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Data on obstetric outcomes in patients with a history of immunoglobulin A vasculitis (IgA-V) are lacking. The aim of this study was to assess maternal, neonatal, and vasculitis outcomes during pregnancy. We conducted a French retrospective case–control study. Pregnancies of patients with a history of IgA-V (cases) were retrospectively studied and compared to pregnancies in women who developed IgA-V after their pregnancies and to pregnancies in healthy women (controls). Twenty-six pregnancies in patients with a history of IgA-V were included and compared to 15 pregnancies in women who later developed IgA-V and 52 pregnancies in healthy women. Both gestational hypertension and pre-eclampsia were more frequent in the case group than in the other groups (23% vs 0% vs 0%, p < 0.01; 12% vs 7% vs 0%, p = 0.04). Hypertensive disorder of pregnancy occurred more frequently in patients with pre-existing kidney disease (78% vs 12%, p < 0.01). Caesarean section was more often performed in the case group than in the other groups (27% vs 0% vs 10%, p = 0.04). No foetal loss or maternal deaths occurred. There were no differences in delivery term or birth weight. No vasculitis flares were observed during pregnancy. Women with a history of IgA-V appear to be at higher risk for gestational hypertension and pre-eclampsia, especially in cases with renal involvement; however, both mother and newborn outcomes appear to be favourable. [ABSTRACT FROM AUTHOR]

Objective: To analyze the anatomical relationship between the pubic symphysis and the ischial spines to determine reliable landmarks for the assessment of fetal head descent by intrapartum translabial ultrasound (ITU).Methods: All computed tomography (CT) scans performed for breech presentation and for twin delivery between 2006 and 2014 in a tertiary university hospital were obtained for measurement and analysis by two operators. The symphysis-left ischial spine angle (SIA) and the symphysis-left ischial spine distance (SID) were measured on three-dimensional reconstructions from the CT volume dataset. We calculated intra- and interobserver agreements for SIA and SID with 95% prediction intervals, created Bland-Altman plots with 95% limits of agreement and estimated the intraclass correlation coefficient (ICC). A sagittal plane projection from the SIA enabled calculation of a sagittal angle, corresponding to the angle of progression (AoP) on ITU.Results: SIA and SID were obtained from CT images from 458 women. Reproducibility was good for both SIA (intraobserver ICC, 0.94 (95% CI, 0.88-0.97) and interobserver ICC, 0.81 (95% CI, 0.66-0.92)) and SID (intraobserver ICC, 0.92 (95% CI, 0.82-0.97) and interobserver ICC, 0.83 (95% CI, 0.73-0.92)). The median SIA was 106° (interquartile range (IQR), 105-109°) and median SID was 26.1 (IQR, 23.4-29.5) mm. SIA and SID were not correlated with pelvic diameter or height. The 50th percentile of AoP was 110°.Conclusion: Knowledge of the anatomical relationship between the pubic symphysis and ischial spines makes it possible to establish a sonographic method for assesssing fetal head descent by taking into account the level of the ischial spines. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

À ce jour, les données disponibles sur le déroulement de la grossesse chez des patientes ayant un antécédent de vascularite à IgA (V-IgA) sont parcellaires et peu robustes. L'objectif de cette étude était double: de déterminer l'influence de la V-IgA sur la grossesse et l'impact de cette dernière sur la vascularite. Nous avons conduit une étude française cas-témoin multicentrique. Ont été inclus, des patientes ayant un antécédent de V-IgA et ayant conduit une grossesse après ou pendant la V-IgA (cas), des patientes ayant un antécédent de V-IgA et ayant conduit une grossesse avant le diagnostic (témoins 1), et des patientes sans antécédent médicaux payant accouché au CHRU de Tours (témoins 2). Quatre-vingt-treize grossesses ont été incluses (cas n = 26, témoins1 n = 15 et témoins 2 n = 52). La seule différence en termes de comorbidités au moment de la grossesse était la proportion plus importante de néphropathie chronique dans le groupe des cas en lien avec la V-IgA (p < 0.01). Il y avait plus d'hypertension artérielle gravidique (24 % vs 0 vs 0, p < 0.01), de pré-éclampsie (12 % vs 7 % vs 0 %; p = 0.04) et de césarienne (27 % vs 0 vs 10 %, p = 0.04) chez les cas par rapport aux deux groupes témoins. Les complications obstétricales hypertensives étaient observées plus fréquemment chez les patientes ayant une néphropathie chronique. Aucune prématurité ou mort fœtale n'a été observée. Un diagnostic de V-IgA a été posé en cours de grossesse, aucune nouvelle poussée n'est survenue. Une rémission a été observée. Les patientes présentant un antécédent de V-IgA ont un risque plus important d'hypertension artérielle gravidique, de pré-éclampsie et de césarienne. Les complications hypertensives semblent liées à l'existence d'une néphropathie chronique séquellaire de la vascularite. Il ne semble pas y avoir de risque de poussée de la maladie au cours de la grossesse. [ABSTRACT FROM AUTHOR]

Small follicular or functional theca-lutein cysts are a common finding in fetal and neonatal ovaries. After delivery, decrease of hormonal stimulation may lead to spontaneous resolution of the cyst. A high rate of complication has been underlined by recent studies, the most common being ovarian torsion with subsequent loss of the ovary. Because torsion may happen with any size of cyst, however large or small, we suggest in utero decompression even in small fetal ovarian cysts (< 5 cm). We report here three cases of such cysts managed by intrauterine aspiration with good outcome and no further need for neonatal surgery. In all cases cytology of the cyst aspirate demonstrated numbers of granulosa cells and fluid biochemistry showed a high amount of estradiol, progesterone, and testosterone that confirmed the etiology as ovarian. Despite the small size of the cysts, no technical difficulties were encountered and no maternal or fetal morbidity occured. Prenatal management of fetal ovarian cysts remains controversial, however, and our limited experience needs to be assessed on a larger number of cases. [ABSTRACT FROM AUTHOR]

The article offers information on the use of sonographic method for evaluating fetal head descent. Topics discussed include use of method intrapartum transperineal ultrasound (ITU), clinical classification proposed by the American Congress of Obstetricians and Gynecologists (ACOG), and evaluating the risk of dystocia.

An abstract of the research paper "3D Transvaginal Ultrasonography Appears More Accurate Than 2D in Third Trimester Evaluation of Placenta Previa," by E. Simon and colleagues is presented.

