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1.
Am J Obstet Gynecol MFM ; 5(9): 101062, 2023 09.
Article in English | MEDLINE | ID: mdl-37343695

ABSTRACT

BACKGROUND: Postpartum hemorrhage is a major component of perinatal morbidity and mortality that affects young women worldwide and is still often unpredictable. Reducing the incidence of postpartum hemorrhage is a major health issue and identifying women at risk for postpartum hemorrhage is a key element in preventing this complication. OBJECTIVE: This study aimed to estimate postpartum hemorrhage prevalence after vaginal delivery and to identify postpartum hemorrhage risk factors. STUDY DESIGN: Unselected pregnant women ≥16 years of age admitted to 1 of 6 maternity wards in Brittany (France) for vaginal birth after 15 weeks of gestation were recruited in this prospective, multicenter cohort study between June 1, 2015, and January 31, 2019. Postpartum hemorrhage was defined as blood loss ≥500 mL in the 24 hours following delivery. Independent risk factors for postpartum hemorrhage were determined using logistic regression. Missing data were imputed using the Multivariate Imputation by Chained Equations method. RESULTS: Among 16,382 included women, the postpartum hemorrhage prevalence was 5.37%. A first-degree family history of postpartum hemorrhage (adjusted odds ratio, 1.63; 95% confidence interval, 1.24-2.14) and a personal transfusion history (adjusted odds ratio, 1.90; 95% confidence interval, 1.23-2.92) were significantly associated with postpartum hemorrhage. The use of oxytocin during labor was also a risk factor for postpartum hemorrhage (adjusted odds ratio, 1.24; 95% confidence interval, 1.06-1.44). Inversely, smoking during pregnancy and intrauterine growth restriction were associated with a reduced risk for postpartum hemorrhage (adjusted odds ratio, 0.76; 95% confidence interval, 0.63-0.91, and 0.34; 95% confidence interval, 0.13-0.87, respectively). CONCLUSION: In addition to classical risk factors, this study identified a family history of postpartum hemorrhage and personal transfusion history as new characteristics associated with postpartum hemorrhage after vaginal delivery. The association of postpartum hemorrhage with a family history of postpartum hemorrhage suggests a hereditary hemorrhagic phenotype and calls for genetic studies. Identifying women at risk for postpartum hemorrhage is a key element of being prepared for this complication.


Subject(s)
Postpartum Hemorrhage , Female , Pregnancy , Humans , Postpartum Hemorrhage/diagnosis , Postpartum Hemorrhage/epidemiology , Postpartum Hemorrhage/etiology , Cohort Studies , Prospective Studies , Delivery, Obstetric/adverse effects , Postpartum Period , Risk Factors
2.
J Gynecol Obstet Hum Reprod ; 52(1): 102511, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36417979

ABSTRACT

OBJECTIVE: Determine clinical risk factors for vasculo-placental disorders in singleton pregnancies. DESIGN: Prospective case-control study nested in HEMOTHEPP French cohort. SETTING: Women delivered between June, 2015 and January, 2019 in any maternity ward of Finistère. POPULATION: Cases were women with vasculo-placental disorders (pre-eclampsia, intrauterine growth restriction (IUGR), placental abruption or stillbirth). Controls were women matched for age at delivery and parity. METHODS: Clinical data were collected by obstetricians or midwives during antenatal care visits and delivery, and recorded by trained research assistants. MAIN OUTCOME MEASURES: Occurrence of a vasculo-placental disorder. RESULTS: 505 women with vasculo-placental disorder (299 pre-eclampsia, 253 IUGR, 44 placental abruptions, 11 stillbirths) and 1515 matched controls were selected out of 20,075 participants. In multivariable analysis, four clinical parameters were associated with pre-eclampsia: obesity (Odd ratio (OR) = 3.11, 95%CI 2.11-4.58), French overseas origin (OR = 4.41, 95%CI 1.87-10.42), previous vasculo-placental disorder (OR = 5.14, 95%CI 2.72-9.70), aspirin during pregnancy (OR = 10.10, 95%CI 1.99-51.08). Three clinical parameters were associated with IUGR: auto-immune/inflammatory disorder (OR = 3.75, 95%CI 1.83-7.68), previous vasculo-placental disorder (OR = 3.63, 95%CI 2.06-6.41), smoking during pregnancy (OR = 2.66, 95%CI 1.91- 3.71). A previous venous thromboembolism (VTE) was associated with IUGR in univariable but not in multivariable analysis (OR = 3.72, 95%CI 0.82-17.00, p = 0.09). CONCLUSIONS: Clinical risk factors differ between IUGR and pre-eclampsia, the later, but not the former, being associated with cardiovascular risk factors.


