty, Adolescent, MESH : Male, MESH : Young Adult, Mothers, MESH : Treatment Outcome, MESH : Infant, Newborn, MESH: Patient-Centered Care, MESH: Postpartum Period, 03 medical and health sciences, Young Adult, International Classification of Diseases, MESH : Adolescent, MESH : International Classification of Diseases, medicine, MESH: Mental Disorders, Humans, MESH : Middle Aged, Personality disorders, MESH : Mental Disorders, Psychiatry, MESH: Adolescent, Inpatients, MESH: Humans, Public health, MESH: Questionnaires, MESH : Humans, Infant, Newborn, Social environment, Infant, Mother-baby unit, MESH: Adult, medicine.disease, Mental illness, Mental health, Schizophrenia and psychosis, MESH: Prospective Studies, MESH: Male, 030227 psychiatry, Affective disorders, MESH : Pregnancy, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Female
Abstract

PurposeThis study assessed the underexplored factors associated with significant improvement in mothers’ mental health during postpartum inpatient psychiatric care.MethodsThis study analyzed clinical improvement in a prospective cohort of 869 women jointly admitted with their infant to 13 psychiatric Mother-Baby Units (MBUs) in France between 2001 and 2007. Predictive variables tested were: maternal mental illness (ICD-10), sociodemographic characteristics, mental illness and childhood abuse history, acute or chronic disorder, pregnancy and birth data, characteristics and mental health of the mother's partner, and MBU characteristics.ResultsTwo thirds of the women improved significantly by discharge. Admission for 25% was for a first acute episode very early after childbirth. Independent factors associated with marked improvement at discharge were bipolar or depressive disorder, a first acute episode or relapse of such an episode. Schizophrenia, a personality disorder, and poor social integration (as measured by occupational status) were all related to poor clinical outcomes.DiscussionMost women improved significantly while under care in MBUs. Our results emphasize the importance of the type of disease but also its chronicity and the social integration when providing postpartum psychiatric care.

Published
2011
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12. Postpartum and contraception in women after gestational diabetes

Author

Véronique Kerlan, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Service d'Endocrinologie (CHRU - Endocrino), and Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)

Subjects
Adult, MESH: Contraception, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, [SDV]Life Sciences [q-bio], Breastfeeding, Intrauterine device, MESH: Postpartum Period, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, MESH: Pregnancy, Pregnancy, Diabetes mellitus, MESH: Child, Internal Medicine, medicine, Humans, 030212 general & internal medicine, Child, MESH: Diabetes, Gestational, 030219 obstetrics & reproductive medicine, MESH: Humans, Obstetrics, business.industry, Postpartum Period, MESH: Adult, General Medicine, medicine.disease, 3. Good health, Gestational diabetes, Diabetes, Gestational, Breast Feeding, Contraception, Hormonal contraception, Family planning, MESH: Breast Feeding, Female, business, MESH: Female, Postpartum period
Abstract

International audience; Women who have had gestational diabetes mellitus must be monitored in the immediate postpartum period to ensure that blood glucose levels return to normal without further treatment. In the few studies performed specifically in these women, those that breastfed did not have a different metabolic profile, at least during the period of breastfeeding; the metabolic profiles of children born to women that had gestational diabetes and that breastfed also did not differ from those that were not breastfed. The choice of contraception must mainly take into consideration the associated risk factors. The studies, even if few have specifically focused on women with a history of gestational diabetes, have not demonstrated a significant disturbance of glucose metabolism while using hormonal contraception, whether combined oral oestrogen/progestogen or progestogen-only contraception. However, the presence of obesity, hypertension, or dyslipidaemia must direct the choice of contraception towards one without cardiovascular consequences. In these cases, the intrauterine device is an excellent choice.

