Customized and non-customized live-born birth-weight curves of single and uncomplicated pregnancies from the Burgundy perinatal network. Part I - methodology.

OBJECTIVES: To establish non-customized and customized birth-weight curves of single and uncomplicated pregnancies according to gestational age. MATERIALS AND METHODS: We used data for 64,173 mother-infants pairs from the Burgundy perinatal network database (France) over the period 2005-2013. A validated procedure was used to link mothers with their newborns, and maternal and fetal pathologies likely to affect birth weight were excluded. Multiple regression analysis with covariate selection was used to build a customized growth curve with maternal and fetal parameters. RESULTS: Using this methodology, three different curves were generated: an unadjusted curve for birth weight, named B0, an curve adjusted for fetal gender, named B1 and a curve adjusted for fetal and maternal parameters (fetal gender, maternal height, weight and parity), named B2. CONCLUSION: We present curves showing an original distribution of birth weights for the French population in order to improve the diagnosis of small for gestational age. These curves are not based on the Gardosi in utero growth model but on actual birth weights, thus limiting bias. Nevertheless, the minimum gestational age was 25weeks as there was an insufficient number of live-borns in small gestational ages.

[Thierry's spatulas or forceps--a comparison between maternal-fetal morbidities]. / Spatules de Thierry ou forceps : comparaison des morbidités materno-fœtales.

OBJECTIVE: To compare maternal and fetal morbidity during forceps or Thierry spatulas operative deliveries. METHODS: Retrospective and descriptive study in a one center from 2006 to 2012. Operative deliveries were performed with forceps or spatulas, in case of no mobile fetal progression, on singleton term pregnancies with cephalic presentation, no abnormal heart rate and without any pregnancy pathology. RESULTS: Our studies included 65 operative deliveries with spatulas versus 77 with forceps, among a scientifically comparable population. At maternal level, when comparing spatulas versus forceps, there were more intact perineum (5.19% vs 15.38%; P=0.04), the same rate of vaginal tears and less severe perineal injuries (0 vs 6; P=0.05) in favor of spatulas. Extractions performed in "unfavorable" conditions were mostly conducted with forceps. In 50% of the case, an episiotomy was associated with severe perineal lesions. As far as fetal morbidity is concerned, there were more newborn's facial injuries using the forceps tool (18.18% vs 3.08%; P=0.0046). The remaining data were comparable. CONCLUSIONS: Thierry spatulas are less harmful than forceps to maternal tissues and reduce facial injuries of the newborn. Consequently, spatulas could benefit from a wider use. However, a prospective study will be needed to confirm our results.

[Correlation between the perineal-to-skull measurement by tranperineal ultrasound, failure of vaginal operative delivery and maternal-fetal morbidity]. / Corrélation entre la mesure de la distance périnée-crâne à l'échographie transpérinéale, les échecs d'extraction instrumentale et la morbidité materno-fœtale.

OBJECTIVES: To assess the influence of the perineal-to-skull measurement by tranperineal ultrasound (TPU) on the outcome of vaginal operative extraction together with maternal and fetal morbidity. MATERIALS AND METHODS: Retrospective, monocentric and descriptive study was done on 272 patients, from 2009 January 1st to 2009 December 31st. It compares the failure rate of instrumental extraction, total caesarean section rate together with the maternal morbidity (type of perineal tears and post-partum hemorrhage rate) and fetal morbidity (5' Apgar score, arterial pH, transfer in neonatal intensive care unit) to the values obtained with TPU. RESULTS: There is a correlation between the perineal-to-skull measurements higher or equal to 50mm at TPU and the instrumental failure rate (<50mm 0.8% vs. ≥50mm 11.9%; P<0.0001), caesarean (0.9% vs. 33.3%; P<0.0001), post-partum haemorrhage (3% vs. 11.9%; P=0.02), et paediatric intervention (16.7% vs. 31%; P=0.03). CONCLUSION: Perineal-to-skull distance measured with TPU higher or equal to 50mm is at risk of instrumental failure and maternal morbidity. Associated with clinical examination and usual obstetrical risk factors, TPU could be useful to the decision between operative vaginal delivery and prophylactic caesarean section.