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Background The fetal heart rate (FHR) serves as a guide to fetal well-being during the first stage of delivery. The visual morphological analysis of the FHR during labor is subject to inter- and intra-observer variability – particularly when the FHR is abnormal. It has been suggested that automatic analysis of the FHR can reduce this variability. Objectives To compare 11 morphological FHR analyses (baseline computation, and detection of FHR decelerations and accelerations) produced by automatic analysis methods (AAMs) with an expert consensus. Materials and methods Eleven AAMs were reprogrammed (using the description published in the literature) and applied to 90 FHR recordings collected during the early phase of labor. Furthermore, the recordings were divided into three tertiles, according to the difficulty of analysis. The results of the morphological FHR analyses produced by the AAMs were compared with a consensus morphological analysis performed by four experts. In addition to standard discriminant criteria, a new morphological analysis discriminant index (MADI) was introduced; it provides an overall evaluation that collates all the individual criteria. Results The AAM developed by Lu and Wei's gave better results than the other AAMs for baseline computation. Regarding this method's detection of FHR decelerations and accelerations, the F-measure [95% confidence interval] was respectively 0.73 [0.67; 0.76] and 0.70 [0.64; 0.76]. The MADI indicated that Lu and Wei's AAM agreed best with the expert consensus (discordance: 7.3% [6.10; 8.60]). Conclusion Our study demonstrated the superiority of Lu and Wei's method for baseline computation and deceleration/acceleration detection, although there was still a significant degree of discordance versus expert consensus. The MADI appears to be a good overall index for evaluating AAMs with regard to the quality of baseline computation and acceleration/deceleration detection. The application of precise criteria and the methodology and software tools developed here should facilitate the evaluation of new AAMs and their comparison with other methods.

BackgroundPregnant women are largely exposed to medications. However, knowledge is lacking about their effects on pregnancy and the fetus.ObjectiveThis study sought to evaluate the potential of high-dimensional propensity scores and high-dimensional disease risk scores for automated signal detection in pregnant women from medico-administrative databases in the context of drug-induced prematurity.MethodsWe used healthcare claims and hospitalization discharges of a 1/97th representative sample of the French population. We tested the association between prematurity and drug exposure during the trimester before delivery, for all drugs prescribed to at least five pregnancies. We compared different strategies (1) for building the two scores, including two machine-learning methods and (2) to account for these scores in the final logistic regression models: adjustment, weighting, and matching. We also proposed a new signal detection criterion derived from these scores: the p value relative decrease. Evaluation was performed by assessing the relevance of the signals using a literature review and clinical expertise.ResultsScreening 400 drugs from a cohort of 57,407 pregnancies, we observed that choosing between the two machine-learning methods had little impact on the generated signals. Score adjustment performed better than weighting and matching. Using the p value relative decrease efficiently filtered out spurious signals while maintaining a number of relevant signals similar to score adjustment. Most of the relevant signals belonged to the psychotropic class with benzodiazepines, antidepressants, and antipsychotics.ConclusionsMining complex healthcare databases with statistical methods from the high-dimensional inference field may improve signal detection in pregnant women.

International audience; IntroductionPlanned vaginal delivery in breech presentation is accompanied by an excess neonatal risk that has, however, rarely been compared to that of delivery in vertex presentation. Because of the severity of complications that can occur in long-term follow-up, the risk of asphyxia is of particular concern.Material and methodsTo assess immediate neonatal status after a planned vaginal delivery of fetuses in breech compared with vertex presentation, we planned a retrospective hospital cohort study of singleton term deliveries from 2000 to 2011. The indicators used to assess neonatal status were: 5-min Apgar score < 7, acidosis, both moderate (pH < 7.15) and severe (pH < 7.0), asphyxia (pH < 7.0 and base deficit ≥ 12.0 mmol/L), transfer to the neonatal intensive care unit (NICU), and in-hospital neonatal death.ResultsCompared with 43,595 trials of vaginal delivery in vertex presentation at term during the 12-year study period (93.8% of all vertex presentations), the 665 breech deliveries for which planned vaginal delivery was planned (43.2% of all breech presentations) had a quadrupled risk of severe acidosis (ORa 4.3 [2.2–7.5]), but no increase in the risk of asphyxia (ORa 0.7 [0.1–3.0]), NICU transfer (ORa 0.8 [0.4–1.3]) or in-hospital death (ORa 1.3 [0.1–6.0]). Moreover, compared with the 876 planned cesareans, the risk of severe acidosis in the 665 trials of vaginal delivery in breech presentation was four times higher (OR 4.3 [2.3–4.7]), but we observed no increase in neither asphyxia nor other risks studied.ConclusionIn our hospital, planned vaginal delivery is safe for breech presentations because it is associated with an increase of severe acidosis but not asphyxia.

