Decision-delivery intervals: Impact of a colour code protocol for emergency caesareans.

OBJECTIVE: Assess the impact of implementation by simple distribution of a "colour code" protocol for emergency caesareans on the course over time of the "decision-delivery interval" (DDI) and neonatal outcome. DESIGN: Observational study in 26 maternity units of the AURORE perinatal network, conducted between October 1, 2017, and April 30, 2018. Each maternity ward́ was supposed to prospectively include 20 consecutive cases of caesareans performed either as an emergency, that is, as a code orange, or an extreme emergency, that is, code red. We compared the DDIs observed in 2017 to those in 2007 according to the degree of emergency, the maternity unit level of care, and their adherence to the protocol. Neonatal outcome in 2007 and 2017, assessed from laboratory and clinical indicators, was also compared, overall and according to the degree of emergency. RESULTS: The DDI was significantly lower in 2017 (n = 478) than in 2007 (n = 447), regardless of the degree of emergency and the level of care (p < 0.0001). In 2017, all code red caesareans were performed in less than 15 min in level 3 maternity units compared with 73 % (p = 0.039) in 2007. Fewer than 20 % of the caesareans in the 2007 study period were performed in less than 15 min in level 1 and 2 maternity units. Today, this is the case for 83 % of these caesareans in level 2 units (p < 0.001) and 36 % in level 1 (p = 0.01). In 2017, code orange caesareans were performed in less than 30 min in 96 % of cases in level 3 units, 67 % in level 2, and 33 % in level 1, compared respectively with 67 % (p = 0.015), 25 % (p < 0.0001) and 16 % (p = 0.0003) in 2007. We did not observe any difference in the neonatal outcome between 2007 and 2017 or as a function of the DDI expected based on the caesarean colour code. CONCLUSION: The implementation of the colour code protocols was associated with an improved DDI and better adherence to the recommendations in all 26 maternity units in this perinatal network.

Evaluation of NovaSure® global endometrial ablation in symptomatic adenomyosis: A longitudinal study with a 36 month follow-up.

OBJECTIVE: To evaluate the efficacy of NovaSure® radiofrequency global endometrial ablation (GEA) in adenomyosis. STUDY DESIGN: We conducted a monocentric longitudinal cohort study at Croix-Rousse University Hospital (Lyon, France). Inclusion criteria were symptomatic adenomyosis resistant to drug therapy (dysmenorrhea and abnormal uterine bleeding (AUB)), for whom Novasure® GEA was considered. The diagnosis of adenomyosis was based on ultrasound and/or MRI criteria. A questionnaire evaluating the symptoms was proposed to each patient before GEA and postoperatively at 6 months and 3 years. RESULTS: Forty-three patients were included between December 2012 and May 2014, with a median age of 46.7 years. Preoperatively, 43 patients (100%) had AUB and 33 (76.7%) had dysmenorrhea,. Postoperatively, there was a significant reduction in AUB in 40 patients (-93%, 95% CI [85.3, 100], p < .00001) at 6 months, and in 29 patients (-67.4%, 95% CI [53.3, 81.6], p < .00001) at 3 years. Eleven patients (+ 25.5%, 95% CI [10.9, 40.3], p = .0055) experienced significant recurrence of AUB between 6 months and 3 years. Eighteen patients (41.9%, 95% CI [26.9, 56.8], p < .00001) experienced amenorrhea 6 months after the procedure, and 16 patients (37.2%, 95% CI [22.6, 51.8], p < .00001) at 3 years. Similarly, we observed a significant decrease of dysmenorrhea with an improvement in 20 patients (-60.6%, 95% CI [-46.7, -77.5], p = .00002) at 6 months and 17 patients (-51.5%, 95% CI [34.2, 68.8], p = .0001) at 3 years. The recurrence of dysmenorrhea between 6 months and 3 years in 3 patients (+ 9.1%, 95% CI [-8.7, +26.9], p = .44) was not significant. Eight patients (19%) had a hysterectomy during the study. Patients were 92% satisfied with the procedure. No major postoperative complication was reported after using NovaSure®. CONCLUSION: NovaSure® is effective in the treatment of painful and hemorrhagic symptoms associated with adenomyosis in both the short and long term. However, efficacy in controlling bleeding seems to decrease over time. Nevertheless, it appears to be a good alternative to hysterectomy in this indication, especially in patients close to menopause.

Impact of Hodgkin or non-Hodgkin lymphoma and their treatments on sperm aneuploidy: a prospective study by the French CECOS network.