An abstract of the research paper "New quantitative analysis of uteroplacental perfusion using Doppler and contrast-enhanced ultrasound imaging," by C. Arthuis and colleagues is presented.

An abstract of the article "New approach to the exploration of internal genital fetal organs: an acoustic window to view the fetal uterus" by G. Haddad is presented.

In cases of placenta previa, the distance from the placental edge to the internal os is determinant in deciding on the mode of delivery that will minimize the risk of hemorrhage. The reproducibility and interobserver reliability of this measure are unknown. The internal os is not a point, as two-dimensional (2D) ultrasonography might suggest, but an oval patch that has a measurable width, which may be as wide as the distance separating it from the placenta. It is therefore difficult to determine the exact location of the os using a 2D sectional plane. We report the case of a nulliparous woman admitted for vaginal bleeding at 37 weeks' gestation in whom transvaginal ultrasound examination showed placenta previa, but for which two sonographers reported different measurements for the distance between the placental edge and the internal os. We describe a technique to measure this distance using multiplanar three-dimensional (3D) ultrasound imaging, which allows the smallest distance between the middle of the os and the edge of the placenta, which appears as a line, to be determined. In this case, measurement using 3D ultrasound showed a shorter distance than was suggested by 2D examination. This led us to schedule a Cesarean section delivery, during which there was minimal bleeding. Standardization of 3D measurements should make it possible to define more relevant cut-offs for determining the management of cases of placenta previa. [ABSTRACT FROM AUTHOR]

Summary: Objectives: The aim of this study was to evaluate our practices regarding the use of supplementation for breast-fed neonates. Methods: A descriptive and prospective study conducted between 22/05/2010 and 23/03/2010 comprising breast-fed, healthy, singleton infants at the Maternity University Hospital of Tours. Indications for supplementation were collected prospectively by paramedics. Results: The study included 281 breast-fed neonates, of whom 99 (35 %) received supplementation. Supplemented neonates were more often children of primiparae (61.6 % versus 44%; P =0.005), or born to mothers without experience of breast-feeding (69.7% versus 48.9%; P =0.001), born by cesarean section (21.2% versus 10.4%; P =0.01), or were small for gestational age (10.1 % versus 6.6%; P =0.003). The main indications were: to prevent additional weight loss, hunger of the newborn, hypoglycemia, and difficulty to breast-feed. Twenty-nine percent of the neonates were given supplements without medical indication. Conclusion: One third of breast-fed infants receive supplementation, not always medically justified. A better understanding of medical indications would avoid supplementation being given to breast-fed infants. [ABSTRACT FROM AUTHOR]

Objective: To describe and compare the characteristics of women with placenta accreta spectrum (PAS) and their pregnancy outcomes according to the presence of placenta praevia and a prior caesarean section. Design: Prospective population‐based study. Setting: All 176 maternity hospitals of eight French regions. Population: Two hundred and forty‐nine women with PAS, from a source population of 520 114 deliveries. Methods: Women with PAS were classified into two risk‐profile groups, with or without the high‐risk combination of placenta praevia (or an anterior low‐lying placenta) and at least one prior caesarean. These two groups were described and compared. Main outcome measures: Population‐based incidence of PAS, characteristics of women, pregnancies, deliveries and pregnancy outcomes. Results: The PAS population‐based incidence was 4.8/10 000 (95% CI 4.2–5.4/10 000). After exclusion of women lost to follow up from the analysis, the group with placenta praevia and a prior caesarean included 115 (48%) women and the group without this combination included 127 (52%). In the group with both factors, PAS was more often suspected antenatally (77% versus 17%; P < 0.001) and more often percreta (38% versus 5%; P < 0.001). This group also had more hysterectomies (53% versus 21%, P < 0.001) and higher rates of blood product transfusions, maternal complications, preterm births and neonatal intensive care unit admissions. Sensitivity analysis showed similar results after exclusion of women who delivered vaginally. Conclusion: More than half the cases of PAS occurred in women without the combination of placenta praevia and a prior caesarean delivery, and these women had better maternal and neonatal outcomes. We cannot completely rule out that some of the women who delivered vaginally had placental retention rather than PAS; however, we found similar results among women who delivered by caesarean. Half the women with PAS do not have both placenta praevia and a prior caesarean delivery, and they have better maternal outcomes. Half the women with PAS do not have both placenta praevia and a prior caesarean delivery, and they have better maternal outcomes. [ABSTRACT FROM AUTHOR]

Spontaneous abortions of first trimester pregnancy is a frequent pathology in gynecology (more than 10% of clinical pregnancy). Since the midth of twentieth century, the gold standard of evacuation of spontaneous abortion is manual vacuum aspiration most of the time under general anesthesia. This method is used in France for all miscarriages after 7 weeks’ gestation at the sonography (about 40 000 women in 1999) but complications are not rare. The vaginal sonography and new medical management changes the view. We can now use expectative management or medical management with misoprostol and/or mifepristone. We summarise the current literature and propose a randomised multicentric control trial. [Copyright &y& Elsevier]

Objective: The long-term morbidity associated with isolated left-sided congenital diaphragmatic hernia (CDH) has been described previously. However, antenatal criteria impacting gastrointestinal morbidity (GIM) are not yet defined. The objective of this study was to evaluate the effect of fetal stomach position on the risk of GIM at 2 years of age in children with left-sided CDH.Methods: This was a retrospective, observational multicenter cohort study of data obtained from January 2010 to January 2014, that included patients whose fetus had isolated left-sided CDH, with or without fetal endoscopic tracheal occlusion (FETO). Prenatal maternal, fetal and pediatric data were collected. Fetal stomach position was evaluated a posteriori by two observers, using ultrasound images at the level of the four-chamber view of the heart that had been obtained to calculate the observed-to-expected lung-area-to-head-circumference ratio (O/E-LHR). Fetal stomach position was graded as follows: Grade 1, stomach not visualized; Grade 2, stomach visualized anteriorly, next to the apex of the heart, with no structure in between the stomach and the sternum; Grade 3, stomach visualized alongside the left ventricle of the heart, and abdominal structures anteriorly; or Grade 4, as Grade 3 but with stomach posterior to the level of the atrioventricular heart valves. The primary outcome was GIM at 2 years of age, assessed in a composite manner, including the occurrence of gastroesophageal reflux disease, need for gastrostomy, duration of parenteral and enteral nutrition and persistence of oral aversion. Regression analysis was performed in order to investigate the effect of O/E-LHR, stomach position and FETO on various GIM outcome variables.Results: Forty-seven patients with fetal left-sided CDH were included in the analysis. Thirteen (27.7%) infants did not meet the criterion of exclusive oral feeding at 2 years of age. Fetal stomach position grade was associated significantly and independently with the duration of parenteral nutrition (odds ratio (OR), 19.86; P = 0.031) and persistence of oral aversion at 2 years (OR, 3.40; P = 0.006). On multivariate analysis, O/E-LHR was predictive of the need for prosthetic patch repair, but not for GIM. FETO did not seem to affect the risk of GIM at 2 years.Conclusion: In isolated left-sided CDH, fetal stomach position is the only factor that is predictive of GIM at 2 years of age. © 2020 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

