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Le syndrome des anticorps antiphospholipides (SAPL) est une entité clinico-biologique caractérisée par des manifestations cliniques polymorphes associées à la présence persistante d'anticorps antiphospholipides. C'est une pathologie affectant principalement la femme jeune, bien que l'homme ou les sujets plus âgés puissent également être atteints. Les manifestations cliniques sont principalement thrombotiques (macro- et microvasculaires) et obstétricales. D'autres atteintes sont également décrites : cardiaque, rénale, cérébrale ou cutanée. La mise en évidence des anticorps antiphospholipides fait appel à des méthodes de titrage d'anticorps (anticardiolipides et anti-β2GPI) mais également à des examens d'hémostase pour lesquels la connaissance et l'expérience des techniques utilisées sont indispensables pour assurer la fiabilité des résultats et permettre le diagnostic final de SAPL. Le traitement du SAPL fait notamment appel aux thérapeutiques antithrombotiques mais également aux traitements par corticoïdes voire immunosuppresseurs pour les formes plus sévères. Anti-phospholipid syndrome is a clinical and biological condition characterized by polymorphic clinical manifestations associated with the persistence of antiphospholipid antibodies. This disease mainly involves young women, although men or older people can also be affected. Most of clinical features are thrombotic (macro- and micro-vascular) and obstetrical manifestations. Some other signs are also described: cardiac, renal, cerebral or cutaneous. The detection of antiphospholipid antibodies antibody relies on titration methods (anti-cardiolipin and anti-β2GPl) but also hemostasis tests for which knowledge and experience of the techniques are needed to ensure the reliability of the results and enable the final APS diagnosis. The treatment of APS leans on anti-thrombotic therapies but also on treatments with corticosteroids or even immunosuppressives for more severe forms. [ABSTRACT FROM AUTHOR]

L’article vise à analyser la figure de la sage-femme dans les traités d’obstétrique publiés en Italie entre le XVIe et le XVIIIe siècles. Ces œuvres médicales sont fondamentales pour reconstruire la figure de la sage-femme idéale à l’époque moderne, parce que les savoirs de l’« art des accouchements » ont été transmis oralement et, par conséquent, ces traités représentent une source précieuse d’informations. De plus, ces sources historiques se révéleront utiles afin de mettre en évidence le point de vue des médecins sur la discipline obstétricale.

Introduction: Maternal and perinatal deaths could be prevented if functional referral systems are in place to allow pregnant women to get appropriate services when complications occur. Methodology: The study was a 1-year retrospective study of obstetric referrals in Aminu Kano Teaching hospital, from 1st January to 31st December 2019. Records of all emergency obstetrics patients referred to the hospital for 1 year were reviewed. A structured proforma was used to extract information such as sociodemographic characteristics of the patients, indications for referral, and pre-referral treatment. The care given at the receiving hospital was extracted from the patients' folders. An Audit standard was developed and the findings were compared with the standards in order to determine how the referral system in the study area perform in relation to the standard. Results: There were total of 180 referrals, the mean age of the women was 28.5 ± 6.3 years. Majority (52%) of the patients were referred from Secondary Centres and only 10% were transported with an ambulance. The most common diagnosis at the time of referral was severe preeclampsia. More than half of the patients (63%) had to wait for 30 to 60 minutes before they see a doctor. All the patients were offered high quality care and majority (70%) were delivered via caesarean section. Conclusion: There were lapses in the management of patients before referral; failure to identify high risk conditions, delay in referral, and lack of treatment during transit to the referral centre. [ABSTRACT FROM AUTHOR]

