[Synchronisation of the menstrual cycle and ovarian follicles: interest and benefit]. / Synchronisation du cycle menstruel et des follicules ovariens: de nombreux avantages.

In the menstrual cycle, a slight elevation of plasma FSH levels, the inter-cycle FSH signal, initiates the 1st phase of follicular recruitment. In ovarian stimulation for IVF, exogenous FSH aims at increasing the amplitude of this signal while maintaining FSH levels elevated, in order to fool the natural mechanisms of single follicular dominance. Synchronization consists in maintaining plasma FSH levels low so that all recruitable follicles remain at a resting state, prior to inducing ovarian stimulation. Practically speaking, synchronization of ovarian follicles allows to optimize clinical efforts, reduces the risk of cyst formation and ultimately, helps improving IVF outcome.

Stimulated pressure profile at rest: a noninvasive method for assessing urethral sphincter function.

OBJECTIVES: To validate a method for assessing urethral sphincter muscle function by recording rises in intraurethral pressure during repetitive pudendal nerve stimulations. METHODS: A supine urethral pressure profile at rest was performed on 12 stress-continent and 28 stress-incontinent patients during repetitive pudendal nerve stimulations applied near the ischial spine, and the intraurethral pressure increases were calculated for each third of the urethral functional length. RESULTS: No significant difference in intraurethral pressure increases was seen between continent and stress-incontinent women. On the various regression curves, the intraurethral pressure increases showed a significant correlation with maximal urethral closure pressure values at rest and at stress (r = 0.36 to 0.54) and with the patient's age (r = 0.46), but not with pudendal nerve conduction times to the urethral sphincter on either side (r = 0.14 and 0.19). CONCLUSIONS: This method (1) measures intraurethral pressure increases that correlate well with the anatomic location of the urethral sphincter muscle, (2) shows there is no significant difference between them in continent and stress-incontinent patients, except in patients with a low-pressure urethra, and (3) demonstrates that they correlate well with the maximal urethral closure pressure and the patient's age, but not with pudendal motor latencies to the urethral sphincter. This method gives us a mapping of the urethral sphincter activity, explaining why some patients with a low-pressure urethra have less urinary loss than others with the same urethral closure pressure.

[The prognosis of premature infants: from the viewpoint of gynecologists-obstetricians and results from Lausanne]. / Le pronostic des nouveau-nés prématurés: appréciation des gynécologues-obstétriciens et résultats à Lausanne.

AIM OF THE STUDY: To assess the views of obstetricians concerning the survival rate in neonates on the basis of gestational age and birth-weight, rate of severe handicap, and minimum gestational age for preventive and curative measures (steroids for foetal lung maturation and caesarean section in the event of acute foetal distress). Then, to compare these results with the outcomes observed in the referral centre for these obstetricians. METHOD: We circulated an anonymous questionnaire (two mailings between October 1995 and February 1996) to obstetricians in the Lausanne area. The replies were compared with prospective data from the Lausanne obstetric unit (1989-1995) and neonatal intensive care unit (1982-1993) backed by the neurodevelopmental outcome assessed by regular follow-up until the age of 8 1/2 years. RESULTS: We obtained 116 replies from the 270 specialists questioned (43% participation). The mortality rates in Lausanne are described by gestational age and birthweight, as is the rate of severe handicap. We observed significant overestimation of the mortality rate for premature infants between 25 and 31 weeks and for birthweights over 600 grams. The rate of severe handicap was widely overestimated for a gestational age below 28 weeks at delivery or a birthweight below 1500 g (prognosis 31.2% and 21.5% respectively, compared with actual figures of 7.4% and 6.8%). Moreover, distribution of replies showed marked heterogeneity between 26 and 29 weeks and between 600 and 1000 grams. The estimated minimum gestational age was 26 weeks (mean) for starting steroid therapy and 27 weeks for caesarean section for acute foetal distress. CONCLUSION: Assessment of prognosis by obstetricians did not correlate with our results and reflected the disparity of data found in the literature. Nevertheless, the implications of this discrepancy may be slight. The study stresses the efficacy of the regionalisation of perinatal care in the Lausanne area, where we observed only 6% of outborn weighting less than 1500 grams in the 18 maternity departments covered. The rate of completed antenatal steroid therapy (41% for infants below 1500 grams) appears to be favourable in our population compared with the literature. We advocate permanent information on local results regarding perinatal outcome, to enable individual obstetricians to consider the desirability of treating, transferring or even counselling or reassuring their patients.

Do bladder neck mobility and urethral sphincter function differ during pregnancy compared with during the non-pregnant state?

The aim of the study was to assess and compare urethral sphincter (US) function and bladder neck (BN) behavior in pregnant and non-pregnant women. Urethral pressure profile parameters, intravaginal-anal pressures and BN position/mobility were compared in both pregnant and non-pregnant women. It was found that pregnancy results in a decreased maximal urethral closure pressure (MUCP)/area of continence at rest and at stress, decreased pressure-transmission ratio (PTR) values and backwards displacement of the bladder neck. No significant changes in intravaginal-anal pressures and BN mobility/downwards displacement were seen. Compared with stress continent pregnant patients, pregnant patients with stress urinary incontinence (SUI) have a lower MUCP at rest/stress and area of continence at stress, but show no difference in BN behavior. Regression analysis shows no correlation between advancing pregnancy and any of these parameters. It was concluded that pregnancy induces diminished US function and backwards displacement of the BN. Compared to continent pregnant patients, pregnant women with SUI also have a diminished US function. US parameters are not significantly modified by advancing pregnancy.

[Prenatal care of women delivering in the Vaud canton: retrospective study of 854 cases]. / Le suivi prénatal des femmes accouchant dans le canton de Vaud: etude rétrospective de 854 cas.

The association between prenatal care and infant health has been shown in many studies. Therefore, accurate information on prenatal care is required to assess the organization of preventive measures aiming at a reducing in neonatal mortality any morbidity. We retrospectively collected data on 854 pregnancies. According to a classification scheme developed by Kessner, 61.6% of women had access to adequate prenatal care. Overall, the proportion of adequate prenatal care was lower among multiparas, and in this subgroup we found a lower rate for women with base line insurance. In the primiparas subgroup we found a lower rate of adequate prenatal care for foreigners, women under 20 years or unmarried mothers, and for women without professional activity during pregnancy, besides preterm birth was more frequent amongst women in the group of prenatal care qualified as intermediate or inadequate. The frequency of pregnancy visits and the Kessner index are discussed in a literature review. The association between socio-economic indicators and prenatal care was unexpected considering the overall wealth of Switzerland. With a 6.8% infant mortality registered in 1989, this country can be considered to have one of the lowest rates in the world. These findings nevertheless suggest the way to possible additional gains by interventions targeted to specific socio-economic groups.