BACKGROUND Prophylactic administration of tranexamic acid has been associated with reduced postpartum blood loss after cesarean delivery in several small trials, but evidence of its benefit in this clinical context remains inconclusive. METHODS In a multicenter, double-blind, randomized, controlled trial, we assigned women undergoing cesarean delivery before or during labor at 34 or more gestational weeks to receive an intravenously administered prophylactic uterotonic agent either tranexamic acid (1 g) or placebo. The primary outcome was postpartum hemorrhage, defined as a calculated estimated blood loss greater than 1000 ml receipt of a red-cell transfusion within 2 days after delivery. Secondary outcomes included gravimetrically estimated blood loss, provider-assessed clinically significant postpartum hemorrhage, use of additional uterotonic agents, and postpartum blood transfusion. RESULTS Of the 4551 women who underwent randomization, 4431 underwent cesarean delivery, 4153 (93.7%) of whom had primary outcome data available. The primary outcome occurred in 556 of2086 women (26.7°/0) in the tranexamic acid group and in 653 of 2067 (31.6%) in the placebo group (adjusted risk ratio, 0.84; 95% confidence interval [CI], 0.75 to 0.94; P= 0.003). There were no significant betweengroup differences in mean gravimetrically estimated blood loss or in the percentage of women with provider-assessed clinically significant postpartum hemorrhage, use of additional uterotonic agents, or postpartum blood transfusion. Thromboembolic events in the 3 months after delivery occurred in 0.4% of women (8 of 2049) who received tranexamic acid and in O.F/0 of women (2 of 2056) who received placebo (adjusted risk ratio, 4.01; 95% CI, 0.85 to 18.92; P= 0.08). CONCLUSIONS Among women who underwent cesarean delivery and received prophylactic uterotonie agents, tranexamic acid treatment resulted in a significantly lower incidence of calculated estimated blood loss greater than 1000 mi or red-cell transfusion by day 2 than placebo, but it did not result in a lower incidence of hemorrhage-related secondary clinical outcomes. [ABSTRACT FROM AUTHOR]

Objective: Morbidity in fetuses affected by gastroschisis is mainly the result of bowel ischaemic and inflammatory processes. Experimental studies on animal models show that clearing amniotic fluid from the digestive secretions by amnioexchange procedures reduces the inflammatory process. We evaluated the benefit of the amnioexchange procedure for fetal gastroschisis in humans.Design: Prospective, interventional, randomised study.Setting: Eight referral centres for fetal medicine.Population: Pregnant women carrying a fetus with gastroschisis.Methods: We compared, in utero, amnioexchange with a sham procedure. The protocol included, in both arms, steroid injections at 30 weeks of gestation and the use of postnatal minimal enteral feeding.Main Outcome Measures: The primary outcome was a composite variable based on the duration of ventilation and parenteral nutrition. Secondary outcomes were the effectiveness and safety of the amnioexchange procedure, including the rate of perinatal death, time to full enteral feeding, primary closure, and late feeding disorders.Results: Sixty-four patients were randomised. There was no difference in the composite criteria between the amnioexchange and control groups. Based on an intention-to-treat analysis, there were no significant between-group differences in pregnancy outcome or complications. When studying the relationship between digestive compounds and amniotic fluid inflammatory markers, a clear correlation was found between bile acid and both ferritin and interleukin 1β (IL1β).Conclusions: In humans, amnioexchange, as described in our protocol, is not an option for fetal care; however, we provide supplementary proof of the involvement of inflammation in the pathogenicity of gastroschisis and suggest that future research should aim at reducing inflammation. ClinicalTrials.gov: NCT00127946.Tweetable Abstract: A prospective, interventional, randomised study shows no benefit of amnioexchange for fetal gastroschisis in humans. [ABSTRACT FROM AUTHOR]

Objective: Morbidity in fetuses affected by gastroschisis is mainly the result of bowel ischaemic and inflammatory processes. Experimental studies on animal models show that clearing amniotic fluid from the digestive secretions by amnioexchange procedures reduces the inflammatory process. We evaluated the benefit of the amnioexchange procedure for fetal gastroschisis in humans. Design: Prospective, interventional, randomised study. Setting: Eight referral centres for fetal medicine. Population: Pregnant women carrying a fetus with gastroschisis. Methods: We compared, in utero, amnioexchange with a sham procedure. The protocol included, in both arms, steroid injections at 30 weeks of gestation and the use of postnatal minimal enteral feeding. Main outcome measures: The primary outcome was a composite variable based on the duration of ventilation and parenteral nutrition. Secondary outcomes were the effectiveness and safety of the amnioexchange procedure, including the rate of perinatal death, time to full enteral feeding, primary closure, and late feeding disorders. Results: Sixty‐four patients were randomised. There was no difference in the composite criteria between the amnioexchange and control groups. Based on an intention‐to‐treat analysis, there were no significant between‐group differences in pregnancy outcome or complications. When studying the relationship between digestive compounds and amniotic fluid inflammatory markers, a clear correlation was found between bile acid and both ferritin and interleukin 1β (IL1β). Conclusions: In humans, amnioexchange, as described in our protocol, is not an option for fetal care; however, we provide supplementary proof of the involvement of inflammation in the pathogenicity of gastroschisis and suggest that future research should aim at reducing inflammation. ClinicalTrials.gov: NCT00127946. A prospective, interventional, randomised study shows no benefit of amnioexchange for fetal gastroschisis in humans. A prospective, interventional, randomised study shows no benefit of amnioexchange for fetal gastroschisis in humans. [ABSTRACT FROM AUTHOR]

