[Hysteroscopic fallopian tube sterilization procedure: feasibility and one-year follow-up]. / Stérilisation tubaire par voie hystéroscopique: faisabilité et évaluation à un an.

OBJECTIVES: Hysteroscopic flexible micro-insert (Essure) is an ambulatory improvement of fallopian tube sterilization, which is a deliberated suppression of fertility. The aim of this study was an evaluation of feasibility (learning curve) and the first year outcome of this method. PATIENTS AND METHODS: This prospective study, carried out between February 2002 and March 2003, included patients who were matching with manufacturer recommendations. One surgeon only realized all the device placements. RESULTS: Fifty patients were included (one year follow-up). Mean age was 41 (+/-3.3), mean parity was 2.7 (+/-0.8). Mean time needed for device placement was 26 minutes (+/-6.5) and was reduced with increased experience. Six failures of placement (12%) were related, because of submucus leiomyomas, proximal tubal stenotic disease or too retroverted uterus. Only 5 patients (11,4%) described intensive pelvic pain during the placement. The only case of device expulsion benefited from a successful second placement. The one-year follow-up showed no significant difference of body weight increasing, duration or quantity of menstruation, neither significant pelvic pain nor vaginal bleeding. Tolerance was rated at least at "somewhat satisfied". There have been no pregnancies reported in 670 woman-months of effectiveness. DISCUSSION AND CONCLUSION: Our results agree in any point with those of larger studies. We think that hysteroscopy micro-insert placement is not only reserved to specialized centers but also to any gynecologist who is used to performing hysteroscopy because of its feasibility.

[Delayed versus immediate pushing in the second stage of labor for nulliparous parturients with epidural analgesia: a meta-analysis of randomized trials]. / Poussée retardée versus poussée immédiate lors de la seconde phase du travail chez les nullipares sous anesthésie péridurale.

OBJECTIVES: The main object of this study was to evaluate the effect of delayed pushing on the second phase of delivery and the second one was to analyze the maternal and fetal consequences. MATERIAL AND METHOD: This was a meta-analysis of randomized prospective studies. The inclusion criteria were nulliparous women with epidural analgesia, singleton cephalic presentation at term and a spontaneous or induced labor. RESULTS: There was a significant increase in the number of spontaneous deliveries when pushing was delayed (p=0,019). On the other hand, no significant difference could be found in the incidence of perineal trauma (p=0,64). Post-partum hemorrhage and maternal fever could not be accurately evaluated because of insufficient data in the selected publications. Concerning the neonatal outcomes, the criteria for evaluation were too heterogeneous for analysis. CONCLUSION: In nulliparous parturients under epidural analgesia the fetal descent must be respected, so long as the fetal heart rate is unremarkable, in order to increase the probability of a spontaneous delivery, without apparent adverse consequences for the mother or the neonate.