[Revision of the French colposcopic terminology]. / Nouvelle classification française des images colposcopiques.

OBJECTIVES: To revise the 1983 colposcopic terminology form the French Society of Colposcopy and cervicovaginal pathology (SFCPCV). METHODS: All the three following steps of colposcopic examination were considered for the description of various colposcopic features: inspection without coloration, followed by the application of acetic acid and iodine staining. This revised terminology now includes the different possible colposcopic aspects of the normal cervix, including the ectropion and the normal transformation zone. It also includes colposcopic appearance of abnormal glandular cervical epithelium and of vaginal epithelium. The revised nomenclature was reviewed by all the board of the SFCPCV and was finally approved during the 45th annual conference of the SFCPCV. RESULTS: Abnormal transformation zone grade (TAG) 1a and 1b have been brought together under the sole TAG1 designation. TAG2a and TAG2b now correspond to TAG2, whereas TAG2c corresponds to TAG3. Colposcopic report should mention the interpretability of the colposcopic examination, with the precise type of the squamocolumnar junction (1, 2 or 3), the colposcopic impression, the size of any TAG and finally mention whether one or multiple biopsies were taken and their precise location. Colposcopic impression must give priority to the most pejorative colposcopic aspect which takes precedence over others. CONCLUSION: When performing colposcopy, one should keep in mind that this examination only relies on the interpretation of various colposcopic signs and images with this not guaranteeing for diagnosis. Only histological analysis of a possible guided cervical biopsy provides for a precise diagnosis.

Postpartum maternal anxiety and depression during COVID-19 pandemic: Rates, risk factors and relations with maternal bonding.

Objectives: This study aims to determine the rates of clinically-significant anxiety and depressive symptoms during the immediate postpartum in a sample of women referred to a university maternity department, as well as the associated risk factors and the relations with the level of maternal bonding. Patients and methods: During the third national lockdown for the COVID-19 pandemic (February-April 2021), on days 2-3 after delivery 127 mothers were administrated the Edinburgh postnatal depression scale (EPDS), the state-trait anxiety inventory (STAI-YA), the mother-to-infant bonding scale (MIBS) and questions issued from the coronavirus health impact survey questionnaire (CRISIS). Results: The rate of perinatal clinically-significant symptoms were 17% for depression (EPDS cut-off ≥ 12) and 15% for anxiety (STAI-YA cut-off ≥ 40). In the multivariate analysis, being a single mother, risk of being infected by the SARS-CoV2, risk that a close relative might be infected by the SARS-CoV2 and the length of stay in maternity were associated with an increased EPDS total score, while breastfeeding was associated with a lower EPDS total score. Six variables remained positively associated with the STAI-YA total score in the multivariate model: the maternal level of academic achievement, a hospitalization during the pregnancy, peripartum medical complications, risk of being infected by the SARS-CoV2, risk of a close relative being infected by the SARS-CoV2 and physical fatigue. Low but statistically significant correlations were found between the MIBS total score and the EPDS total score (rs = 0.26) and with the STAI-YA total score (rs = 0.26). Discussion: The observed rates of anxiety and depressive symptoms were in the same range as those reported in observational studies conducted in high-resource countries during the COVID-19 pandemic. Risk of being infected by the SARS-CoV2 was both an independent risk factor for anxiety and depressive symptoms. The relations between the measure of maternal bonding and the severity of maternal emotional symptoms call for a better consideration of the long-term consequences of the pandemic on children's socio-emotional development.

Objectifs: Cette étude a pour objectif de déterminer la fréquence des symptômes dépressifs et anxieux maternels lors de la période du post-partum immédiat dans un groupe de femmes venant d'accoucher sur un service universitaire, ainsi que les facteurs de risques associés et les conséquences sur le lien mère-enfant. Patients et méthodes: Au tout début de la pandémie de COVID-19 (entre les mois de février et avril 2021), 127 femmes venant d'accoucher ont complété dans les 2 à 3 jours qui suivent l'accouchement l'Edinburgh postnatal depression scale (EPDS), le State-trait anxiety inventory (STAI-YA), le Mother-to-infant bonding scale (MIBS) et le Coronavirus health impact survey questionnaire (CRISIS). Résultats: La fréquence des symptômes dépressif cliniquement significatifs était de 17 % et de 15 % pour les symptômes anxieux. Le risque d'infection par le SARS-CoV2 était associé à la sévérité de ces symptômes dans les analyses multivariées. Des corrélations statistiquement significatives ont été mis en évidence entre le score MIBS et le score EPDS (rs = 0.26) et avec le score STAI-YA (rs = 0.26). Discussion: La fréquence des symptômes anxieux et dépressifs du péripartum étaient comparable avec d'autres études conduites dans les pays à haut niveau de ressource au cours de la pandémie de COVID-19. Le risque d'infection par le SARS-CoV2 est associé à des niveaux plus élevés de symptômes anxieux et dépressifs, à côté des autres facteurs connus de symptômes émotionnels du post-partum. Les liens retrouvés entre ces symptômes et le niveau de lien mère-enfant invitent à être attentif aux conséquences à long-terme de la pandémie sur le développement socio-émotionnel du nourrisson. Conclusion: Des études complémentaires sont nécessaires pour confirmer ces résultats et déterminer les conséquences potentiellement délétères sur le développement des interactions mère-enfant et du nourrisson.