Objective: To assess the efficacy and safety of in-utero aspiration (IUA) of anechoic fetal ovarian cysts.Methods: This multicenter, prospective, randomized open trial in two parallel groups included women from nine outpatient fetal medicine departments with singleton pregnancy ≥ 28 weeks of gestation and a female fetus with an ultrasound-diagnosed simple ovarian cyst, defined as a single fully anechoic cystic structure measuring ≥ 30 mm. They were allocated randomly to IUA under ultrasound guidance or expectant management. All procedures were performed by trained senior obstetricians. Primary outcome was need for neonatal intervention, by laparoscopy, laparotomy or transabdominal aspiration. Secondary outcomes were in-utero involution of the cyst and oophorectomy at birth. Analyses were conducted according to the intention-to-treat principle.Results: Of 61 participants, 34 were allocated to IUA and 27 to expectant management. Three IUA procedures (9%) could not be performed (one due to fetal position and two due to aspirations being dry). The remaining 31 IUA procedures were uneventful. The incidence of neonatal intervention did not differ significantly between the IUA and the expectant management groups (20.6% vs 37.0%; relative risk (RR), 0.55; 95% CI, 0.24-1.27). Nonetheless, IUA was associated with increased incidence of in-utero involution of the cyst (47.1% vs 18.5%; RR, 2.54; 95% CI, 1.07-6.05) and reduced rate of oophorectomy (3.0% vs 22.0%; RR, 0.13; 95% CI, 0.02-1.03) compared with expectant management.Conclusion: IUA of anechoic fetal ovarian cysts, compared with expectant management, was not associated with a reduction in overall neonatal interventions but was associated with a reduced oophorectomy rate. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Introduction Le syndrome des anti-phospholipides (SAPL) est une maladie auto-immune rare définie par la survenue de thromboses veineuses et/ou artérielles, ou par une morbidité obstétricale (fausses couches précoces, mort fœtale ou pré-éclampsie) associée à la présence d’anticorps anti-phospholipides (APL) : anticoagulant circulant (ACC), anticorps anti-cardiolipine (aCL) de classe immunoglobuline G (IgG) et/ou immunoglobuline M (IgM) à taux élevés ou anticorps anti-β-2-glycoprotéine 1 (aβ2GP1) de classe IgG et/ou IgM détectés au moins 2 fois à 12 semaines d’intervalle [1] . Vingt-trois cas de dissection ont été rapportés au cours du SAPL dans la littérature [2] . Toutefois, cette manifestation reste exceptionnelle. Ainsi, nous rapportons l’observation originale d’un SAPL révélé par une pré-éclampsie sévère compliquée de dissections artérielles multiples, soulevant la question de l’association de mécanismes obstétricaux et vasculaires du SAPL chez une patiente. Observation Une femme primigeste âgée de 39 ans, aux antécédents de phénomène de Raynaud et de tabagisme sevré, était hospitalisée pour une pré-éclampsie à 29 semaines d’aménorrhée. La grossesse obtenue par stimulation ovarienne se déroulait sans problème, jusqu’à l’apparition d’un tableau de pré-éclampsie sévère avec un scotome central de l’œil gauche justifiant une césarienne en urgence après instauration de sulfate de magnésium et d’inhibiteur calcique. L’examen au fond d’œil retrouvait un œdème papillaire bilatéral avec un décollement séro-rétinien et l’imagerie cérébrale était normale. La patiente était transférée en réanimation pour l’apparition d’anomalies biologiques compatible avec un Hemolysis, Elevated Liver Enzymes and Low Platelet count (HELLP) syndrome. Après une amélioration clinique initiale, la patiente présentait à j9 des douleurs abdominales associées à des nausées et des vomissements, ainsi qu’une majoration de la pression artérielle malgré une trithérapie anti-hypertensive. Elle se plaignait d’une baisse de l’acuité visuelle. Biologiquement, le HELLP syndrome persistait. L’imagerie par résonance magnétique (IRM) cérébrale et les éléments cliniques évoquaient un syndrome d’encéphalopathie postérieure réversible, initialement retenu sur l’IRM. La tomodensitométrie abdominale révélait un hématome mural sur dissection de l’artère mésentérique supérieure. Des paresthésies du membre supérieur gauche et des céphalées apparaissaient à j1. Une nouvelle IRM cérébrale montrait un accident ischémique constitué occipital gauche secondaire à une dissection de l’artère vertébrale gauche, ainsi qu’un accident ischémique constitué cérébelleux droit. La réévaluation ophtalmologique retrouvait une neuropathie optique ischémique antérieure aiguë. Un ACC, des aCL à 120 GPL et des aβ2GP1 de classe IgG à 99 U/mL étaient retrouvés et contrôlés à 12 semaines. L’ensemble de ces éléments confirmait le diagnostic de SAPL. Le traitement par anti-coagulation curative, un antiagrégant plaquettaire et une monothérapie anti-hypertensive permettaient un retour à domicile. L’examen clinique et la recherche génétique de pathologie héréditaire du collégène étaient négatifs. Trois mois après sa sortie, seuls les troubles visuels persistaient. Conclusion L’originalité de notre observation tient au mode de révélation de ce SAPL, notamment la survenue de dissections multiples, une complication rare du SAPL Nous proposons un mécanisme multifactoriel avec initialement une fragilité vasculaire acquise impliquant un âge tardif de la grossesse, un tabagisme, ainsi qu’une action directe des APL sur l’endothélium vasculaire secondaire à l’activation du complément et à une altération du remodelage de la matrice extracellulaire par activité de la métalloprotéase-9. Le rôle de la stimulation ovarienne restant incertain. Une synthèse de facteur tissulaire et de facteur pro-inflammatoire contribue habituellement à la survenue de thrombose et à la pré-éclampsie. La pré-éclampsie, complication du SAPL obstétrical, a ensuite été le facteur favorisant des dissections. La thrombopénie du HELLP a sans doute « protéger » la patiente d’une thrombose mésentérique, ce qui n’a pas été le cas pour l’artère cérébral. Il est habituel de considérer le SAPL obstétrical comme une entité indépendante du SAPL vasculaire, notamment parce que les mécanismes thrombotiques ne peuvent pas expliquer l’ensemble des manifestations obstétricales [3] . Chez notre patiente, les complications vasculaires et obstétricales du SAPL ont probablement contribué à la survenue de cette présentation atypique. [ABSTRACT FROM AUTHOR]

