Comparative analysis of quality scores images between second- and third-trimester ultrasound scan.

OBJECTIVES: To evaluate whether the quality scores validated for second-trimester ultrasound scan can be used for third-trimester ultrasound scan. METHODS: Prospective multicenter ancillary study using data from the RECRET study. Nulliparous women, with no reported history, with second- and third-trimester ultrasound examinations performed by the same ultrasonographer and using the same ultrasound machine were recruited. The global score and the individual score of each ultrasound image were compared between second- and third-trimester ultrasound scan. The sample size was calculated for a non-inferiority (one-sided) paired Student t test. RESULTS: 103 women with 1606 anonymized ultrasound images were included. The median term at second- and third-trimester ultrasound scan was 22.2 weeks gestation (22.0-22.7) and 31.6 weeks gestation (30.7-34.7), respectively. The mean global score of ultrasound images was comparable between the second- and the third-trimester ultrasound examination (32.37 ± 2.62 versus 31.80 ± 3.27, p = 0.13). Means scores for each biometric parameters i.e. head circumference, abdominal circumference, and femur diaphysis length were comparable. The scores for the four-chamber view (5.11 ± 0.91 versus 5.36 ± 0.75, p = 0.02) and the spine (4.18 ± 1.17 versus 5.22 ± 1.02, p < 0.001) were significantly lower in the third trimester compared to the second trimester. The score for the kidney image was significantly higher for third trimester images compared to second trimester images (4.73 ± 0.51 versus 4.32 ± 0.67, p < 0.001. CONCLUSIONS: Biometrics parameters quality scores images previously validated for the second trimester ultrasound scan can be also used for the third trimester scan. However, anatomical quality scores images performances may vary between the second and the third trimester scan.

[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.