Published
2010
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13. Venous thromboembolism during pregnancy, postpartum or during contraceptive use

Author

A, Blanco-Molina, L L, Rota, P, Di Micco, B, Brenner, J, Trujillo-Santos, A, Ruiz-Gamietea, M, Monreal, A, Visona, Department of Internal Medicine (DIM - Rio de Janeiro), Federal University of Rio de Janeiro, Department of Internal Medicine (DIM - Cartagena), Hospital Universitario Santa Maria de Rosell, Servicio de Medicina Interna (SMI), Hopital Universitario Germans Trias i Pujol, Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), and Université de Brest (UBO)-Université de Brest (UBO)

Subjects
Adult, MESH: Pulmonary Embolism, MESH: Humans, MESH: Registries, Postpartum Period, Pregnancy Complications, Cardiovascular, MESH: Contraceptive Agents, MESH: Adult, MESH: Retrospective Studies, MESH: Pregnancy Complications, Cardiovascular, Venous Thromboembolism, MESH: Venous Thromboembolism, MESH: Cause of Death, MESH: Postpartum Period, MESH: Pregnancy, Contraceptive Agents, Pregnancy, Cause of Death, Humans, Female, Registries, Pulmonary Embolism, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Retrospective Studies
Abstract

International audience; Venous thromboembolism (VTE) is a leading cause of maternal death during pregnancy or postpartum, and in women using hormonal contraceptives. However, important issues concerning its natural history and therapy remain unsolved, and most of the protocols for treatment of VTE in this patient population are based on data extrapolated from other populations. RIETE is an ongoing registry of consecutive patients with objectively confirmed, symptomatic, acute VTE. We examined the clinical characteristics and three-month outcome of all enrolled women with pregnancy, postpartum or using hormonal contraceptives. As of December 2008, 173 pregnant women, 135 postpartum, and 798 contraceptive users were enrolled. Of these, 438 (40%) presented with pulmonary embolism (PE) and 668 with deep-vein thrombosis (DVT). Most women with acute PE had dyspnea (72%) or chest pain (75%), but only 2.0% had hypoxaemia. During the three-month study period, five women (0.45%; 95% CI: 0.17-1.00) died (3 had fatal PE), 13 (1.18%; 95% CI: 0.66-1.95) had VTE recurrences, and seven (0.63%; 95% CI: 0.28-1.25) major bleeding. Two of the three women with fatal PE died during the first few hours after arriving at the emergency ward, with no time to start any therapy. The outcome of pregnant or postpartum women with VTE is similar to that in contraceptive users, even though the treatment is different. The non-specific nature of PE signs may have caused some delay in PE diagnosis.

Published
2010
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14. Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group

Author

Sophie Alexander, William M. Callaghan, Marian Knight, Jane B. Ford, Gwyneth Lewis, Jeremy Oats, Christine L. Roberts, Robert Liston, K.S. Joseph, James J. Walker, Cynthia J. Berg, Marie-Hélène Bouvier-Colle, National Perinatal Epidemiology Unit, University of Oxford, Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), Perinatal Epidemiology and Reproductive Health Unit, Université libre de Bruxelles (ULB), Recherches épidémiologiques en santé périnatale et santé des femmes, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), The Kolling Institute of Medical Research, University of Sydney at Royal North Shore Hospital, Dept of Obstetrics & Gynecology and Pediatrics, Dalhousie University [Halifax], Dept of Obstetrics & Gynecology and the School of Population and Public Health, University of British Columbia (UBC), Department of Health, BC Women's Hospital & Health Centre, The Royal Women's Hospital, St James University Hospital, The workshop was co-funded by the Institute of Human Development, Child and Youth Health, Canadian Institutes of Health Research and the Centers for Disease Control and Prevention (CDC), Atlanta. MK is supported by a personal fellowship from the National Institute for Health Research National Coordinating Centre for Research Capacity Development, JF is supported by the Health Research and Outcomes Network, a NHMRC Capacity Building Grant in Population Health Research and CR is supported by a NHMRC Senior Research Fellowship., University of Oxford [Oxford], Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Santé et de la Recherche Médicale (INSERM), and BMC, Ed.