Small for gestational age (SGA) is defined by weight (in utero estimated fetal weight or birth weight) below the 10th percentile (professional consensus). Severe SGA is SGA below the third percentile (professional consensus). Fetal growth restriction (FGR) or intra-uterine growth restriction (IUGR) usually correspond with SGA associated with evidence indicating abnormal growth (with or without abnormal uterine and/or umbilical Doppler): arrest of growth or a shift in its rate measured longitudinally (at least two measurements, 3 weeks apart) (professional consensus). More rarely, they may correspond with inadequate growth, with weight near the 10th percentile without being SGA (LE2). Birthweight curves are not appropriate for the identification of SGA at early gestational ages because of the disorders associated with preterm delivery. In utero curves represent physiological growth more reliably (LE2). In diagnostic (or reference) ultrasound, the use of growth curves adjusted for maternal height and weight, parity and fetal sex is recommended (professional consensus). In screening, the use of adjusted curves must be assessed in pilot regions to determine the schedule for their subsequent introduction at national level. This choice is based on evidence of feasibility and the absence of any proven benefits for individualized curves for perinatal health in the general population (professional consensus). Children born with FGR or SGA have a higher risk of minor cognitive deficits, school problems and metabolic syndrome in adulthood. The role of preterm delivery in these complications is linked. The measurement of fundal height remains relevant to screening after 22 weeks of gestation (Grade C). The biometric ultrasound indicators recommended are: head circumference (HC), abdominal circumference (AC) and femur length (FL) (professional consensus). They allow calculation of estimated fetal weight (EFW), which, with AC, is the most relevant indicator for screening. Hadlock's EFW formula with three indicators (HC, AC and FL) should ideally be used (Grade B). The ultrasound report must specify the percentile of the EFW (Grade C). Verification of the date of conception is essential. It is based on the crown-rump length between 11 and 14 weeks of gestation (Grade A). The HC, AC and FL measurements must be related to the appropriate reference curves (professional consensus); those modelled from College Francais d'Echographie Fetale data are recommended because they are multicentere French curves (professional consensus). Whether or not a work-up should be performed and its content depend on the context (gestational age, severity of biometric abnormalities, other ultrasound data, parents' wishes, etc.) (professional consensus). Such a work-up only makes sense if it might modify pregnancy management and, in particular, if it has the potential to reduce perinatal and long-term morbidity and mortality (professional consensus). The use of umbilical artery Doppler velocimetry is associated with better newborn health status in populations at risk, especially in those with FGR (Grade A). This Doppler examination must be the first-line tool for surveillance of fetuses with SGA and FGR (professional consensus). A course of corticosteroids is recommended for women with an FGR fetus, and for whom delivery before 34 weeks of gestation is envisaged (Grade C). Magnesium sulphate should be prescribed for preterm deliveries before 32-33 weeks of gestation (Grade A). The same management should apply for preterm FGR deliveries (Grade C). In cases of FGR, fetal growth must be monitored at intervals of no less than 2 weeks, and ideally 3 weeks (professional consensus). Referral to a Level IIb or III maternity ward must be proposed in cases of EFW <1500g, potential birth before 32-34 weeks of gestation (absent or reversed umbilical end-diastolic flow, abnormal venous Doppler) or a fetal disease associated with any of these (professional consensus). Systematic caesarean deliveries for FGR are not recommended (Grade C). In cases of vaginal delivery, fetal heart rate must be monitored continuously during labour, and any delay before intervention must be faster than in low-risk situations (professional consensus). Regional anaesthesia is preferred in trials of vaginal delivery, as in planned caesareans. Morbidity and mortality are higher in SGA newborns than in normal-weight newborns of the same gestational age (LE3). The risk of neonatal mortality is two to four times higher in SGA newborns than in non-SGA preterm and full-term infants (LE2). Initial management of an SGA newborn includes combatting hypothermia by maintaining the heat chain (survival blanket), ventilation with a pressure-controlled insufflator, if necessary, and close monitoring of capillary blood glucose (professional consensus). Testing for antiphospholipids (anticardiolipin, circulating anticoagulant, anti-beta2-GP1) is recommended in women with previous severe FGR (below third percentile) that led to birth before 34 weeks of gestation (professional consensus). It is recommended that aspirin should be prescribed to women with a history of pre-eclampsia before 34 weeks of gestation, and/or FGR below the fifth percentile with a probable vascular origin (professional consensus). Aspirin must be taken in the evening or at least 8h after awakening (Grade B), before 16 weeks of gestation, at a dose of 100-160mg/day (Grade A). [ABSTRACT FROM AUTHOR]

Introduction Le diaphragme, principal muscle inspiratoire [1] est exposé à des contraintes mécaniques en fin de grossesse [2] . Notre étude a pour objectif l’évaluation échographique de l’amplitude diaphragmatique couplée à la spirométrie en peripartum, selon la modalité d’accouchement (césarienne ou voie basse [VB]). Matériel et méthodes Dans cette étude, prospective, monocentrique, 25 patientes à terme (≥ 37 SA) devant bénéficier soit d’une césarienne programmée ( n = 12) soit d’un déclenchement ( n = 13) ont été incluses. Chez toutes les patientes, l’amplitude diaphragmatique était mesurée par échographie en mode TM (technique validée [3] ) à la fois en ventilation de repos (DIAr) et en inspiration forcée (DIAmax) avec un pince-nez/embout buccal. Ces mesures échographiques étaient couplées à des mesures spirométriques (volume inspiratoire en ventilation de repos (Vt) et capacité inspiratoire (CI) en inspiration forcée). Ces mesures étaient effectuées à J-1(avant l’accouchement) et J + 1, avec pour les césariennes une mesure supplémentaire à J + 3. Les tests non-paramétriques de Wilcoxon et de Kruskall–Wallis ont été utilisés. Les résultats sont exprimés en médiane [extrêmes]. Un p < 0,05 était retenu. Résultats Quatorze patientes ont été étudiées, 7 dans le groupe voie basse (VB) et 7 dans le groupe césarienne. 11 ont étaient exclues pour les motifs suivant : refus de poursuivre l’étude, macrosomie ou impossibilité de respecter les consignes spirometriques. A J-1 les groupes sont comparables. Dans le groupe Césarienne entre J-1 et J + 1, on constate une baisse du DIAmax de 18 %, passant de 57 [54–64] mm à 50 [40–55] mm ( p = 0,02) avec un retour aux valeurs du prépartum à J + 3 (55 [50–59] mm) mais sans modification des paramètres spirométriques. Dans le groupe VB entre J-1 et J + 1, on ne constate pas de modification significative de la cinétique diaphragmatique (avec respectivement 63 [52–70]mm et 59 [55–67] mm), ni de la spirométrie. Discussion Chez les patientes ASA 1, la césarienne diminue la cinétique diaphragmatique à J + 1, avec à J + 3 un retour aux valeurs prépartum. L’absence de modification lors d’un accouchement par VB suggère que cette voie est à privilégier chez la femme avec une pathologie respiratoire. [ABSTRACT FROM AUTHOR]