[Peripartum cardiomyopathy: A review of the literature]. / Cardiomyopathie du péripartum : une revue de la littérature.

Peripartum cardiomyopathy is a rare and unpredictable pregnancy-related pathology. Idiopathic cardiomyopathy is characterized by a heart failure secondary to left ventricular systolic dysfunction appearing towards the end of pregnancy or in the months following delivery with a non-specific clinic presentation. Through reviewing previous research, our critical literature review wishes to bring a concise and objective summarize for a better understanding of physiopathology, evocative symptoms and knowing of factors influencing prognosis in order to standardize peripartum management. The treatment remains mainly symptomatic but other promising treatments are still in development. In conclusion, early detection and treatment allow a better cardiac function recovery reducing cardiac transplantation.

[COVID-19 and lockdown: Impact on pregnancy complications]. / COVID-19 et confinement : impact sur les complications de la grossesse.

OBJECTIVE: The COVID-19 lockdown led to the establishment of a national lockdown in France from March 17th to May 11th, 2020. The purpose of our study is to evaluate the impact of lockdown on the rate of hospitalization for threatened preterm delivery and on the rate of preterm delivery. METHODS: Multicenter retrospective epidemiological study carried out over the lockdown period from March 15th to May 31st, 2020 compared to the same period over the previous two years (2018 and 2019) in Picardy hospitals (University Hospital center Amiens Picardie, Hospital Center of Beauvais, Compiègne and Saint-Quentin). RESULTS: In total, 608 patients were included. Our study shows a decrease in hospitalisations (207 in 2019 vs. 176 in 2020). We find a significant reduction in Premature Ruptures of Membranes (16.9% [73/432] in 2018/2019 vs. 9.7% [17/176] in 2020; P=0.02) and also in the preterm delivery rate (9.3% (276/2961) in 2018/2019 vs. 6.8% [96/1416] in 2020; P<0.05). CONCLUSION: A reduction in the rate of preterm birth is observed during the first lockdown's period. It would also be interesting to evaluate the psychological impact of lockdown.

[Efficacy and safety of oral misoprostol 25µg vs. vaginal dinoprostone in induction of labor at term]. / Efficacité et tolérance du misoprostol oral 25µg vs dinoprostone vaginale dans le déclenchement du travail à terme.

OBJECTIVE: To compare the efficacy and safety of oral misoprostol 25µg compared to vaginal dinoprostone in the induction of labor at term. METHODS: Analytic, retrospective study of patients induced at term by prostaglandins with an unfavorable cervix, over two consecutive periods from 01/01/2019 to 19/02/2020 and from 20/02/2020 to 07/04/2021, within a regional level III university hospital center. We compared the safety and the efficacy between the oral misoprostol Angusta® used since 20/02/2020 and the vaginal dinoprostone previously used in gel or diffuser. The primary endpoint was the rate of vaginal deliveries within 24h. Secondary endpoints were cesarean section rate, indications for cesarean section, uterine contractility abnormalities and neonatal outcomes. RESULTS: Our study found no difference in terms of efficacy with similar rates of vaginal deliveries within 24h (51.88% vs. 51.25%; P=0.87) and caesarean sections (misoprostol group: 19.42% vs. dinoprostone group: 16.62%; P=0.33). However, the tolerance criteria revealed in the dinoprostone group an increase in tachysystole (misoprostol group: 9.28% vs. dinoprostone group: 16.90%; P=0.003) and acidosis (arterial pH<7.10, misoprostol group: 3.83% vs. dinoprostone group: 9.29%; P=0.006). CONCLUSION: No difference in efficacy was found between the two induction techniques. Oral misoprostol 25µg seems to be better tolerated from a maternal and fetal point of view.

[IBD and pregnancy: From conception to birth]. / Maladie chronique inflammatoire de l'intestin et grossesse : de la conception à la naissance.

Inflammatory Bowel Diseases (IBD) are chronic conditions affecting young people in their reproductive age. Patient misinformation can be responsible for a self-imposed infertility as well as a suboptimal observance during pregnancy. The aim of this work was to review the influence of IBD and pregnancy on one another at each gestational stage and according to current literature. IBD activity is a major influential factor. In case of a well-controlled IBD, fertility won't be affected and pregnancy will take place without increase risk of complications. With the exception of thalidomide and methotrexate, most of treatments used in IBD are compatible with pregnancy and breastfeeding. Each flare should be optimally managed. Vaginal delivery is a safe option except for patients with active anoperineal lesions. Cesarean section should be systematically discuss in patient with ileal pouch-anal anastomosis.

Obstetrical and neonatal outcomes after successful external cephalic version relative to those after spontaneous cephalic presentations.