Subjects
Pediatrics, Quality Assurance, Health Care, MESH: Quality Assurance, Health Care, International Cooperation, 02 engineering and technology, 030204 cardiovascular system & hematology, Medical Records, Collaborative group, 020210 optoelectronics & photonics, 0302 clinical medicine, MESH: Pregnancy, MESH: Practice Guidelines as Topic, Pregnancy, Risk Factors, MESH: Risk Factors, Obstetrics and Gynaecology, Health care, Epidemiology, 0202 electrical engineering, electronic engineering, information engineering, Childbirth, 030212 general & internal medicine, MESH: Incidence, 030219 obstetrics & reproductive medicine, Incidence, Incidence (epidemiology), Medical record, Postpartum Period, Pregnancy Outcome, Obstetrics and Gynecology, Prenatal Care, General Medicine, MESH: Postpartum Hemorrhage, 3. Good health, Obstetrics, Maternal Mortality, Population Surveillance, Practice Guidelines as Topic, MESH: Great Britain, Female, France, Developed country, MESH: Obstetrics, MESH: Medical Records, Canada, medicine.medical_specialty, Resource (biology), Reproductive medicine, MESH: Australia, Prenatal care, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, lcsh:Gynecology and obstetrics, MESH: Population Surveillance, MESH: Postpartum Period, 03 medical and health sciences, MESH: Canada, Environmental health, Research article, medicine, MESH: United States, Humans, MESH: Prenatal Care, lcsh:RG1-991, MESH: Humans, business.industry, Postpartum Hemorrhage, Australia, MESH: Pregnancy Outcome, United Kingdom, United States, MESH: France, [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, MESH: International Cooperation, Emergency medicine, Women's Health, MESH: Maternal Mortality, business, MESH: Female, MESH: Women's Health, Postpartum period
Abstract

Background Postpartum hemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. Several recent publications have noted an increasing trend in incidence over time. The international PPH collaboration was convened to explore the observed trends and to set out actions to address the factors identified. Methods We reviewed available data sources on the incidence of PPH over time in Australia, Belgium, Canada, France, the United Kingdom and the USA. Where information was available, the incidence of PPH was stratified by cause. Results We observed an increasing trend in PPH, using heterogeneous definitions, in Australia, Canada, the UK and the USA. The observed increase in PPH in Australia, Canada and the USA was limited solely to immediate/atonic PPH. We noted increasing rates of severe adverse outcomes due to hemorrhage in Australia, Canada, the UK and the USA. Conclusion Key Recommendations 1. Future revisions of the International Classification of Diseases should include separate codes for atonic PPH and PPH immediately following childbirth that is due to other causes. Also, additional codes are required for placenta accreta/percreta/increta. 2. Definitions of PPH should be unified; further research is required to investigate how definitions are applied in practice to the coding of data. 3. Additional improvement in the collection of data concerning PPH is required, specifically including a measure of severity. 4. Further research is required to determine whether an increased rate of reported PPH is also observed in other countries, and to further investigate potential risk factors including increased duration of labor, obesity and changes in second and third stage management practice. 5. Training should be provided to all staff involved in maternity care concerning assessment of blood loss and the monitoring of women after childbirth. This is key to reducing the severity of PPH and preventing any adverse outcomes. 6. Clinicians should be more vigilant given the possibility that the frequency and severity of PPH has in fact increased. This applies particularly to small hospitals with relatively few deliveries where management protocols may not be defined adequately and drugs or equipment may not be on hand to deal with unexpected severe PPH.

Published
2009
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15. [The challenges of preventing mother-to-child transmission of HIV in Africa]

Author

Becquet , Renaud, Leroy , Valériane, Epidémiologie, santé publique et développement, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR99-ISPED, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR99-ISPED, and Becquet, Renaud

