Persistent occiput posterior position: predictive factors of spontaneous rotation of the fetal head.

OBJECTIVES: To assess factors associated with spontaneous rotation in the occiput anterior position for fetuses in persistent occiput posterior (OP) during the second stage of labor. To evaluate maternal and fetal outcomes after spontaneous rotation of persistent OP. METHODS: This is a prospective cohort of 495 women with fetuses in persistent OP position, confirmed with ultrasonography during the second stage of labor. We performed simple logistic regressions, followed by multiple logistic regressions. RESULTS: Among 495 women with fetuses in persistent OP position, 78 fetuses (16%) underwent a spontaneous rotation during the second stage of labor. The multivariate analysis found that a short duration of the first stage of labor (<7 h) was associated with a spontaneous rotation of the fetal head in the second stage of labor (OR 0.43 [0.23; 0.76. There were fewer episiotomies (25.6% vs 52.3%, p < .01), cesarean sections (0% v. 5.4%, p = .03), and instrumental deliveries (8.9% vs. 50%, p < .01) in the "spontaneous rotation" group, and the two groups were similar regarding post-partum hemorrhage.The newborns in the "spontaneous rotation" group had a higher Apgar score at 1 min (10 v. 9, p = .02). The two groups did not differ for other neonatal parameters, such as arterial pH value, Apgar score at 5 min, birth trauma, or transfer into the pediatric unit. CONCLUSION: A shorter duration of the first stage of labor (< 7 h) is a predictive factor of spontaneous rotation in the occiput anterior position for fetuses in persistent OP position. A spontaneous rotation in case of an OP position is associated with better maternal and fetal outcomes.

Semi-automated versus manual embryo vitrification: inter-operator variability, time-saving, and clinical outcomes.

PURPOSE: Does semi-automated vitrification have lower inter-operator variability and better clinical outcomes than manual vitrification? METHODS: Retrospective analyses of 282 patients whose embryos had been cryopreserved, manually with Irvine®-CBS® (MV) or semi-automatically vitrified with the GAVI® method (AV) (from November 2017 to September 2020). Both techniques were performed during the same period by 5 operators. Inter-operator variability was statistically analyzed between operators who performed the vitrification and those who performed the warming process to compare the intact survival rate (% embryos with 100% intact blastomeres) and the positive survival rate (at least 50% intact blastomeres). Additionally, the complete vitrification time was assessed for the 2 techniques according to the number of vitrified embryos. RESULTS: Manual vitrification involved warming 338 embryos in 266 cycles for 181 couples compared to 212 embryos in 162 AV cycles for 101 patients. The positive survival rate was higher (p < 0.05) after MV (96%; 323/338) than after AV (90%; 191/212). The intact survival rate (86 vs 84%) and the clinical pregnancy rate (27 vs 22%) were not significantly different between MV and AV. Regarding the inter-operator variability, no significant difference in positive and intact survival rate was evident between the 5 technicians, neither by vitrification nor by warming steps with MV and AV. Concerning time-saving, the MV technique proved to be quicker than AV (minus 11 ± 9 min). CONCLUSIONS: Manual vitrification exhibited favorable total survival rates and was more time efficient, while both MV and AV cooling and warming treatments showed little operator variability.

Fertility and sexuality of women with inflammatory arthritis.

OBJECTIVE: This study aimed to evaluate the impact of the four main types of inflammatory arthritis (rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PA), juvenile chronic arthritis (JCA)) on female fertility. DESIGN: We performed a monocentric observational study, which took place in the Reproductive Medicine Department and the Rheumatology Department of the Toulouse University Hospital. An anonymous questionnaire was sent to patients aged 18-50 with RA, AS, PA or JCA who were diagnosed before the age of 40 and who consented to participate in the study. A section of the questionnaire was completed using the medical file of each patient. RESULTS: Of the 521 eligible patients, 202 (39 %) answered the questionnaire. Before being diagnosed with a rheumatic disease, 87 % of patients with a desire for pregnancy had a spontaneously obtained live birth, compared to 75 % after (P < 0.05). However, this decrease only concerned RA (90 % before diagnosis vs 68 % after; P < 0.05). This difference was due to a lower rate of pregnancies achieved, but the number of miscarriages did not increase. Moreover, for patients who managed to conceive, the time required for conception did not increase, regardless of the type of rheumatic disease they had. Two thirds of patients reported a decrease in the frequency of sexual intercourse after diagnosis, mainly (75 %) because of the pain relating to the disease. CONCLUSION: Our study shows a trend of decreased fertility in patients with RA, perhaps due to sexual problems, while no impact of AS and PA on the ability to conceive was found. This impact on fertility didn't seem to be related to the decrease of sexuality. Multidisciplinary care including treatment from a rheumatologist, gynecologist and sexologist would appear essential in order to provide RA patients with the necessary information concerning their fertility, answer their questions about pregnancy and thus optimize their care.