OBJECTIVE: External cephalic version (ECV) is a procedure during which the fetus is rotated from breech or transversal to cephalic presentation. Our aim was to assess the outcomes of successful ECV in terms of obstetrical and immediate neonatal outcomes relative spontaneous cephalic presentation. METHODS: We performed a retrospective single-center observational study from January 2007 to December 2017. All included participants benefited from trial of labor with delivery of the fetus in cephalic presentation. They were divided into two groups depending on whether an ECV had been successfully performed or cephalic presentation was spontaneous. RESULTS: The cephalic presentation after ECV and spontaneous cephalic groups comprised 55 and 244 patients, respectively. The two groups differed significantly in terms of the proportion of induced labor (20 [36.4 %] and 56 [22.9 %], p = 0.04), use of oxytocin during labor (31 [56.4 %] and 100 [49.9 %], p = 0.04), duration of labor (342 ± 183 min and 279 ± 140 min, p = 0.008), spontaneous delivery (38 [69.1 %] and 199 [81.5 %], p = 0.04), intrapartum cesarean section (9 [16.4 %] and 16 [6.6 %], p = 0.02), occiput-posterior variety at birth (20 [36.4 %] and 56 [22.9 %], p = 0.04), and brace umbilical positioning at birth (3 [5.4 %] and 2 [0.8 %], p = 0.04), respectively. There were no significant intergroup differences in terms of APGAR score, cord arterial pH/lactates, or reanimation/intensive care admission. CONCLUSION: A successful ECV does not seem to guaranty an identical labor progress and obstetrical outcome as spontaneous cephalic presentations. Immediate neonatal state, on the other hand, seems unaffected by a history of ECV.

[Contribution of array CGH in the management of fetal nuchal translucency]. / L'apport de l'ACPA dans la prise en charge des hyperclartés nucales.

OBJECTIVES: Increased nuchal translucency and cystic hygroma have a neonatal prognosis, when the karyotype is normal, which depends on the findings during the medical follow-up. Array comparative genomic hybridization (aCGH) has been systematically included in this follow-up by prenatal diagnosis teams. There are no guidelines and little information on the advantages of carrying out this test systematically. The aim of our study is to evaluate the contribution of the aCGH in the medical follow-up. METHODS: Fifty-one patients were included during 18 months and followed till the end of their pregnancy in prenatal diagnosis centers in Brest and Amiens. Inclusion criterion was a nuchal translucency above 3,5mm on the first trimester ultrasound. A fetal DNA ChromoQuant and aCGH analysis on chorionic villi sampling, and an ultrasound at 18 weeks of gestation were performed during the follow-up. RESULTS: The aCGH was decisive in only 2 cases. The ultrasound at 18 weeks gestation seemed to be more sensible in the detection of an abnormality. When the aCGH relieved an abnormality, the ultrasound permitted already to detect the presence of a deformity. In 10 cases, the aCGH could not be interpreted on the chorionic villi sampling. In 9 cases, an amniocentesis was performed in order to obtain this result. CONCLUSION: Given the results of this study, the aCGH was rarely determinant or decisive on the realization of a therapeutic abortion. These elements make us reflect on the necessity of maintaining this test before 14 weeks of gestation or propose it as a second-line test after the ultrasound shows signs at 18weeks of gestation.

[Correlation between prenatal and postnatal observations in case of gastroschisis: Experience in a prenatal referral diagnosis center]. / Corrélation des données anténatales et postnatales en cas de laparoschisis : expérience d'un CPDPN.

OBJECTIVES: Ultrasonography plays a key role in surveillance of gastroschisis. Indeed, ultrasound should allow an early diagnosis of its specific complications all the while avoiding their over-diagnosis which could induce an unnecessary prematurity in these fragile children. The aim of this study was to evaluate the relevance of ultrasonography in the surveillance of this malformation. METHODS: We conducted a retrospective single center study from 2008 until 2018 including all cases of apparently isolated gastroschisis followed during the prenatal period and surgically treated in our institution. Prenatal data gathered during the ultrasound follow-up were compared to those observed during surgery. RESULTS: Thirty-one cases of gastroschisis were included. Regarding the abdominal wall defect, the latter was described prenatally as tight in seven cases with a weak correlation, and as situated to the right of the umbilical cord insertion in 11 cases with a high correlation to the per-operative observations. Sonographic observations were responsible for inducing birth in 14 cases (45%), of which 12 due to the presence of a specific gastroschisis complication, confirmed in five cases (42%, weak correlation). Pre- and post-natal correlation for compression/atresia/stenosis and eviscerated bowel inflammation were very weak in both cases, with a respective tendency of over- and under-diagnosis. CONCLUSIONS: Diagnosing the specific complications of gastroschisis by ultrasound is difficult, even though ultrasonography is responsible for many anticipated births. Thus, this monitoring should be performed by experienced sonographers on devices with appropriate settings. In addition, reproducible parameters such as oligohydramnios or increased bowel dilations should alone be indications of anticipated birth.