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1.
J Gynecol Obstet Biol Reprod (Paris) ; 44(6): 550-7, 2015 Jun.
Article in French | MEDLINE | ID: mdl-25260605

ABSTRACT

OBJECTIVE: To evaluate the impact of a medical audit assessing the accuracy of caesarean indications on the final caesarean section rate of an obstetrics department. MATERIAL AND METHOD: Comparative observational study conducted in a regional university teaching hospital on the two first quadrimester periods of 2013. During the first quadrimester, there was no cesarean section audit introduced for the daily reports meetings, while an audit was introduced during the second quadrimester. The caesarean rate and the instrumental delivery rate on both quadrimesters were compared. RESULTS: In the first quadrimester period, there were 248 caesarean sections for 947 deliveries (26.2%), while in the second quadrimester period, there were 246 for 1033 deliveries (23.8%), P=0.014. The emergency caesarean rate decreased from 19.6 to 16.7%, P=0.02 in the second quadrimester period while the instrumental delivery rate increased from 14.4 to 17.2%, P=0.0004. Mothers and children's health was not modified between the two periods. CONCLUSION: In our experience, the introduction of a daily obstetric audit of the caesarean indications is effective to decrease the emergency caesarean section rate and it encourages us to be active in the first like in the second part of the labor.


Subject(s)
Cesarean Section/statistics & numerical data , Medical Audit/statistics & numerical data , Obstetrics and Gynecology Department, Hospital/statistics & numerical data , Adult , Female , Hospitals, University/statistics & numerical data , Humans , Medical Audit/standards , Obstetrics and Gynecology Department, Hospital/standards , Pregnancy
2.
Gynecol Obstet Fertil ; 42(4): 216-21, 2014 Apr.
Article in French | MEDLINE | ID: mdl-23602139

ABSTRACT

OBJECTIVE: Presenting our experience concerning interstitial pregnancies (IP) surgical management and to evaluate our patients' subsequent long-term fertility. PATIENTS AND METHOD: Twenty patients underwent surgical treatment of IP in our department over 15 years. In this retrospective study, we present symptoms that led to diagnosis, treatments, fertility and obstetrical outcome. RESULTS: Mean gestational age at diagnosis was 8SA, with a median BHCG rate of 7411 IU/L, and a patient mean age of 30 years. Ninety percent of patients had at least one risk factor for ectopic pregnancy. Pain or bleeding were the most common symptoms at admission, 4 patients were admitted in an hypovolemic shock status. Location of the interstitial ectopic pregnancy was discovered during surgery in 45 % of cases. Six patients had a large hemoperitoneum bigger than 1L, 5 patients had an IP of uterine stump after salpingectomy for a previous ectopic pregnancy. The most used surgical technique was in 60 % of cases the excision by Endo GIA stapling(®) with salpingectomy. Regarding fertility, 12 patients wished pregnancy in the aftermath of the intervention, 10 had at least one pregnancy, among them there is an ectopic contralateral ampullary pregnancy, and a contralateral recurrence of interstitial pregnancy. Four patients were delivered by cesarean section and 4 patients were delivered vaginally, some several times. No uterine rupture occured. DISCUSSION AND CONCLUSION: Interstitial pregnancy is a rare ectopic pregnancy. Its diagnosis is difficult and may involve maternal life-threatening and fertility. In subsequent pregnancies, the clinician has to be careful concerning the risks of interstitial pregnancy recurrence and uterine rupture.


Subject(s)
Pregnancy, Interstitial/surgery , Adult , Female , France , Gynecologic Surgical Procedures/methods , Humans , Infertility, Female/etiology , Pregnancy , Pregnancy, Interstitial/diagnosis , Recurrence , Retrospective Studies , Salpingectomy , Uterine Rupture , Young Adult
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