Fertility of women with cystic fibrosis: a French survey.

RESEARCH QUESTION: Although the impact of cystic fibrosis on male fertility is well known, very few studies have investigated its effect on female fertility. This study aimed to evaluate the fertility status of women with cystic fibrosis. DESIGN: A questionnaire was sent to 220 women with cystic fibrosis. The questions concerned their desire to become a parent, achievement or not of a pregnancy, the time to become pregnant, the means of achieving pregnancy (spontaneously or with medical assistance) and the outcome of the pregnancy. Ninety-eight patients responded to the questionnaire. RESULTS: Of the 46 women who sought pregnancy, 25 (54%) had at least one live birth without treatment, while 11 (24%) required infertility treatment to obtain a live birth and 10 (22%) had no delivery. The mean time-to-pregnancy was 12 months (1-180). The reasons for preferring not to become pregnant were mainly fear of the interaction between cystic fibrosis and pregnancy and of the transmission of cystic fibrosis to children. CONCLUSIONS: Fertility seems to be slightly impaired in women with cystic fibrosis, because 37% of them failed to become pregnant without medical assistance. Because the outcome of pregnancies appears normal, patients should be informed about the possibility of becoming mothers and be made aware of the risk of unwanted pregnancies.

Pregnancy outcome in Turner syndrome: A French multi-center study after the 2009 guidelines.

OBJECTIVE: This study aimed to assess the application of the French guidelines for pregnancies in Turner syndrome (TS) and their impact on perinatal prognosis. STUDY DESIGN: We performed a French multi-center retrospective study (14 centers), including TS pregnant patients (spontaneously or by Assisted Reproductive Technology (ART)) between January 2006 and July 2017. Only clinical pregnancies were analyzed. The adjustment of medical follow-up modalities to French guidelines was evaluated for all pregnancies after 2009. Pregnancies from oocyte donation (OD) after 2009 were compared to those of a cohort of TS pregnancies obtained by OD before 2009, which were reported by the French Study Group for Oocyte Donation. RESULTS: One hundred seventy pregnancies in 103 patients were included: 35 spontaneous, 5 by means of intra-conjugal ART, and 130 with OD. No serious maternal complications were observed. We reported two stillbirths and one intra uterine fetal death. The French guidelines were partially respected. The preconceptional assessment was carried out in 74% of cases. Cardiology follow-up during pregnancy was performed in accordance with guidelines in 74% of patients. Postpartum cardiac ultrasonography was performed in 45% of pregnancies but only in 11% within 8 days post-partum. When compared to the 2009 historical cohort, the rates of high blood pressure (19% vs. 38%; p < 0.005) pre-eclampsia (8% vs. 21%; p < 0.005) and prematurity <35 weeks (15% vs 38%; p < 0.0001) were lower. CONCLUSIONS: The implementation of guidelines has allowed the standardization of TS pregnancy care and improved perinatal indicators for both mothers and children. However, an effort must be done, in a postpartum survey.

Differential involvement of glutamate-gated chloride channel splice variants in the olfactory memory processes of the honeybee Apis mellifera.

Glutamate-gated chloride channels (GluCl) belong to the cys-loop ligand-gated ion channel superfamily and their expression had been described in several invertebrate nervous systems. In the honeybee, a unique gene amel_glucl encodes two alternatively spliced subunits, Amel_GluCl A and Amel_GluCl B. The expression and differential localization of those variants in the honeybee brain had been previously reported. Here we characterized the involvement of each variant in olfactory learning and memory processes, using specific small-interfering RNA (siRNA) targeting each variant. Firstly, the efficacy of the two siRNAs to decrease their targets' expression was tested, both at mRNA and protein levels. The two proteins showed a decrease of their respective expression 24h after injection. Secondly, each siRNA was injected into the brain to test whether or not it affected olfactory memory by using a classical paradigm of conditioning the proboscis extension reflex (PER). Amel_GluCl A was found to be involved only in retrieval of 1-nonanol, whereas Amel_GluCl B was involved in the PER response to 2-hexanol used as a conditioned stimulus or as new odorant. Here for the first time, a differential behavioral involvement of two highly similar GluCl subunits has been characterized in an invertebrate species.