OBJECTIVE: To assess sperm production and aneuploidy in Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) before and after treatments. DESIGN: Multicenter, prospective, longitudinal study of lymphoma patients analyzed before treatment and after 3, 6, 12, and 24 months. SETTING: University hospitals. PATIENT(S): Forty-five HL and 13 NHL patients were investigated before and after treatment. Treatment regimens were classified in two groups: ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) with or without (±) radiotherapy, and CHOP (doxorubicin, cyclophosphamide, vincristine, prednisone)/MOPP-ABV (mechlorethamine, oncovin, procarbazine, prednisone-doxorubicin, bleomycin, vinblastine). A control group of 29 healthy men was also studied. INTERVENTION(S): Semen analyses and aneuploidy study by FISH were performed at each time point. MAIN OUTCOME MEASURE(S): Comparison of mean sperm characteristics and percentage of sperm aneuploidy rates before and after treatment. RESULT(S): Before treatment, HL and NHL men had altered semen characteristics and higher sperm aneuploidy rates (median 0.76 [interquartile range 0.56-0.64]) than the control group (0.54 [0.46-0.74]). After treatment, sperm production was significantly lowered 3 and 6 months after ABVD ± radiotherapy or CHOP/MOPP-ABV. After ABVD ± radiotherapy, the aneuploidy rate increased significantly only at 3 months, and values obtained 1 or 2 years later were lower than pretreatment values. In contrast, in the CHOP/MOPP-ABV treatment group, semen characteristics and aneuploidy rate did not return to normal levels until 2 years after treatment. CONCLUSION(S): Lymphoma itself has consequences on sperm aneuploidy frequency before treatment. Moreover, lymphoma treatments have deleterious effects on sperm chromosomes related to treatment type and time since treatment. Patient counseling is essential concerning the transient but significant sperm aneuploidy induced by lymphoma and its treatments.

FISH and tips: a large scale analysis of automated versus manual scoring for sperm aneuploidy detection.

BACKGROUND: Approximately 1% of the spermatozoa found in ejaculate of healthy men are aneuploid and this rate increases in the population of subfertile and infertile men. Moreover, fertilization with these aneuploid sperm can lead to impaired embryo development. Fluorescent In Situ Hybridization (FISH) is the common cytogenetic tool used for aneuploidy screening on sperm. However, it is a time-consuming technique and cytogenetic or in vitro fertilization laboratories cannot routinely use it and face the increasing demand of such analyses before Assisted Reproductive Techniques (ART). As automation can be a clue for routine practice, this study compares manual and automated scoring of sperm aneuploidy rates using a Metafer Metasystems® device. The results obtained also contribute to global data about FISH on sperm cells. METHODS: We recruited 100 men addressed for sperm cryopreservation. They all signed an informed consent to participate in the study. 29 men were donors or consulted before vasectomy (control group) and 71 were suffering of Hodgkin's disease or non Hodgkin lymphoma (patient group). One semen sample was collected for each patient, analyzed according to WHO criteria and prepared for a triple-color FISH using centromeric probes for chromosomes 18, X and Y. Automated scoring was performed using a Metafer Metasystems® device. RESULTS: 507,019 cells were scored. We found a strong concordance between the automated and the manual reading (d < 0.01 in Bland-Altman test). We also did not find a statistically significant difference between the automated and the manual reading using Wilcoxon test for total aneuploidy rate (p = 0.06), sex chromosomes disomy (p = 0.33), chromosome 18 disomy (p = 0.39) and diploidy (p = 0.21). Cumulative rate of total aneuploidy was 0.78% ± 0.212% for patient group and 0.54% ± 0.15 for control group and among this, sex chromosome XY disomy rate was of 0.54% for patient group and 0.27% for control group. CONCLUSION: This study validates the automated reading for FISH on sperm with a Metafer Metasystems® device and allows its use in a laboratory routine.

CONTEXTE: Le taux d'aneuploïdies spermatiques est d'environ 1% pour les hommes fertiles et augmente notablement dans la population des individus infertiles. L'obtention d'une fécondation à partir de ces spermatozoïdes aneuploïdes peut entrainer des anomalies de développement embryonnaire. L'évaluation des taux d'aneuploïdies est actuellement possible de façon simple par hybridation in situ fluorescente, toutefois la lecture manuelle des signaux obtenus est longue et fastidieuse. Les techniques de lecture automatisée des spots fluorescents se sont développées ces dernières années et sont actuellement de plus en plus utilisées en cytogénétique de routine. L'application de ces techniques aux spermatozoïdes permettrait donc une évaluation plus régulière des aneuploïdies spermatiques en infertilité. Nous présentons une étude comparée de la lecture manuelle et de la lecture automatisée en système Metafer Metasystem® sur un échantillon important de témoins fertiles et de patients à caryotype normal. MÉTHODE: 100 hommes consultant pour congélation de spermatozoïdes ont été inclus dans l'étude après information et recueil de leur consentement écrit. Cet échantillon était divisé en 29 donneurs fertiles ou patients consultant avant vasectomie et 71 patients consultant dans le cadre d'une maladie de Hodgkin ou d'un lymphome non hodgkinien. Un recueil a été réservé pour l'étude, les paramètres spermatiques ont été analysés selon les recommandations de l'OMS. Ensuite les taux d'aneuploïdies ont été évalués par FISH pour les chromosomes X, Y et 18 en système à trois couleurs utilisant des sondes centromériques. RÉSULTATS: 507,019 spermatozoïdes ont été analysés. La concordance entre les deux modes de lecture est forte (d < 0.01 in Bland-Altman test) et aucune différence n'a été observée entre la lecture automatique et manuelle au test de Wilcoxon (p > 0,05) pour le taux global d'aneuploïdies, les disomies des chromosomes sexuels ou du chromosome 18 et les diploïdies. Le taux global d'aneuploïdies était de 0.78% ± 0.212% pour les patients et 0.54% ± 0.15 pour les témoins fertiles et le taux de disomies XY était de 0.54% chez les patients et 0.27% chez les témoins. CONCLUSION: Les données présentées dans ce travail permettent de valider une utilisation du lecteur automatisé de spots Metafer Metasystems® pour l'analyse chromosomique des spermatozoïdes en routine.