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In 2016, only 7% of French women had received an influenza vaccination during their pregnancy. In this vaccine-averse country, the possibility of reaching the rates of 50% observed in other countries remains unknown. To measure the rate of influenza vaccination in a French university maternity. To study its evolution and determinants over the last 5 years. Single-center observational study of all women who gave birth during March 2020 in this maternity. Comparison with rates observed in 2015 in the same conditions. Of the 337 women included in the study, 202 received a vaccination during pregnancy (59.9%). After logistic regression, the factors significantly associated with achieving vaccination were the offer of vaccination during pregnancy, odds ratio (ORa) 26.2 [7.0; 98.2]; previous vaccination, ORa 20.3 [9.6; 42.6]; high education level, ORa 2.9 [1.3; 6.2]; delivery of a CERFA government reimbursement form, ORa 2.5 [1.3; 4.8]; a vaccination offer made by a general practitioner, ORa 2.1 [1.0; 4.4] and not by a hospital midwife, ORa 0.3 [0.1; 0.6]. The rate of vaccination increased from 35% to 59.9% between 2015 and 2020 ( p  < .001), with a significant increase in the offer of vaccination during pregnancy (+14.6%) - especially by a general practitioner (+17.2%) - and in the rate of women with earlier vaccination (+13.6%). In France, vaccination rates above 50% are possible at a center level. A proposal of vaccination during pregnancy - especially by the general practitioner - seems to be a determining factor in this development.

