[Impact of the aged-related changes of sagittal spinal curvature on pelvic organ prolapse. A systematic review of the literature]. / Impact des modifications des courbures vertébrales sagittales liées à l'âge sur les prolapsus des organes pelviens. Une revue systématique de la littérature.

OBJECTIVES: The aim of this review was to specify the potential association between age-related changes in sagittal spinal curvature and risk of pelvic organ prolapse in women. METHODS: A systematic review based on the PRISMA statement was performed. Keywords were chosen according to the eligibility criteria in line with the PICO model. For inclusion, studies had to be based on observational cohorts, case controls and cross sectional studies. The quality of the articles was assessed using the STROBE scale. RESULTS: Five papers from 1996 to 2021 were included in the present review with conflicting results. Four studies reported a positive association between anatomical pelvic organ prolapse at clinical examination, a loss of lumbar lordosis and an increase in thoracic kyphosis. The remaining study, using a questionnaire-based assessment of symptoms, found no association between prolapse-related symptoms and age-related changes in sagittal spinal curvatures. CONCLUSION: Based on the available evidence, this systematic review suggested a very moderate evidence of association between the development of anatomical pelvic organ prolapse and age-related changes in sagittal spinal curvature in women. This review remains very limited by the small number and the heterogeneity of the studies included. Further studies in the lifetime continunm, with high quality methodology are needed to better understand the physiopathology of pelvic organ prolapse.

[If you were to have another abortion, would you choose the same method? A study on 1032 patients' level of satisfaction]. / Si vous deviez bénéficier d'une autre IVG, opteriez-vous pour la même méthode ? À propos du niveau de satisfaction de 1032 patientes.

INTRODUCTION: In 2016, the French National College of Gynaecologists and Obstetricians revised the recommandations on abortion care. Abortions can now be medical, regardless of the term, depending on the patients' preference. The aim was to assess the influence of the term and method on patients' satisfaction, in Haute-Normandie. METHOD: This is a prospective multicentric study. A questionnaire was completed by patients the day of the hospitalization. The main efficacy parameter was the patient's satisfaction depending on term and method. RESULTS: A total of 1032 patients were included from November 2018 till August 2019: 733 medical abortions and 259 surgical abortions. For equivalent terms, medical abortion was associated with a lower satisfaction, OR: 1.9, CI 95 % [1.23; 2.99] P=0.004. For equivalent methods, a term higher than 9 weeks of gestation was also associated with a lower satisfaction OR: 1.56, CI 95 %: [1.09; 2.23], P=0.01. The satisfaction rate was up to 4 out of 5, regardless of the term or the method. For equivalent term and method, an imposed method due to the term was associated with a lower satisfaction OR:3.82, CI 95 % [2.15;6.90], P<0.001. CONCLUSION: Term higher than 9 weeks of gestation, medical abortion and an imposed method are associated with a lower satisfaction.

[Conflicting recommendations between the French national authority for health (HAS) and clinical practice guidelines (CNGOF); focus on 200 late medical abortions, conducted outside marketing authorizations]. / Recommandations discordantes entre HAS et CNGOF ; le point avec 200 IVG médicamenteuses tardives, réalisées hors AMM.

OBJECTIVES: There are conflicting recommandations about late medical abortion: the French National College of Gynaecologists and Obstetricians (CNGOF) and the French Superior Health Authority are opposed. The aim was to assess misoprostol's efficiency in medical abortions at 9 to 14 weeks gestational age (GA) METHODS: This is an epidemiologic retrospective study led from March 2017 till January 2019, in Evreux's hospital, France, including all patients undergoing a medical abortion from 9 to 14 weeks GA. We followed the CNGOF's recommandations published in 2016. The main efficacy parameter was the failure rate of medical abortion at 9 to 14 weeks GA. The secondary efficacy parameters were the number of patients absent at the post-medical abortion examination, the consumption of misoprostol, the consumption of symptomatic treatment, the type of complication and the length of hospital stay. RESULTS: 200 patients were included: 19 patients had vacuum aspiration, so we report a 10.2 % failure rate (95% CI: 6.4%; 15.7%). 7 (3.5%) had vacuum aspiration for haemorrhage (2 (1%) receveived a blood transfusion) 9 (4.5%) had a vacuum aspiration for failure and 3 (1.5%) for retention. 71 (35.5%) patients were absent at the post-medical abortion examination. The mean consumption of misoprostol was 1234µg (441). The mean length of hospital stay was 12.2hours (8.28). CONCLUSIONS: The abortion failure rate is 10.2%. Our study didn't report any elements of bad tolerance of misoprostol in this indication.

[Limitations of breast reconstruction using exclusive lipofilling: A retrospective study over 10 years]. / Limites de la reconstruction mammaire par lipofilling exclusif : étude rétrospective sur 10 ans.

OBJECTIVES: The primary objective was to assess the failure rate of exclusive lipofilling breast reconstruction. The secondary objectives were the identification of failure predictive factors of exclusive lipofilling breast reconstruction and the early complications. METHODS: We performed a retrospective study in Normandy analysing cases of secondary breast reconstruction by exclusive lipofilling after radical mastectomy, from January 2006 to December 2016. We compared a group of patients who completed exclusive lipofilling breast reconstruction (n=22) with a group of patients who underwent other techniques of breast reconstruction (n=16). RESULTS: The failure rate of breast reconstruction by exclusive lipofilling was 32.6%. Need of adjuvant chemotherapy treatment was associated with a higher failure rate than exclusive lipofilling breast reconstruction (81.2% vs. 45.5%, P<0.05). The age of patients was significantly higher in case of reconstruction failure (45.2 vs. 50.9 years mean age, P<0.05). Need of adjuvant radiotherapy treatment was not associated with a higher failure rate than exclusive lipofilling breast reconstruction. The main complications were cutaneous burn due to cannula and haematoma at the donor site (11/22) and breast haematoma (11/22). CONCLUSIONS: Informing patients of the risk of breast reconstruction failure due to the high adipocytes resorption, is necessary when patients are undergoing exclusive lipofilling breast reconstruction. A prospective study with greater workforce is needed to shore these results and assess postoperative complications.