The fetal heart rate (FHR) is a screening signal for preventing fetal hypoxia during labor. When experts analyze this signal, they have to position a baseline and identify decelerations and accelerations. These steps can potentially be automated and made more objective by data processing analysis, but training and evaluation datasets are required. Here, we describe a dataset of 155 FHR recordings in which a reference baseline, accelerations and decelerations have been annotated by expert consensus. 66 FHR recordings with a shared expert analysis have been included in a training dataset, and 90 other FHR recordings with a non-shared expert analysis have been included in an evaluation dataset. Researchers wishing to evaluate their automatic analysis method should submit their results for comparison with the expert consensus. The dataset also contains the results produced by 11 re-coded automatic analysis methods from the literature. All the data are available at http://utsb.univ-catholille.fr/fhr-review.

The fetal heart rate (FHR) is a screening signal for preventing fetal hypoxia during labor. When experts analyze this signal, they have to position a baseline and then identify decelerations and accelerations. These steps can potentially be automated and made more objective by signal processing analysis. Various methods have been described in the literature but there are no open-source programs for performing these steps. The MATLAB toolbox presented here comprises a standard signal pre-processing function, 11 re-coded literature methods for fetal heart rate analysis, a signal viewer (enabling annotation by an expert) and an evaluation procedure with various criteria measuring intrarater agreement.

Objective To identify clinical parameters and intrapartum fetal heart rate parameters associated with a risk of umbilical cord acidosis at birth, using an automated analysis method based on empirical mode decomposition. Methods Our single-center study included 381 cases (arterial cord blood pH at birth pHa ≤7.15) and 1860 controls (pHa ≥7.25) extracted from a database comprising 8,383 full datasets for over-18 mothers after vaginal or caesarean non-twin, non-breech deliveries at term (>37 weeks of amenorrhea). The analysis of a 120-min period of the FHR recording (before maternal pushing or the decision to perform a caesarean section during labor) led to the extraction of morphological, frequency-related, and long- and short-term heart rate variability variables. After univariate analyses, sparse partial least square selection and logistic regression were applied. Results Several clinical factors were predictive of fetal acidosis in a multivariate analysis: nulliparity (odds ratio (OR) 95% confidence interval (CI)]: 1.769 [1.362–2.300]), a male fetus (1.408 [1.097–1.811]), and the term of the pregnancy (1.333 [1.189–1.497]). The risk of acidosis increased with the time interval between the end of the FHR recording and the delivery (OR [95%CI] for a 1-min increment: 1.022 [1.012–1.031]). The risk factors related to the FHR signal were mainly the difference between the mean baseline and the mean FHR (OR [95%CI]: 1.292 [1.174–1.424]), the baseline range (1.027 [1.014–1.040]), fetal bradycardia (1.038 [1.003–1.075]) and the late deceleration area (1.002 [1.000–1.005]). The area under the curve for the multivariate model was 0.79 [0.76; 0.81]. Conclusion In addition to clinical predictors, the automated FHR analysis highlighted other significant predictors, such as the baseline range, the instability of the FHR signal and the late deceleration area. This study further extends the routine application of automated FHR analysis during labor and, ultimately, contributes to the development of predictive scores for fetal acidosis.

International audience; This paper presents a web viewer of Fetal Heart Rate (FHR) signals developed on HTML5/JavaScript. It provides an easy solution to remotely consult an FHR signal on a web browser without installing any specific software and it can be used either on a computer or on mobile device. There are three major applications of this tool. First, it is used to build up our FHR database used for research on signal processing and analysis. Secondly, it is used on our E-learning website e.RCF in order to train midwives and obstetricians to interpret FHR signals. At last, it could be used on telemedicine either on tele-monitoring to remotely check the fetal welfare, or on tele-expertise to enable practitioners to ask for specialists’ opinion. This viewer is designed to correspond to practitioners’ habits while including tools to ease the interpretation the FHR signal.

In 2007, the French National College of Obstetricians published some recommendations concerning the Fetal Heart Monitoring (FHM) analyse, insisting on the importance of the initial and continuous education. This study deals with the evaluation of an FHM e-learning website named “e.RCF” using a pre and post assessment and a feedback form. The findings reveal a significantly greater efficiency of the “e.RCF” teaching software over the “classical” training. The impact is all the more important since the student is struggling, no matter the year of study. The questionnaire results show that they appreciate this teaching method and think “e.RCF” should integrate of their formation.