Background: Sustained injury, through radiotherapy, burns or surgical trauma, can result in fibrosis, displaying an excessive deposition of extracellular matrix (ECM), persisting inflammatory reaction, and reduced vascularization. The increasing recognition of fibrosis as a cause for disease and mortality, and increasing use of radiotherapy causing fibrosis, stresses the importance of a decent anti-fibrotic treatment., Aim: To obtain an in-depth understanding of the complex mechanisms underlying fibrosis, and more specifically, the potential mechanisms-of-action of adipose-derived stomal cells (ADSCs) in realizing their anti-fibrotic effect., Methods: A systematic review of the literature using PubMed, Embase and Web of Science was performed by two independent reviewers., Results: The injection of fat grafts into fibrotic tissue, releases ADSC into the environment. ADSCs' capacity to directly differentiate into key cell types ( e.g. , ECs, fibroblasts), as well as to secrete multiple paracrine factors ( e.g. , hepatocyte growth factor, basis fibroblast growth factor, IL-10), allows them to alter different mechanisms underlying fibrosis in a combined approach. ADSCs favor ECM degradation by impacting the fibroblast-to-myofibroblast differentiation, favoring matrix metalloproteinases over tissue inhibitors of metalloproteinases, positively influencing collagen organization, and inhibiting the pro-fibrotic effects of transforming growth factor-β1. Furthermore, they impact elements of both the innate and adaptive immune response system, and stimulate angiogenesis on the site of injury (through secretion of pro-angiogenic cytokines like stromal cell-derived factor-1 and vascular endothelial growth factor)., Conclusion: This review shows that understanding the complex interactions of ECM accumulation, immune response and vascularization, is vital to fibrosis treatments' effectiveness like fat grafting. It details how ADSCs intelligently steer this complex system in an anti-fibrotic or pro-angiogenic direction, without falling into extreme dilation or stimulation of a single aspect. Detailing this combined approach, has brought fat grafting one step closer to unlocking its full potential as a non-anecdotal treatment for fibrosis., Competing Interests: Conflict-of-interest statement: This article is not subject to any conflict of interest or financial disclosure., (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: Among the strategies to encourage pregnant women to be vaccinated against pertussis in the postpartum period, that of giving them a prescription has been evaluated only sparsely., Objective: To measure the effect of giving women who are not immunized against pertussis a prescription for the vaccine at discharge from the maternity unit., Material and Methods: Single-center before-and-after study (2011: before; 2015: after). All women received both oral and written information about vaccination against pertussis. During the after period, they were also specifically asked their immunization status during pregnancy. Those currently unimmunized received a written prescription for it at discharge., Results: Among the women unimmunized at delivery, the percentage who were vaccinated postpartum climbed from 17 to 42% between 2011 and 2015 (p < 0.001), while the percentage of their unimmunized partners who were vaccinated remained stable (27 and 29%, p = 0.74). During this time, the percentage of women immunized against pertussis at the beginning of pregnancy rose from 32 to 52% (p < 0.001). Finally, the percentage of all women protected against this disease postpartum climbed from 44 to 72% between these two periods (p < 0.001)., Conclusions: In the postpartum period, giving a prescription for pertussis vaccine to women unimmunized is accompanied by a significant elevation in their vaccination rate. Nevertheless, this rate remains low and better strategies have to be implemented., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: Although vaccination of pregnant women against influenza is recommended, the vaccination rate remains low. We conducted a study to identify determinants of influenza vaccination uptake in pregnancy in order to identify strategies to improve seasonal influenza vaccination rates., Methods: Prospective observational hospital-based study in the French hospital performing the highest number of deliveries, located in the city of Lille, among all women who had given birth during the 2014-2015 influenza season. Data were collected through a self-completed questionnaire and from medical files. The vaccination uptake was self-reported. Determinants of vaccination uptake were identified using logistic regression analysis., Results: Of the 2045 women included in the study, 35.5% reported that they had been vaccinated against influenza during their pregnancy. The principal factors significantly associated with greater vaccination uptake were previous influenza vaccination (50.9% vs 20.2%, OR 4.1, 95% CI 3.1-5.5), nulliparity (41.0% vs 31.3%, OR 2.5, 95% CI 1.7-3.7), history of preterm delivery < 34 weeks (43.4% vs 30.3%, OR 2.3, 95% CI 1.1-4.9), the mother's perception that the frequency of vaccine complications for babies is very low (54.6% vs 20.6%, OR 1.1, 95% CI 0.5-2.2), the mother's good knowledge of influenza and its vaccine (61.7% vs 24.4%, OR 3.1, 95% CI 2.2-4.4), hospital-based prenatal care in their first trimester of pregnancy (55.0% vs 30.2%, OR 2.1, 95% CI 1.2-3.7), vaccination recommendations during pregnancy by a healthcare worker (47.0% vs 2.7%, OR 18.8, 95% CI 10.0-35.8), receipt of a vaccine reimbursement form (52.4% vs 18.6%, OR 2.0, 95% CI 1.5-2.7), and information from at least one healthcare worker about the vaccine (43.8% vs 19.1%, OR 1.8, 95% CI 1.3-2.6)., Conclusions: Our findings suggest that in order to increase flu vaccination compliance among pregnant women, future public health programmes must ensure cost-free access to vaccination, and incorporate education about the risks of influenza and the efficacy/safety of vaccination and clear recommendations from healthcare professionals into routine antenatal care.

Postpartum endometritis accounts for 2% of postpartum infections in developed countries. In France, 2.3% of deaths are attributed to puerperal infections. The most important risk factor is cesarean delivery, especially if it is done after the start of labor. Bacteria of the vaginal microbiota are associated with postpartum endometritis. Symptoms are abdomino-pelvic pain, hyperthermia and abnormal lochia. The diagnosis is confirmed by uterine mobilization pain. The first-line antibiotic therapy is amoxicillin-clavulanic acid 3 to 6 grams per day depending on the weight, intravenously or orally. In case of impossibility to use penicillins (anaphylaxis for example), the combination of clindamycin 600mg×4/d plus gentamicin 5mg/kg×1/d may be use, it must be a specialized decision in case of maternal breastfeeding. The treatment is continued until obtaining 48hours of apyrexia and the disappearance of pelvic pain. In case of persistence of fever and/or pelvic pain after 72hours of antibiotic therapy, pelvic imaging should be performed for placental retention, septic thrombophlebitis, deep abscess or any other surgical complication and eliminate differential diagnoses. It is important to highlight the difficulties of interpreting endo-uterine images in ultrasound. Hypocoagulant heparin therapy should be started in case of septic thrombophlebitis for 6 weeks, or longer if there are complications such as embolism or thrombotic risk factors. Regarding prevention, during a caesarean section, a vaginal swab with iodinated polividone or chlorhexidine is recommended before caesarean if possible, and extraction of the placenta must be spontaneous., (Copyright © 2019 CNGOF, SPILF. Published by Elsevier Masson SAS.. All rights reserved.)