Introduction La partie la plus étroite des voies aériennes supérieures (VAS) est le diamètre transverse sous glottique cricoïdien [1] , dont la mesure par échographie est une technique validée. Il a déjà été montré qu’il n’existe pas de différence significative du diamètre transverse sous glottique mesuré par échographie chez des femmes au 3ème trimestre avec une grossesse physiologique et des femmes non gestantes [2] . Chez les patientes pré-éclamptiques il a été montré qu’elles présentaient des VAS plus étroites au niveau du pharynx et de la jonction oropharyngée [3] . L’Objectif de notre étude est de comparer par échographie le diamètre transverse de la lumière sous glottique au niveau cricoïdienne des patientes prééclamptique à celui d’un groupe contrôle. Matériel et méthodes Il s’agit d’une étude observationnelle, ouverte, prospective et monocentrique. Les patientes étaient recrutées dans le service de grossesse pathologique. Les patientes incluses dans le groupe prééclampsie, présentaient les critères diagnostiques de la prééclampsie. L’inclusion des patientes dans le groupe contrôle, concernait les femmes enceintes hospitalisées dans le même service, mais ne présentant pas de signes ou de facteurs de risques de prééclampsie. Elles bénéficiaient toutes d’une mesure du diamètre transverse sous glottique (DTSG) par échographie en mode B. Le test de Student's était utilisé et une corrélation linéaire recherchée. Un p < 0,05 était retenu. Résultats 62 patientes ont été incluses (31 dans le groupe « contrôle » et 31 dans le groupe « prééclampsie »). 12 patientes ont été exclues pour mauvaise échogénicité. 27 dans le groupe « contrôle » et 23 dans le groupe « prééclampsie » ont finalement été analysées. Le DTSG au niveau cricoïdien était similaire dans le groupe contrôle (12 ± 1 mm) et prééclampsie (12 ± 1,2 mm) ; ( p = 0,91). Discussion L’absence de modification du DTSG chez les patientes prééclamptiques vient confirmer l’étude précédente, qui n’avait pas mis en évidence de modification du DTSG au 3ème trimestre de la grossesse physiologique. Il semble donc que les modifications des VAS responsables de difficultés d’exposition glottique au cours de la grossesse soient essentiellement sus glottiques. [ABSTRACT FROM AUTHOR]

Résumé Objectif Les méthodes mécaniques de maturation cervicale sont aussi efficaces que les prostaglandines pour le taux d’accouchement par voie basse. Notre étude a pour objectif d’étudier les pratiques professionnelles de maturation cervicale par méthodes mécaniques en France. Méthodes Enquête déclarative menée sur un échantillon représentatif des maternités françaises (échantillon 1), d’une part, et sur l’ensemble des maternités de type 3, d’autre part (échantillon 2). Un questionnaire a été envoyé par courrier électronique aux responsables des unités obstétricales de ces maternités entre mai et juillet 2014. Résultats Quarante-trois des 104 maternités de l’échantillon 1 (41,3 %) et 43 des 64 maternités de l’échantillon 2 (67,2 %) ont répondu au questionnaire. Des maturations mécaniques sont réalisées dans 44,2 et 69,8 % des maternités de ces échantillons. Les principaux moyens utilisés sont la sonde à double ballonnet et la sonde de Foley. La principale indication des maturations mécaniques est l’indication de déclenchement sur utérus unicicatriciel. En cas d’indication de déclenchement du travail avec utérus unicicatriciel et score de Bishop < 7 dans l’échantillon 1, 46,6 % des maternités réalisent une césarienne, 32,3 % réalisent un déclenchement par méthodes mécaniques, 13,9 % par ocytocine et 6,9 % par prostaglandines. Dans l’échantillon 2, 25,6 % des maternités réalisent une césarienne, 53,6 % pratiquent un déclenchement par méthodes mécaniques, 9,3 % par ocytocine et 11,6 % par prostaglandines. Conclusion En France, près de 50 % de l’ensemble des maternités et près de ¾ des maternités de type 3 disent pratiquer des maturations mécaniques. Leur principale indication est le déclenchement du travail avec utérus cicatriciel. Objective Mechanical methods for cervical ripening are as effective as prostaglandins for the rate of vaginal delivery. Our aim was to study professional practices of mechanical cervical ripening in France. Methods A declarative survey was conducted among two groups of maternity units: a sample representative of French maternity units (group 1) and on the whole of type 3 maternity units (group 2). A questionnaire was emailed to physicians of these obstetric units between May and July 2014. Results Forty-three of the 104 units (41.3%) in the first group and 43 of the 64 units in the second group (67.2%) answered the questionnaire. Among these maternity units, mechanical methods were used respectively in 44.2 and 69.8% of the establishments. The two main devices used were the trans-cervical balloon catheter and the Foley catheter. The main indication for mechanical methods was induction of labor with prior caesarean. In case of induction of labor, a prior caesarean and a Bishop score < 7, in the first group, 46.6% of the maternity units did a caesarean, 32.3% performed an induction of labor with mechanical methods, 13.9% with oxytocin and 6.9% with prostaglandins. In the second group, 25.6% of maternity units performed a caesarean, 53.6% used mechanical methods, 9.3% used oxytocin and 11.6% used prostaglandins. Conclusion In France nearly half of the maternity units and nearly three-quarters of type 3 maternity units say they use mechanical cervical ripening, mainly used in case of prior caesarean. [ABSTRACT FROM AUTHOR]

