[Factors predicting unsuccessful labor induction with dinoprostone in post-term pregnancy with unfavorable cervix]. / Facteurs prédictifs d'échec d'entrée en travail par dinoprostone en cas de grossesse prolongée et de conditions locales défavorables.

OBJECTIVE: To identify predictive factors for unsuccessful induction of labor within 24hours after dinoprostone insertion in post-term pregnancy with unfavorable cervix. MATERIAL AND METHODS: We retrospectively reviewed 325 singleton pregnancies with a diagnosis of post-term pregnancy and unfavorable cervix (Bishop score<6) during the period January 2012-Decembre 2012. Patients were classified into 2 groups: successful labor, defined as cervical ripening, within 24hours after dinoprostone insertion (Group R; n=248; 76.3 %) or failure group (Group E; n=77; 23.7 %). Antepartum and perpartum characteristics of women were compared. RESULTS: Nulliparity (74.0 versus 56.0 %; OR=2.23; 95 % CI: 1.27-4.00; P=0.005), gestational age ≤41 SA+4 (53.2 versus 33.9 %; OR=2.22; 95 % CI: 1.32-3.74; P=0.003) and history of dilatation and curettage (27.3 versus 10.5 %; OR=3.19; 95 % CI: 1.66-6.11; P=0.0005) were significantly associated with unsuccessful induction of labor. Bishop score was significantly higher in Group R (3.6 versus 1.9; P=0.001). Also, consistency (74.0 versus 44.4 %; OR=3.57; 95 % CI: 2.04-6.40; P<10(-5)) and absence of dilatation of the cervix (59.7 versus 23.0 %; OR=4.97; 95 % CI: 2.89-8.56; P<10(-6)) were identified as significant predictive factors for unsuccessful induction of labor. CONCLUSION: Nulliparity, gestational age ≤41 SA+4, history of dilatation and curettage and Bishop score, in particular consistency and dilatation, are correlated with failure of cervical ripening in post-term pregnancy with unfavorable cervix.

[Estimation of fetal weight by external abdominal measurements and fundal height measurement near term for the detection of intra-uterine growth retardation]. / Estimation clinique du poids fœtal et hauteur utérine dans le dépistage de l'hypotrophie fœtale à terme.

OBJECTIVES: To evaluate the estimation of fetal weight by external abdominal measurements, alone or associated with fundal height measurement and/or ultrasonographic exams near 32 weeks, to detect intra-uterine growth retardation (IUGR) near term. PATIENTS AND METHODS: A retrospective cohort study included all women who delivered a small-for-gestational-age infant less than 37 weeks gestation during 2008-2009. We analyzed the sensitivity of estimation of fetal weight by external abdominal measurements and the others different routine exams during third trimester, and compared them to detect IUGR near term. RESULTS: The estimation of fetal weight by external abdominal measurements was used in 263 pregnant patients. External abdominal measurements and fundal height measurement were not statistically different and were better tests than ultrasonographic exams at 32 weeks to detect IUGR near term (sensitivity: 41.4%, 42.2% and 22.8%, respectively; P<0.05). External abdominal measurements associated with regular ultrasonographic examination at 32 weeks of gestation significantly increased the sensitivity to detect IUGR near term (42.9% vs. 22.8%; P<0.05). But, the association of external abdominal measurements and fundal height measurement did not increase the rate of detection (47.9% vs. 42.2%; P=0.22). DISCUSSION AND CONCLUSION: The present findings confirm that the use of the estimation of fetal weight by external abdominal measurements to detect intra-uterine growth retardation is effective. Measures to improve the learning of this technique and its reproducibility are recommended.

[Face presentation: retrospective study of 32 cases at term]. / Présentation de la face : étude rétrospective de 32 cas à terme.

OBJECTIVE: To determine the etiologic factors, circumstances of diagnosis, obstetrical management and complications of face presentation and to value the maternal and foetal prognosis of this presentation. PATIENTS AND METHODS: Thirty-two cases of face presentation have been observed in the maternity wards of Reims and Troyes over the last 12 years. RESULTS: The incidence of face presentation was 0.7 per 1000 deliveries. Spontaneous vaginal delivery occurred with mento-anterior presentation 73% of the time and caesarean section was performed in 100% of mento-posterior presentation. There was no increasing rate of foetal or maternal mortality and morbidity with vaginal delivery. DISCUSSION AND CONCLUSION: Face presentation is an unusual complication of pregnancy with obstetric factors that predispose the foetus to face presentation. The low foetal and maternal mortality and morbidity substantiate the effectiveness of conservative management in face presentation.