Subjects
Time Factors, MESH: Infant Formula, MESH : HIV, HIV Infections, MESH : Pregnancy Trimester, Third, MESH: Africa, MESH : Randomized Controlled Trials as Topic, MESH: Pregnancy, Pregnancy, Risk Factors, MESH: Risk Factors, Infant Mortality, MESH: Infant Mortality, MESH : Female, Pregnancy Complications, Infectious, Randomized Controlled Trials as Topic, MESH: Drug Resistance, Viral, MESH: HIV, Postpartum Period, MESH: Infant, Newborn, MESH : Infant, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: HIV Infections, MESH : Adult, MESH: Infant, MESH : Risk Factors, Infant Formula, MESH : Postpartum Period, MESH : Drug Resistance, Viral, Breast Feeding, Anti-Retroviral Agents, MESH: Breast Feeding, MESH: Pregnancy Trimester, Third, Drug Therapy, Combination, Female, MESH : Time Factors, Adult, MESH : Africa, Pregnancy Trimester, Third, Health Promotion, MESH : Infant, Newborn, MESH: Anti-Retroviral Agents, MESH: Postpartum Period, Drug Resistance, Viral, MESH : HIV Infections, Humans, MESH : Anti-Retroviral Agents, MESH: Pregnancy Complications, Infectious, MESH : Infant Mortality, MESH: Humans, MESH : Drug Therapy, Combination, MESH: Time Factors, MESH : Humans, Infant, Newborn, HIV, Infant, MESH: Adult, MESH : Disease Transmission, Vertical, Infectious Disease Transmission, Vertical, MESH: Drug Therapy, Combination, MESH : Pregnancy, MESH: Randomized Controlled Trials as Topic, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH : Pregnancy Complications, Infectious, Africa, MESH : Health Promotion, MESH : Infant Formula, MESH : Breast Feeding, MESH: Health Promotion, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Female, MESH: Disease Transmission, Vertical
Abstract

International audience; HIV (human immunodeficiency virus) is the leading cause of infant mortality in Africa where 1700 children are infected each day, principally by mother-to-child transmission. Prevention of this risk is therefore a public health priority. Considerable progress has been made in the past 10 years in preventing the risk of mother-to-child transmission in the peripartum period in Africa: short antiretroviral regimens during the third trimester of pregnancy can reduce transmission rates to less than 5%. Breast-feeding, which is widespread and prolonged in Africa, causes many HIV infections and thus reduces the efficacy of peripartum interventions. Interventions that offer alternatives to prolonged breast-feeding and are both socially acceptable and safe for the infant can effectively reduce the risk of postnatal HIV transmission. But operational implementation of these postnatal interventions remains complex. Use of antiretroviral agents as prophylaxis for mother and child during the breast-feeding period and clinical management of breast-feeding mothers with combined antiretroviral treatments offer hope that the risk of postnatal HIV transmission can be reduced, but the effectiveness and safety of these interventions still need to be assessed.

Published
2007
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16. Molecular characterization of Streptococcus pyogenes isolates to investigate an outbreak of puerperal sepsis

Author

Raymond, Jean, Schlegel, L., Garnier, Fabien, Facklam, R.R., Bouvet, A., Biologie moléculaire et cellulaire des microorganismes (EA3175), Université de Limoges (UNILIM)-Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Bactériologie, Virologie, Hygiène [CHU Limoges], and CHU Limoges

Subjects
0301 basic medicine, Epidemiology, medicine.disease_cause, Disease Outbreaks, MESH: Random Amplified Polymorphic DNA Technique, MESH: Genotype, MESH: Pregnancy, 0302 clinical medicine, MESH: Streptococcal Infections, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Pregnancy, Genotype, 030212 general & internal medicine, MESH: Disease Outbreaks, Postpartum Period, RAPD, Electrophoresis, Gel, Pulsed-Field, Random Amplified Polymorphic DNA Technique, MESH: Electrophoresis, Gel, Pulsed-Field, Infectious Diseases, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Carrier State, Female, France, MESH: Genes, Bacterial, MESH: Carrier State, Endometritis, MESH: Streptococcus pyogenes, Microbiology (medical), Streptococcus pyogenes, 030106 microbiology, Biology, Microbiology, MESH: Postpartum Period, 03 medical and health sciences, Streptococcal Infections, medicine, Pulsed-field gel electrophoresis, Humans, Typing, MESH: Humans, Molecular epidemiology, Outbreak, bacterial infections and mycoses, Streptococcaceae, biology.organism_classification, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Virology, MESH: France, MESH: Endometritis, Genes, Bacterial, MESH: Female
Abstract

