DEPIST 21: Information and knowledge of pregnant women about screening strategies including non-invasive prenatal testing for Down syndrome.

OBJECTIVE: To evaluate the knowledge of pregnant women and provide information about Down syndrome (DS) screening, including non-invasive prenatal testing (NIPT). MATERIALS AND METHODS: A prospective unicenter study of pregnant women recruited during their first trimester foetal ultrasound was carried out. Single pregnancies from 11 to 17 + 6 weeks of amenorrhoea (SA) without a history of DS were included. "Pre" and "post" questionnaire were fulfilled before and after the consultation. Patient characteristics, prior information, information provided during the consultation, and patient satisfaction were also analysed. RESULTS: A total of 273 were included in the study, and 147 completed surveys (pre and post) were examined. In pre-consultation, 82 % of women know that integrated screening includes maternal serum markers and nuchal translucency (n = 103). Concerning NIPT for DS, 8% (n = 11) of women declare having been informed before the ultrasound. A minority of patients know modalities of reimbursement (n = 33, 26 %) and invasive sampling is mandatory for diagnosis when NIPT is positive (n = 37, 28 %). Significant improvement in right answers was obtained for three questions: "nuchal translucency is included in the combined screening test for DS" (p = 0,007); "blood serum markers is included in the combined screening for DS" (p = 0,009) and advanced maternal age increases risk for DS" (p = 0,004). Total score in the post questionnaire was significantly higher than the "pre" consultation questionnaire (14,7 ± 2.8 versus 14,1 ± 2.9; p = 0.01). CONCLUSION: Patients show a high level of knowledge on screening strategies for DS in pre-consultation. They benefit from the consultation on global knowledge, NIPT, and ultrasound notions.

Intrauterine adhesions: What is the pregnancy rate after hysteroscopic management?

OBJECTIVE: To evaluate the rate of pregnancy following hysteroscopic management of intrauterine adhesions. DESIGN: Retrospective study. SETTING: From June 2009 to December 2014 in a teaching hospital. PATIENTS: Women treated by operative hysteroscopy for intrauterine adhesions. INTERVENTION: Operative hysteroscopy to manage intrauterine adhesions. MAIN OUTCOME MEASURE: rate of intrauterine pregnancy after hysteroscopic management of intrauterine adhesions. RESULTS: Out of the 202 women whom benefit from hysteroscopic adhesiolysis, 112(55%) had an effective pregnancy desire. Among them, an intrauterine pregnancy was obtained for 58 women (52%) with a trend to a lower rate for type IV and Vb intrauterine adhesions management (40.5%, p = 0.09). Pregnancy rates were similar for women undergoing one or more procedures. CONCLUSION: Hysteroscopic management of intrauterine adhesions seems useful as it leads to a pregnancy rate of 52%. However, this rate is lower in case of type IV and Vb intrauterine adhesions. Repeated procedures don't seem to lead to less pregnancy; however, a more powerful prospective study should be performed to answer this specific question.

Operative hysteroscopy for retained products of conception: Efficacy and subsequent fertility.

Retained product of conception complicates nearly 1% of pregnancies and can lead to synechiae and compromise ulterior fertility. The aim of this study is to evaluate efficiency of operative hysteroscopy in management of retained products of conception (RPOC). Secondary objectives are assessments of intra-uterine adhesions rate and later fertility. This unicentric retrospective study includes women who undertook an operative hysteroscopy for retained products of conception between January 2012 and March 2014. Assessment of the efficiency of operative hysteroscopy is defined by a complete resection of retained products of conception confirmed by office hysteroscopy. One hundred fourteen women were included in the study. Efficiency of operative hysteroscopy for retained products of conception is 91% for women with a postoperative office hysteroscopy. The authors observed a 7.5% rate of postoperative intra-uterine adhesions. Fertility rate was 83% (30 women out of 36 with a desired pregnancy). Hysteroscopic resection of retained products of conception is an efficient procedure and seems to be a real alternative.

Vaginal cervico-isthmic cerclage versus McDonald cerclage in women with a previous failure of prophylactic cerclage: A retrospective study.

AIM: Compare preterm births before 30 weeks of gestation in women with a previous failed McDonald cerclage that benefit from another McDonald cerclage (or simplified Shirodkar cerclage) or a vaginal cervico-isthmic cerclage. METHODS: Women with a cerclage performed at the end of the first trimester of a singleton pregnancy with a previous failed prophylactic McDonald cerclage were included in this mutlicenric study involving four teaching hospitals. Comparisons between groups were done using a chi square test and a student t-test. RESULTS: We enrolled130 women, 85 in the vaginal cervico-isthmic cerclage group and 45 in the classic cerclage group. There was no significant difference in the rate of delivery after 30 weeks of gestation (92 versus 93% p=0.75). However in the cervico isthmic cerclage, women were significantly older, presented more late foetal loss and fewer live children in the cervico-isthmic cerclage group. Rate of antenatal hospitalization andantenatal corticotherapy were significantly higher in the classic cerclage group (69% versus 46%, p<0.05 and 56% versus 29%, p<0.05). CONCLUSIONS: Rate of delivery before 30 weeks of gestation was not significantly different between the two groups, but women in the vaginal cervico-isthmic cerclage group seem to be at higher risk for late foetal loss or premature delivery. This procedure generates less threatened premature delivery, thus, less hospitalization and antenatal corticotherapy. These arguments are important for women with previous pregnancy loss.