[Mother's experience of planned caesarean section in the absence of the father or companion: Impact of Covid-19 pandemic-related lockdown]. / Vécu de l'absence du père ou de l'accompagnant en césarienne programmée : impact du confinement lié à la pandémie Covid-19.

BACKGROUND: The presence of the father or companion during planned caesarean section presents several benefits. However, we found no study regarding the mother's experience of his presence or absence. MATERIAL AND METHODS: We conducted an observational, prospective, two-centre study based on the data of women who had a planned caesarean section in Bel Air and Mercy Maternities between November 17th 2020 and June 4th 2021. Two groups were formed : a control group, including women who had a c-section in the presence of the father or companion, and a case group, including women who had a c-section without the father or companion due to Covid-19 pandemic-related containment measures. The primary endpoint was to assess the mother's anxiety regarding the presence or absence of the father or companion during planned c-section, by the use of a numerical scale of stress and STAI YA inventory. The secondary endpoint was the appraisal of information given by the medical team concerning c-section and the containment measures. RESULTS: Regarding the level of stress during the c-section, we did not find a significant difference by the use of the numerical scale of stress. With a mean of 53 in the case group and 49 in the focus group (P=0,048), the STAI YA scores showed a significant difference. Between the day before and the day of the c-section, we found no significant difference by the use of the numerical scale of stress. STAI YA scores showed a significant difference, with a delta of 5 in the case group against 1 in the focus group (P=0,01). Most patients estimated that the information given by the medical team helped to reduce their stress. 93 % of the patients in the focus group reckoned they would have been more stressed in the absence of the father or companion. DISCUSSION AND CONCLUSION: The significant results of this study suggest the absence of the father or companion during planned caesarean section has an impact on mother's experience. Therefore, this should be considered in order to better our practices and improve mother's experience. In the long term, we could imagine making their presence possible during emergency caesarean sections as well (general anesthesia excluded). We could also envision adding to preparation courses to c-section to birth preparation courses, for mothers (to reduce psychological impact) but also for fathers or companions (to allow their presence in the operation room).

[Analysis of obstetric-pediatric care in the perinatal period. Are births before 31 weeks' gestation in level 2B maternity units avoidable?] / Analyse des parcours de soins en périnatalité. Les naissances avant 31 SA en maternité de type 2B sont-elles évitables ?

INTRODUCTION: Regionalization of perinatal care has been developed to improve the survival of preterm babies. The mortality rate is higher among very premature infants born outside level-3 maternity units. The objective of this study was to evaluate the preventability of these very premature births occurring outside recommendations within level-2B maternity units. The secondary objective was to describe the care of premature infants between 23 and 24 weeks. METHODS: This is a single-center retrospective qualitative study of the care delivery pathways. Thirty-one deliveries in which the fetus was alive between 23 and 30 weeks+6 days occurred in a level-2B maternity unit in Thionville, France, between 1 January 2013 and 31 December 2015. After oral presentation of the cases, a level 2-3 multidisciplinary committee of experts in Lorraine evaluated the preventability criteria and reasons, and divided the deliveries into three groups: (i) birth in level-2B institutions avoidable, (ii) inevitable with factors related to the mother or the organization of care, (iii) with no inevitable factors. RESULTS: Out of the 31 deliveries included, the committee classified six deliveries as preventable, 14 as inevitable with factors, and 11 as inevitable with no factors. The criteria for preventability of birth in a level-2B unit were underestimation of maternal and fetal risk, an erroneous initial estimate of term or preterm labor, and two births in the upper limits of the French recommendations for in utero transfer. Nineteen of the 35 premature infants before 31 weeks' gestation died, 16 children were transferred to a level-3 maternity ward, and 16 children were allowed to go home. CONCLUSION: Analysis of the obstetrical-pediatric care course by an expert committee determined the preventability of the average birth and prematurity in level-2B maternity units in Lorraine for a small but significant number of cases. The local regionalization of neonatal care could be improved by the application of this method of analysis to other maternity wards in the Lorraine network.

[Ovarian stimulation and follicular puncture risks]. / Risques de la stimulation ovarienne et du prélèvement ovocytaire.

The ovarian stimulation and the follicular puncture in ART present risks which must be planned in order to better prevent them. These complications are the ovarian hyperstimulation syndrome, the thromboembolic and carcinologic risks; the anaesthetic, hemorrhagic and infectious risks of the punctures. The presence of an endometrioma can generate an increase in the infectious risk.

[Premature ovarian failure: which protocols?]. / L'insuffisance ovarienne débutante: quels protocoles?

This review shows the results of the various studies concerning the protocols applied to the women presenting a premature ovarian failure. Will be thus analyzed the natural cycles (or semi-natural), the increase in the dose of gonadotrophins, the clomiphene citrate and the anti-aromatases, the protocols with GnRH agonists long, short, stop or microdoses, the protocols with GnRH antagonists and the adjuvant treatments: aspirin, nitric oxyde, recombinant LH recombining, growth hormone and androgens. The interest of several protocols is to collect a sufficient number of oocytes (and thus of embryos to be transferred), making it possible to obtain reasonable rates of pregnancy. However, it arises that the rates of pregnancy observed among these women depend not only on their ovarian reserve and their age, but are also function of the type of infertility, of the cycle number and the uterus.

[Septate uterus: role of hysteroscopic metroplasty]. / Utérus cloisonné: place de la septoplastie hystéroscopique.

The uterus septum is the most frequently encountered uterine malformation. The prevalence of the uterine septa in the infertile patients is estimated at approximately 1%. On the other hand, it increases to reach 3,3% among women presenting repeated fetal losses. The objective of this article is to propose an updating of the data of the literature concerning the cure of uterine septa by hysteroscopic metroplasty. Operative hysteroscopy, with its simplicity, its reproducibility and its low morbidity between the hands of a trained operator, remains the gold standard treatment of the uterine partitions. The abortive disease always constitutes the main indication of the cure of septum. In the infertile patients, a metroplasty seems to be legitimate in the following situations: women more than 35 years old; unexplained infertility, resistant to any technique of assisted reproduction; discovery of a uterine septum at the time of the coelioscopy and the diagnostic hysteroscopy realized within the framework of an assessment of infertility; patients for whom it is assumed that Assisted reproductive technique (ART) is needed; women with past obstetrical history. The complications related to the hysteroscopic metroplasty are not very frequent. However, the hysteroscopic resection of a uterine septum could expose later to the risk of uterine rupture.