Objective:To describe microbiological characteristics and epidemiologic features of an outbreak of postpartum endometritis.Methods:Various markers were investigated in five patients and three throat carriage isolates ofStreptococcus pyogenesobtained during an outbreak of endometritis occurring in a 13-week period. Molecular characterization included biotyping, T-serotyping,emmgene sequence and restriction, pulsed-field gel electrophoresis (PFGE), and random amplified polymorphic DNA (RAPD) analysis.Results:Biotype, T-serotype, and genotypic data (emmanalysis, PFGE, and RAPD analysis) revealed a close relationship among the isolates from three patients, suggesting that cross-contamination had occurred. These isolates were biotype 1, T type 28, andemmtype 28. The isolates from one patient and one carrier differed from those of the index patient by minor variations of theemmamplicon restriction pattern, PFGE pattern, or RAPD pattern. The remaining isolates were phenotypically and genetically different.Conclusion:Identification of different isolates demonstrated that different strains may circulate simultaneously during a true outbreak and that the predominant strain might persist for several months.

Published
2005
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17. Postpartum Spontaneous Coronary Artery Dissection: A Case of Pseudoaneurysm Evolution Detected on MDCT

Author

Pascal Motreff, Pascal Chabrot, Louis Boyer, CHU Clermont-Ferrand, Institut Pascal (IP), SIGMA Clermont (SIGMA Clermont)-Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), CHU Gabriel Montpied [Clermont-Ferrand], Image Science for Interventional Techniques (ISIT), Université d'Auvergne - Clermont-Ferrand I (UdA)-Clermont Université-Centre National de la Recherche Scientifique (CNRS), and SIGMA Clermont (SIGMA Clermont)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS)

Subjects
Adult, medicine.medical_specialty, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, Dissection (medical), MESH: Coronary Aneurysm, 030204 cardiovascular system & hematology, Asymptomatic, MESH: Postpartum Period, 03 medical and health sciences, Pseudoaneurysm, MESH: Pregnancy, 0302 clinical medicine, Pregnancy, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, ComputingMilieux_MISCELLANEOUS, MESH: Aneurysm, Dissecting, Cardiac imaging, MESH: Aneurysm, False, MESH: Humans, medicine.diagnostic_test, business.industry, Postpartum Period, Coronary Aneurysm, MESH: Adult, General Medicine, medicine.disease, 3. Good health, Aortic Dissection, medicine.anatomical_structure, Angiography, cardiovascular system, Cardiology, Female, Radiology, medicine.symptom, Tomography, X-Ray Computed, MESH: Tomography, X-Ray Computed, business, MESH: Female, [SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing, Aneurysm, False, Postpartum period, Artery
Abstract

Postpartum Spontaneous Coronary Artery Dissection: A Case of Pseudoaneurysm Evolution Detected on MDCT Spontaneous coronary dissection predominantly affecting young women is rare but is often dramatic. A third of the cases occur at the end of pregnancy or during the postpartum period [1]. Its treatment remains empiric [2], usually depending on the symptoms, hemodynamic state, and angiography results. A 31-year-old woman, gravida 2, para 2, without medical history of cardiovascular disease or cardiovascular risk factors presented with an acute myocardial infarction 3 days postpartum. The angiography images obtained in the emergency department showed a left main artery dissection extending to the proximal left anterior descending (LAD) coronary artery with good distal flow and occlusion of the first diagonal artery. Once the patient received medical treatment, the initial clinical and ECG evolution were favorable. The next day, MDCT showed the same dissection with recanalization of the diagonal artery (Fig. 1A). The diagnosis was confirmed on angiography. At 6 weeks, MDCT showed a pseudoaneurysm of the left main artery in addition to the LAD artery dissection (Figs. 1B and 1C). Because of this fast evolution, we chose to treat the lesion with stenting guided by the MDCT images and measurements. After angiographic confirmation, the proximal LAD and left main arteries were treated using two short paclitaxel-eluting stents (3.5 × 8 and 4 × 8 mm; Taxus Express, Boston Scientific) to allow intimal flap correction and closure of the pseudoaneurysm. The stent placement showed satisfactory exclusion of the pseudoaneurysm, which was confirmed at 6 months using angiography and MDCT (Fig. 1D). At 1 year after stent placement, the patient remains asymptomatic. To our knowledge, this is the first observation of pseudoaneurysm complicating a spontaneous coronary dissection in which MDCT allowed an early diagnosis and was used to guide the therapeutic strategy. A B

Published
2006
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