Objectives: The aim of this study was to establish the panorama of uropathies discovered during the antenatal period and to analyze the explorations performed. Pregnancy outcome and infant prognosis was also recorded., Method: Ultrasonographic imaging revealed dilatation in 62.5% of the cases, parenchymal anomalies in 26.3% and unilateral or bilateral agenesia in 11.2%. The percentage of abnormal karyotypes was 4.76% for all urorenal symptomatologies. These abnormal karyotypes corresponded to 10% of those performed in 17 fetuses, urine puncture was used in order to assess in utero renal function. There were 113 live births, 31 medically termined pregnancies and 3 spontaneous abortions. Among the 113 live infants, 12 died during the post-natal period. Thirty-two infants were considered to be normal and 69 had an urorenal malformation, including 2 infants with pre-end-stage renal failure at 4 and 3 years., Conclusion: It is uncommon to discover an urorenal malformation at prenatal ultrasonography. The main problem is antenatal management and evaluation of prognosis. Urine puncture and in utero derivation are discussed. When no other reliable factors affecting fetal prognosis are available, puncture of fetal urine provides useful information for management although the technique remains under debate.

The prenatal diagnosis of trisomy for the distal half of the short arm of n(o) 9 chromosome (partial trisomy 9p) has been realized from a morphologic ultrasound. A genetic investigation has permitted to establish that this trisomy was due to a bad segregation of a stable translocation present in the patient's mother. To our knowledge, the ultrasound prenatal diagnosis of partial trisomy 9p has never been reported in the literature. The prognosis of this syndrome remains very pejorative and the termination of pregnancy is the most often proposed solution.

Total abdominal hysterectomy and bilateral salpingo-oophorectomy has long been the standard surgical treatment for endometrial cancer. Radical hysterectomy is not useful in stage I. in women with extreme obesity and medical risk factors, vaginal hysterectomy is recommended. Laparoscopy-assisted vaginal hysterectomy complete the oncologic treatment if lymphadenectomy is necessary.

Objective: A retrospective study of local faiture and cosmetic results after conservative surgery for retroareolar breast cancer., Patients and Results: Seventy-seven patients underwent a conservative surgical procedure between 1983 and 1994. Median follow-up was 37,5 months. Fourteen patients experienced a recurrence (5 local, 2 local and distant, 7 distant). Only two probably interrelated factors were associated with a risk of local recurrence: nipple-areola complex removed or not, and pathological margins. Cosmetic results were evaluated with patient's questionnaires: 40/47 patients (85%) stated they were satisfied., Conclusion: In spite of the short follow-up, conservative surgery is a safe procedure for local control only in cases with negative margins. Procedure for nipple areola complex is now questionable. Cosmetic results are achieved if indication of central lumpectomy are confined to small and limited tumors. For other tumors, plastic remodelling is necessary.

Granulosa cell tumours are relatively rare ovarian tumors. The incidence was 0.9 cases per 100,000 women per year. We describe a quite uncommon granulosa tumour found in the broad ligament. The patient was a 25-year-old, white woman, gravida 4, para 2. Surgical treatment was tumourectomy with homolateral salpingo-oophorectomy. From this observation, embryology, clinical and paraclinical aspects, treatment and prognosis of these tumours are reviewed.