International audience; PurposeTo provide an up-to-date account of drug prescription during pregnancy in France from 2011 to 2014 using the permanent sample of the French national computerized healthcare database and with a focus on recommended supplementations, fetotoxic drugs and teratogenic drugs.MethodsAll pregnancies identified by the International Classification of Diseases, 10th Revision codes list in the hospitalization database, lasting more than 9 weeks of amenorrhea and whose delivery occurred between 01/01/2011 and 12/31/2014, were included. Drugs delivered between the trimester before and until the end of the pregnancy were included. Drug exposure prevalence was calculated for each year and according to pregnancy trimesters.ResultsThe study included 28,491 pregnancies with a median number of 9 [5–13] (median [IQ range]) drugs delivered. The most prescribed drug class was antianemia (in 72.5% of exposed). The prescription rate of recommended vitamins (B9 and D) increased over the study period (+10%). Influenza vaccination also increased but remained at a low rate (1%). Exposure to fetotoxic drugs decreased as pregnancy advanced. Exposure to the main teratogenic antiepileptics was stable over the study period. Low-income pregnant women had a higher average drug consumption except for recommended vitamins.ConclusionPregnant French women are among the largest consumers of prescription medications worldwide. Overall, the dispensation trends observed in this study are in line with the recommendations of the French National College of Gynecologists and Obstetricians. Nevertheless, while being low, exposure to fetotoxic drugs, teratogenic drugs or those under safety alerts still occurred. Supplementations and vaccines in low-income pregnant women should also be increased.

Visual analysis of fetal heart rate (FHR) during labor is subject to inter- and intra-observer variability that is particularly troublesome for anomalous recordings. Automatic FHR analysis has been proposed as a promising way to reduce this variability. The major difficulty with automatic analysis is to determine the baseline from which accelerations and decelerations will be detected. Eleven methods for automatic FHR analysis were reprogrammed using description from the literature and applied to 66 FHR recordings collected during the first stage of delivery. The FHR baselines produced by the automatic methods were compared with the baseline defined by agreement among a panel of three experts. The better performance of the automatic methods described by Mongelli, Lu, Wrobel and Pardey was noted despite their different approaches on signal processing. Nevertheless, for several recordings, none of the automatic studied methods produced a baseline similar to that defined by the experts.

Introduction Selon l’étude du CIANE, 75% des patientes relatent avoir souffert de l’épisiotomie. La qualité de lasuture est donc essentielle à une cicatrisation sans conséquence à court et moyen terme. Selon le typede traumatisme périnéal obstétrical, différentes méthodes de réparation s’offrent aux professionnels,elles sont diverses et variées et présentent chacune des avantages et inconvénients. Le CNGOFpréconise d’appliquer la technique de sutures « un fil un nœud ». Notre étude recense les données quantà l’utilisation et à la connaissance de cette méthode. Matériel et Méthode À travers les quatre réseaux du Nord-Pas-de-Calais, les professionnels de santé exerçant en salle denaissance et habilités à pratiquer la réfection de suture ont répondu à un questionnaire. 245 réponses ontété récoltées, répondant à des questions de type démographique, à des questions sur les connaissancespures, et sur les habitudes de pratique ainsi que sur les facteurs de choix de leur pratique habituelle. Résultats Concernant les RPC du CNGOF, les gynécologues-obstétriciens déclarent connaitre à 59.6% lesrecommandations vs 22.9% pour les sages-femmes. Ils connaissent en grande majorité les avantagesdes méthodes. La technique la plus usuelle lors de l’apprentissage est la technique 3 plans avec pointssimples sur la peau (53%) vs la technique un fil un nœud (8%). La technique actuelle employée setrouve être en majorité la technique 3 plans avec points simples sur la peau (39%), mais l’utilisation dela technique un fil un nœud est augmentée (37%). Ils choisissent leur méthode de réparation selon leurdextérité personnelle (45.9%), ou s’ils ne la pratiquent pas c’est par manque d’expérience (46.3%). Conclusion Ce mémoire a pour but de souligner le manque de connaissance des RPC dans le Nord-Pas-de-Calais.Le manque d’expérience soulignée ici, suppose une formation initiale et continue à approfondir par lebiais souhaitable de compagnonnage sur le terrain, mais également de formation pratique via dessimulateurs de suture.

Le jeûne per-partum fut instauré en salle de naissance depuis la publication du Dr MENDELSON sur l’inhalation bronchique en 1946. Au fil des années, des moyens de prévention ont été mis en place pour éviter le syndrome de Mendelson. Les sociétés savantes ont publié depuis les années 2000 de nouvelles recommandations plus permissives concernant l’hydratation orale. Une étude quantitative, multicentrique, observationnelle, descriptive et transversale a été réalisée au sein du réseau Pauline. Un questionnaire informatique et papier adressé aux sages-femmes travaillant en salle de naissance a été distribué afin de connaître leurs pratiques, leurs connaissances et les directives des médecins concernant l’alimentation et l’hydratation orale en salle de naissance. L’interdiction de l’alimentation en salle de naissance semble établie au sein du réseau. Concernant l’hydratation orale, les pratiques sont hétérogènes. Les connaissances des sages-femmes au sujet de l’anesthésie générale de la femme enceinte et des recommandations de la Société Française d’Anesthésie et de Réanimation sont insuffisantes. L’hydratation orale en salle de naissance doit être encadrée. Les sages-femmes du réseau Pauline participantes de l’étude réclament un protocole de service afin d’harmoniser les pratiques.