Subject(s)
Abruptio Placentae , Fetal Growth Retardation , Placental Insufficiency , Pre-Eclampsia , Female , Humans , Male , Pregnancy , Case-Control Studies , Cohort Studies , Fetal Growth Retardation/epidemiology , Placenta/blood supply , Pre-Eclampsia/epidemiology , Risk Factors , Stillbirth , Venous Thromboembolism
3.
Eur Surg Res ; 46(3): 139-47, 2011.
Article in English | MEDLINE | ID: mdl-21372578

ABSTRACT

PURPOSE: Hyperthermic intraperitoneal chemotherapy is continuously under evaluation in ovarian cancer. The purpose of the present study was to evaluate the effect of chemotherapy, drug concentration and temperature. MATERIALS AND METHODS: A human ovarian carcinoma cell line was used. The effect of hyperthermia combined with chemotherapy was analyzed. RESULTS: When hyperthermia was combined with chemotherapy, the 50% lethal dose (LD(50)) decreased with the duration of exposure. The effect of temperature was similar between 39 and 43 °C for a 30-min exposure. For a 60- to 90-min exposure, the LD(50) was equivalent between 38 and 43 °C. Beyond 40 °C, an increase in platinum salt concentration was necessary to obtain similar results according to the duration of exposure. CONCLUSIONS: The cytotoxic effect of the combination seemed to be potentiated and limited at 40 °C.


Subject(s)
Antineoplastic Agents/therapeutic use , Carboplatin/therapeutic use , Cisplatin/therapeutic use , Hyperthermia, Induced , Ovarian Neoplasms/drug therapy , Ovarian Neoplasms/therapy , Antineoplastic Agents/administration & dosage , Carboplatin/administration & dosage , Cell Line, Tumor , Cell Survival/drug effects , Cisplatin/administration & dosage , Combined Modality Therapy , Dose-Response Relationship, Drug , Drug Resistance, Neoplasm , Female , Humans , Ovarian Neoplasms/pathology
4.
Ann Pathol ; 31(1): 41-5, 2011 Feb.
Article in French | MEDLINE | ID: mdl-21349388

ABSTRACT

Aggressive fibromatosis (desmoid tumour) of the breast is a rare tumour that accounts only for 0.2% of primary breast tumours. This is a benign mesenchymal tumour that develops from muscular fasciae and aponeuroses. It is characterized by its local evolution and its tendency to relapse without metastasizing. Wide radical resection should be attempted whenever possible. Positive margins at resection and reoperation are associated with a high risk of local recurrence. The role of radiotherapy and of medical treatments- especially anti-estrogens - remains unclear. We report here the case of desmoid tumour of the breast arising in a 9-year-old little girl.


Subject(s)
Breast Neoplasms/pathology , Fibromatosis, Aggressive/pathology , Age of Onset , Breast Neoplasms/chemistry , Breast Neoplasms/diagnosis , Breast Neoplasms/epidemiology , Breast Neoplasms/surgery , Carcinoma/diagnosis , Child , Diagnosis, Differential , Female , Fibromatosis, Aggressive/diagnosis , Fibromatosis, Aggressive/epidemiology , Fibromatosis, Aggressive/surgery , Humans , Magnetic Resonance Imaging , Mastectomy, Segmental , Menarche , Neoplasm Proteins/analysis , Prognosis , Receptors, Estrogen/analysis , Receptors, Progesterone/analysis , Reoperation
5.
Am J Obstet Gynecol ; 203(6): 592.e1-6, 2010 Dec.
Article in English | MEDLINE | ID: mdl-20932506

ABSTRACT

OBJECTIVE: Pregnancies medical follow-up and ultrasonography development have enabled detection of fetal echogenic bowel, a sign associated with various pathologies, including cystic fibrosis. Based on the long experience of a region where cystic fibrosis is frequent (Brittany, France), we describe disorders diagnosed in fetal echogenic bowel fetuses and assess ultrasonography ability in detecting cystic fibrosis in utero. STUDY DESIGN: We reviewed the cases of fetal echogenic bowel diagnosed in pregnant women living in Brittany and referred for CFTR gene analysis over the 1992-2007 period (n = 289). RESULTS: A disorder was diagnosed in 32.2% of the fetuses, cystic fibrosis being the most commonly identified (7.6%). We also found digestive malformations (7.0%), chromosomal abnormalities (3.7%), and maternofetal infections (3.7%). Combining these data with our ongoing newborn screening program since 1989 showed that ultrasonography enabled diagnosis of 10.7% of the cystic fibrosis cases. CONCLUSION: This study highlights the importance of pregnancy ultrasound examinations and their efficiency in detecting cystic fibrosis.


Subject(s)
Cystic Fibrosis/diagnostic imaging , Cystic Fibrosis/genetics , Echogenic Bowel/diagnostic imaging , Ultrasonography, Prenatal , Cohort Studies , Cystic Fibrosis/epidemiology , Cystic Fibrosis Transmembrane Conductance Regulator/genetics , Echogenic Bowel/epidemiology , Female , France/epidemiology , Gestational Age , Humans , Incidence , Pregnancy , Retrospective Studies , Risk Assessment , Time Factors
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