This article summarizes several Canadian court decisions from 2015 onward stemming from wrongful birth and wrongful life litigation. Plaintiff success often turns on whether causation is established, on a balance of probabilities, between a physician's breach of standard of care and the harm to the parents and/or the child later born. Physicians' failure to offer or order screening or diagnostic tests has been a source of wrongful birth liability, as too can be failure to ensure patient understanding of results. Physicians should ensure that they recommend diagnostic testing when presented with concerning clinical indications in accordance with professional practice guidance. Given noninvasive prenatal screening's (NIPS) advantages and the threat of wrongful birth liability for failure to discuss this procedure, it is likely to be propelled into an ever more prominent position as a first-choice offering for aneuploidy screening. Appropriately cautious physician behaviour involves discussing and offering NIPS, and also involves ensuring that results are understood. This can reduce physician liability, improve patient reproductive autonomy, and sometimes benefit patient health by preventing or lessening trauma that informed women may opt to mitigate when granted the opportunity. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Developing a measuring tool for physician's performance anxiety during obstetrical procedures, as a self-administered questionnaire., Methods: We used the Delphi method. First, we did a literature review to identify the items to submit for the first round. A panel of experts was asked to rate the relevance of items from one to six. For the first round of Delphi, items were retained if more than 70% of respondents assigned a five or six rating. Items were excluded if more than 70% of respondents assigned a one or two rating. All the other items, plus those suggested by the panel, were submitted to a second round of Delphi. The same item selection conditions were applied to the second round., Results: The overall response rate to the Delphi was 79% (19 respondents). At the end of the first round, 14 items were consensually relevant, no item was consensually irrelevant. For the second round, the 18 items that did not find consensus and seven new items suggested by the experts in the first round were submitted. At the end of the second round, nine items were retained by consensus as relevant., Conclusion: This study defined by consensus 23 items for a self-questionnaire to measure specific performance anxiety in obstetrics divided into five dimensions: perceived stress, assessment of the risk of complications, medico-legal risk, impact of the healthcare team and peers, self-confidence and decision-making confidence. We intend to validate this tool in real population., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Objectif : évaluer l'effet synergique d'un inhibiteur sélectif de la recapture sérotoninergique (ISRS) et d'un inhibiteur sélectif de la cyclo-oxygénase 2 (ISCOx-2) dans la prise en charge des céphalées postrachianesthésie en milieu obstétrical (CPRAO). Patientes et méthodes : étude multicentrique randomisée contrôlée de non-infériorité en double aveugle sur une période de 12 mois dans six hôpitaux au sud-est de la République Démocratique du Congo, ayant inclus toutes les patientes opérées ou analgésiées sous rachianesthésie pour une indication obstétricale et ayant présenté les céphalées caractéristiques d'une brèche dure-mérienne, sans autres causes connues. Les patientes étaient reparties dans quatre groupes : A = réhydratation + paracétamol, B = réhydratation + célécoxib, groupe C = réhydratation + néfopam et 4 = réhydratation + célécoxib + néfopam (groupe d'étude). Résultats : le protocole associant le célécoxib et le néfopam montre son efficacité dans la réduction des CPRAO dès les deux premiers jours avec une diminution progressivement significative de l'anxiété et de la durée de séjour. Par ailleurs, la majorité des patientes (75,6 %) avait manifesté un grand niveau global de satisfaction avec ce protocole. Conclusion : étant donné la bonne tolérance et l'accessibilité de ces produits, nous suggérons l'utilisation de ce protocole pour sa validation dans notre milieu et ailleurs. [ABSTRACT FROM AUTHOR]

Copyright of Orthodontie Française is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: To investigate what women who have experienced vacuum extraction or second stage caesarean section (CS) would recommend as mode of birth in case of prolonged second stage of labour.Methods: A prospective cohort study was conducted in a tertiary referral hospital in Uganda. Between November 2014 and July 2015, women with a term singleton in vertex presentation who had undergone vacuum extraction or second stage CS were included. The first day and 6 months after birth women were asked what they would recommend to a friend: vacuum extraction or CS and why. Outcome measures were: proportions of women choosing vacuum extraction vs. CS and reasons for choosing this mode of birth.Results: The first day after birth, 293/318 (92.1%) women who had undergone vacuum extraction and 176/409 (43.0%) women who had undergone CS recommended vacuum extraction. Of women who had given birth by CS in a previous pregnancy and had vacuum extraction this time, 31/32 (96.9%) recommended vacuum extraction. Six months after birth findings were comparable. Less pain, shorter recovery period, avoiding surgery and the presumed relative safety of vacuum extraction to the mother were the main reasons for preferring vacuum extraction. Main reasons to opt for CS were having experienced CS without problems, CS presumed as being safer for the neonate, CS being the only option the woman was aware of, as well as the concern that vacuum extraction would fail.Conclusions: Most women would recommend vacuum extraction over CS in case of prolonged second stage of labour. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: To evaluate the use of simulation among French Obstetrics and Gynecology residency programs., Methods: A survey was conducted with all 28 French residency program directors. The questionnaire covered equipment and human resources, training programs, types of simulation tools and time spent., Results: Of the cities hosting a residency program, 93% (26/28) responded regarding equipment and human resources, and 75% (21/28) responded regarding training program details. All respondents declared having at least one structure dedicated to simulation. A formal training program was reported by 81% (21/26) of cities. This training program was mandatory in 73% of the cases. There was a median number of seven senior trainers involved, three of whom had received a specific training in medical education. Most of declared simulation activities concerned technical skills in obstetrics and surgery. Simulations to practice breaking bad news were offered by 62% (13/21) of cities. The median number of half-days spent annually on simulation training was 55 (IQR: 38-83)., Conclusion: Simulation training is now widely available among French residency programs. There remains heterogeneity between centers regarding equipment, time spent and content of simulation curricula. The French College of Teachers of Gynecology and Obstetrics has proposed a roadmap for the content of simulation-based training based on the results of this survey. An inventory of all existing "train the trainers" simulation programs in France is also provided., (Copyright © 2023. Published by Elsevier Masson SAS.)