Postpartum haemorrhage (PPH) is a major cause of maternal mortality, accounting for one-quarter of allmaternal deaths worldwide. Uterotonics after birth are the only intervention that has been shown to be effective for PPH prevention. Tranexamic acid (TXA), an antifibrinolytic agent, has therefore been investigated as a potentially useful complement to this for both prevention and treatment because its hypothesized mechanism of action in PPH supplements that of uterotonics and because it has been proved to reduce blood loss in elective surgery, bleeding in trauma patients, and menstrual blood loss. This review covers evidence from randomized controlled trials (RCTs) for PPH prevention after caesarean (n=10) and vaginal (n=2) deliveries and for PPH treatment after vaginal delivery (n=1). It discusses its efficacy and side effects overall and in relation to the various doses studied for both indications. TXA appears to be a promising drug for the prevention and treatment of PPH after both vaginal and caesarean delivery. Nevertheless, the current level of evidence supporting its efficacy is insufficient, as are the data about its benefit:harm ratio. Large, adequately powered multicentre RCTs are required before its widespread use for preventing and treating PPH can be recommended. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective In the first trimester of pregnancy, a biparietal diameter ( BPD) below the 5th percentile is a simple marker that enables the prenatal detection of half of all cases of open spina bifida. We hypothesized that relating the BPD measurement to the transverse abdominal diameter ( TAD) might be another simple and effective screening method. In this study we assessed the performance of using the BPD/ TAD ratio during the first trimester of pregnancy in screening for open spina bifida. Methods A total of 20 551 first-trimester ultrasound scans (11-13 weeks' gestation), performed between 2000 and 2013, were analyzed retrospectively; there were 26 cases of open spina bifida and 17 665 unaffected pregnancies with a crown-rump length of 45-84 mm and a record of both BPD and TAD measurements. Results The mean (± SD) BPD/ TAD ratio was 1.00 ± 0.06 for fetuses with spina bifida and 1.13 ± 0.06 for those without ( P < 0.0001). A BPD ≤ 5th percentile enabled the prenatal detection of 46.2% of spina bifida cases, while a BPD/ TAD ratio of ≤ 1.00 detected 69.2%. If we considered cases in which either BPD was ≤ 5th percentile or BPD/ TAD ratio was ≤ 1, we identified 76.9% of cases. In the latter case, the false-positive rate was 5.1%, while that for using a combination of both BPD ≤ 5th percentile and BPD/ TAD ratio ≤ 1 was 0.6%, with a sensitivity of 38.5%. The positive predictive value of using a combination of BPD ≤ 5th percentile and BPD/ TAD ratio ≤ 1 for detecting spina bifida was 8.5%. Conclusions Between 11 and 13 weeks' gestation, relating BPD to TAD improves considerably the diagnostic performance of using BPD measurement alone in screening for open spina bifida. Screening using this marker is simple and applicable to a large population. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article on sonographic labor monitoring and specification of ischial spine plane in pregnant women.

Résumé: Objectifs: L’interruption sélective de grossesse (ISG) sur grossesse gémellaire monochoriale pour anomalie fœtale discordante est une intervention peu pratiquée et qui soulève des questions techniques et éthiques. Il n’existe pas de registre ou de statistiques nationales, ni de recommandation ou de consensus sur les modalités de réalisation ou le terme le plus favorable. Matériel et méthodes: Nous avons mené une étude déclarative des pratiques nationales par questionnaire mail, auprès de chaque médecin coordonnateur des 48 Centres Pluridisciplinaires de Diagnostic Prénatal français. Les questions portaient sur les dossiers de 2010 et 2011. Deux relances ont été effectuées en cas de non-réponse. Résultats: Le taux de réponse au questionnaire a été de 56 %. Quatre-vingt-un pour cent des centres ont été confrontés au moins une fois lors des 2 années 2010–2011 à une anomalie fœtale discordante sur grossesse monochoriale. Seulement 59 % des centres pratiquent des ISG toutes techniques confondues. Pour les gestes d’interruption de la circulation au cordon, c’est la coagulation bipolaire qui est la plus utilisée (75 %). La réalisation d’une ISG en cours de césarienne est une pratique fréquente (75 % des centres). Pour la réalisation d’une ISG le mode d’anesthésie le plus employé est l’anesthésie locorégionale. Discussion et conclusion: L’ISG sur grossesse monochoriale n’est pas pratiquée dans tous les centres en France. La technique la plus pratiquée et la mieux étudiée est la coagulation cordonale à la pince bipolaire. L’option de ne pas intervenir devrait cependant toujours être considérée et ses risques mis en balance avec ceux de l’ISG. La pratique d’une ISG en cours de césarienne n’est pas exceptionnelle. [Copyright &y& Elsevier]

Résumé: Objectifs: Estimer le nombre moyen d’échographies par grossesse et estimer la proportion des échographies sans examen morphologique du fœtus au cours des grossesses à bas risque. Type d’étude: Étude rétrospective portant sur des patientes ayant accouché entre janvier 2012 et février 2012 au CHU de Tours. Population de l’étude: Patientes ayant présenté une grossesse singleton et ayant accouché d’un enfant eutrophe au-delà de 37 semaines d’aménorrhée. Collection des données: On distinguait les échographies morphologiques et les échographies non morphologiques, ainsi que le type d’examen non morphologique. Résultats et discussion: Sur les 300 patientes de l’étude, le nombre moyen d’échographies par patiente est de cinq (écart-type=1,9), ce qui est donc plus élevé que les trois échographies recommandées pour ces grossesses à bas risque. Dans cette étude, 77 % des patientes bénéficiaient de plus de trois échographies. Par ailleurs, 28,1 % de l’ensemble des examens étaient des échographies non morphologiques. Ces dernières représentaient 42,2 % des examens réalisés au 3e trimestre de la grossesse. Parmi ces échographies non morphologiques du 3e trimestre, on comptait 51,9 % de contrôles biométriques et une mesure de la longueur du col dans 18,5 % des cas. Selon nous, le recours à l’échographie non morphologique au cours des grossesses à bas risque n’est pas critiquable en soi et doit même être encouragé. Mais une réflexion doit être menée afin d’améliorer la pertinence de tous ces examens. [ABSTRACT FROM AUTHOR]

An abstract of the article "3 case reports of congenital nephrotic syndrome diagnosed in the second trimester of congenital nephrotic syndrome in 3 non Finnish families," by L. K. Daher, F. Muller, F. Perrotin, S. Blesson, E. Roussel, C. Antignac, E. Anastasiades, and colleagues is presented.