Copyright of Obésité is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Le partogramme est un outil incontournable dans la pratique quotidienne en salle de naissance. C'est le reflet écrit de la qualité de la prise en charge materno-fétale pendant l'accouchement et le post-partum immédiat. Le but de notre travail est d'évaluer la conformité de la tenue du partogramme au sein de notre maternité et de proposer des axes d'amélioration de la qualité de sa tenue. il s'agit d'une étude rétrospective par audit clinique, effectuée sur 400 dossiers des patientes ayant accouché dans la maternité universitaire de Kairouan du 1er Janvier au 31 décembre 2014. Le référentiel utilisé est celui de la Haute Autorité de Santé (2006) comportant 29 critères divisés en 3 domaines (PARTOten, PARTOobs, PARTOeve). le Taux de Conformité Globale (TCG) de la tenue du partogramme dans notre audit était de 55,9%. Pour le domaine I à La tenue du partogramme à (PARTOten), le TCG était de 88,9%. Pour le domaine II à la traçabilité du déroulement du travail à (PARTOobs), le TCG était de 51,4%. Pour le domaine III à la traçabilité des actes, des évènements et des traitements au cours du travail à (PARTOeve), le TCG était de 27,4%. Notre étude a permis de dégager plusieurs points à améliorer. Le but ultime de l'Audit Clinique est l'amélioration des pratiques professionnelles, de ce fait nous allons mettre en place un plan d'action (formation, sensibilisation...) qui sera suivi par une réévaluation afin de vérifier la pérennité des actions correctives.

Etude prospective et descriptive sur la pratique de l'analgésie péridurale (APD) obstétricale au CHU Sylvanus Olympio (CHU SO) de Lomé. Etude menée de février à juin 2014. Après accord des gestantes choisies au hasard et en l'absence de contre-indication à l'issue de la consultation d,anesthésie, faite au 8ème mois de la grossesse, des femmes ont été retenues pour l'étude. Sur 29 gestantes retenues, 20 (69%) ont bénéficiées de l'APD. Age moyen 30,6,6,6 ans, primigestes : 35%, multipares 50%, Obèses (BMI=30): 25%. Nombre moyen de ponctions: 1,2,0,5; reflux de sang dans le cathéter: 5%, brèche dure-mérienne : 0. Délai moyen d'installation: 8,5 ,2,2mn. Quantité moyenne de bupivacaine isobare à 0,125%: 28,8,8ml; Echelle Numérique à T10min 3 pour toutes les parturientes. Bloc moteur: 0. Hypotension: 1cas (5%). Mode d'accouchement: voie basse: 19 (95%), césarienne: 1 (5%). Détresse respiratoire à la naissance du nouveau né: 0. Note de satisfaction: 9,8,0,5 /10. L'APD obstétricale est possible au CHU Sylvanus Olympio de Lomé. En attendant sa vulgarisation à toutes les parturientes par la disponibilité des moyens humains et matériels, la réaliser pour ses indications médicales serait un premier pas.

We conducted a prospective and descriptive study on epidural analgesia (EA) at the Sylvanus Olympio University Hospital Center in Lomé from February to June 2014. After taking consent from pregnant women selected by simple random sampling and in the absence of contraindication for anesthesia (pre-anesthetic assessment performed in their 8th month of pregnancy), women were enrolled. Out of 29 selected women, 20 (69%) underwent EA. The average age was 30.6 ± 6.6 years: primiparas 35%, multiparas 50%, Obese women (BMI> 30)25%. Average number of punctures: 1.2 ± 0.5; blood reflux into the catheter: 5%; dural puncture: 0. Delay for anesthesia induction: 8.5 ± 2, 2mn. Mean dosage of 0.125% isobaric bupivacaine: 28.8 ± 8ml; digital scale at T10min <3 for all parturient women. Motor block: 0. Hypotension: 1 case (5%). Mode of delivery: vaginal births 19 (95%), cesarean section 1 (5%). Respiratory distress in the newborn: 0. Level of satisfaction: 9,8 ± 0.5 / 10. Sylvanus Olympio University Hospital Center in Lomé provides obstetric EA. While awaiting its availability to all parturient women based on human and material resources, the use of epidural analgesia in the presence of medical indications would be a first step. [ABSTRACT FROM AUTHOR]

Copyright of Revue d'Histoire Moderne & Contemporaine is the property of Societe d'Histoire Moderne et Contemporaine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)