Abstract: Objectives: Indications for fetal blood sampling (FBS) are getting more limited. In this context, we aimed to evaluate fetal loss and morbidity associated with FBS and to precise the predictive parameters for fetal complications. More than a retrospective evaluation of our practices, the final end point of our study was to better inform the patients coming to our centre. Patients and methods: Retrospective monocentric cohort (Canadian Task Force classification II-2) of the 99 FBS performed between April 2004 and June 2010 on 80 fetuses, after excluding the procedures done for termination of pregnancy. The main clinical outcome was a composite outcome criteria for fetal tolerance including cesarean section for abnormal non stress test within the 24hours, or any event responsible of a modified obstetrical management during the 14day following FBS. Results: Mean maternal age at FBS was 30years±5.13 SD and parity was 2.49±1.38SD. FBS was performed by an experienced operator in 86.5% of cases (CI 95%, 78–92.6); with a single insertion in 83.3% of circumstances (CI 95%, 74.4–90.2). The mean duration was 11min±6.37 SD. The total rate of intrauterine death, in our series, was 7.1% (CI 95%, 2.9–14), including all reported fetal demise within the 14 days after FBS, whatever the relation with the procedure. Our study demonstrated a 9.1% occurrence of post-FBS altered CTG fetal testing (CI 95%, 4.2–16.6), half of it with spontaneous resolution. The rate of severe complications (main clinical outcome) was 11.1% (CI 95%, 5.7–19) including one fetal death liable to FBS and 10 emergency caesarean sections: 5.1% for fetal bradycardia (CI 95%, 1.7–11.4), 2% for placental abruption (CI 95%, 0.2–7.1), 2% for premature preterm rupture of membranes (CI 95%, 0.2–7.1) and 1% for significative umbilical cord bleeding (CI 95%, 0–5.5). Univariate factor analysis highlights 4 parameters for impaired fetal tolerance; a prolonged procedure, presence of low fetal platelets (<30.109/L); and FBS performed for fetal anaemia during Parvovirus B19 infection or allo-immune thrombocytopenia. Discussion and conclusion: FBS remains a tricky procedure with a substantial risk of fetal loss or complications especially when performed on high-risk fœtuses. The length of the procedure should be shortened as much as possible (trained operator, postponed procedure when all favourable condition are not available). Fetal thrombocytopenia is a meaningful risk factor encouraging carefulness when exploring allo-immune fetal thrombocytopenia. [Copyright &y& Elsevier]

Abstract: In the second stage of labor, fetal head rotation and fetal head position are determinant for the management of labor to attempt a vaginal delivery or a cesarean section. However, digital examination is highly subjective. Nowadays, delivery rooms are often equipped with compact and high performance ultrasound systems. The clinical examination can be easily completed by quantified and reproducible methods. Transabdominal ultrasonography is a well-known and efficient way to determine the fetal head position. Nevertheless, ultrasound approach to assess fetal head descent is less widespread. We can use translabial or transperineal way to evaluate fetal head position. We describe precisely two different types of methods: the linear methods (3 different types) and the angles of progression (4 different types of measurement). Among all those methods, the main pelvic landmarks are the symphysis pubis and the fetal skull. The angle of progression appears promising but the assessment was restricted to occipitoanterior fetal position cases. In the coming years, ultrasound will likely play a greater role in the management of labor. [Copyright &y& Elsevier]

Abstract: Objective: For several years in French labour wards, delivery in the lateral decubitus position (LP) has raised great interest. We wanted to assess perineal outcomes and neonatal morbidity following delivery in the lateral LP compared to the dorsal decubitus position (DP). Patients and methods: Two teams of midwives, in a private and in a public hospital, performed a total of 6800 deliveries in the area of Tours following a training session on the techniques of delivery in the lateral decubitus position. The design was a retrospective case-control study including patients with low obstetrical risks and normal vaginal delivery. We included 645 patients who gave birth from May 1st to September 30th, 2007. Results: We showed a significant difference in perineum outcomes, with a lower episiotomy rate (56.7% in LP/40.7% in DP, P =0.0001), a higher rate of intact perineum (56.7% in LP/40.7% in DP, P =0.0001) and no differences with respect to perineal laceration. These differences were significant in primiparous (intact perineum: 46.8% in LP/20.2% in DP, P =0.004; episiotomy: 17% en DL/44.7% en DD, P =0.006) and secondiparous patients (episiotomy: 8.6% in LP/30.7% in DP, P =0.0001). We showed significant differences in fetal heart abnormalities during labour in favour of the lateral decubitus position (no anomaly, P =0.00004; separated decrease, P =0.04; bradycardia, P =0.0009; early decrease, P =0.04). Discussion and conclusion: The neonatal mortality and morbidity did not differ between delivery positions. The lateral position seems to be protective for the perineum without affecting neonatal outcome. Incorporating lateral decubitus deliver into daily practice is possible in large groups of midwives after appropriate training. [Copyright &y& Elsevier]

Abstract: Objective: We have observed the association between uterine leiomyomas and complications during pregnancy, delivery and post-partum among our patients over the last 10 years. Patients and methods: We realized a retrospective case-control study comparing pregnancy and delivery outcomes in women with and without leiomyomas. In order to strengthen our observations, we conducted both univariate and multivariate analyses, and carefully respected 3 matching criteria between the two groups: age, parity and date of delivery. Results: Over a ten-year period, 117 (0.38%) women with at least one leiomyoma would give birth – among the 30,805 births registered in our unit. By multivariate analysis, the presence of leiomyomas was significantly associated with women''s age over 35 (adjusted odds ratio [AOR] 2.48, 95% confidence interval (CI) [1.31–4.67]), smoking (AOR=4.3, [1.82–10.13]), cystitis (AOR = 6.55, [2.12–20.16]), hydramnios (AOR = 5.12, [1.57–16.65]), threatened preterm labor (AOR = 3.99, [1.66–9.56]), first trimester bleeding (AOR = 3.92, [1.62–13.26]), anaemia during pregnancy (AOR = 2.97, [1.30–6.78]), labor dystocia (AOR = 11.79, [2.80–49.56]), retained placenta (AOR = 4.25, [1.49–12.11] and neonatal pediatric intensive care (AOR = 4.44, [1.19–16.60]). Regarding cesarean delivery, the multivariate analysis found that women with several leiomyomas underwent 8.48 times more cesarean sections than women with a single leiomyoma (p = 0.001). Discussion and conclusion: Our study shows how specific features are to be kept in mind regarding obstetric outcomes for women with leiomyomas. These results emphasise the need for good perinatal care and raise the question of the treatment of those leiomyomas before pregnancy with the development of non-invasive procedures. [Copyright &y& Elsevier]