Application of the French guidelines for preventing neonatal group B streptococcal disease in a university hospital.

This study evaluated the application of the French guidelines for prevention of neonatal group B streptococcus (GBS) infections. The prevalence of GBS vaginal carriage by pregnant women during the study period was 6%. Less than 50% of pregnant women testing positive for GBS were treated with at least two doses of antibiotics during labour, and most received only one dose or no antibiotics. In addition, several neonates were colonised or infected by GBS although their mothers were GBS-negative. These results are consistent with vaginal screening having a poor sensitivity, as suggested by the low prevalence of GBS carriage.

Factors influencing laparoconversions during the learning curve of laparoscopic myomectomy.

BACKGROUND: To assess the probability of conversion of a laparoscopic myomectomy to an open procedure, we only found the score developed by Dubuisson et al. (2001) based on four preoperative risk factors. Routinely this score is not appropriate, as realized by the most skilled laparoscopic surgeons. METHODS: The aim of this study was to identify the preoperative factors affecting the risk of conversion in data collected in different centers among a population of surgeons at the beginning of their experience in laparoscopic myomectomy. We collected preoperative clinical and ultrasonography data for all laparoscopic myomectomies performed in 11 hospital centers between January 1996 and December 2000. Data were available for 116 patients. Multiple logistic regression was use to develop a simple predictive model based on available preoperative risk factors of laparoconversion. RESULTS: We encountered 33 laparoconversions (28%) compared to an expected number of 7.8 using Dubuisson's score. We confirmed the importance of two of the four risk factors in Dubuisson's model: biggest myoma size at ultrasonography (increased 1 mm) (OR: 1.06) and intramural type (OR: 3.25) of the dominant myoma. However, we also identified another risk factors: surgeon's experience (OR: 0.15). Simple score was calculated and used to provide an estimated risk of conversion. CONCLUSION: Our model is a useful tool to predict laparoconversion for surgeons beginning in laparoscopic myomectomy. Ultrasound evaluation is essential before performing the procedure. Skilled surgeons in laparoscopy and in laparoscopic myomectomy must help their trainees during their learning curve in order to reduce laparoconversion rate.

Fetal tele-echography using a robotic arm and a satellite link.

OBJECTIVE: To design a method for conducting fetal ultrasound examinations in isolated hospital sites using a dedicated remotely controlled robotic arm (tele-echography). METHODS: Tele-echography was performed from our hospital (expert center) on 29 pregnant women in an isolated maternity hospital (patient site) 1700 km away, and findings were compared with those of conventional ultrasound examinations. At the patient site, a robotic arm holding the real ultrasound probe was placed on the patient's abdomen by an assistant with no experience of performing ultrasound. The robotic arm, remotely controlled with a fictive (expert) probe, reproduced the exact movements (tilting and rotating) of the expert hand on the real ultrasound probe. RESULTS: In 93.1% of the cases, all biometric parameters, placental location and amniotic fluid volume, were correctly assessed using the teleoperated robotic arm. In two cases, femur length could not be correctly measured. The mean duration of fetal ultrasound examination was 14 min (range, 10-18) and 18 min (range, 13-23) by conventional and tele-echography methods, respectively. The mean number of times the robotic arm was repositioned on the patient's abdomen was seven (range, 5-9). CONCLUSION: Tele-echography using a robotic arm provides the main information needed to assess fetal growth and the intrauterine environment within a limited period of time.

[Doppler monitoring of fetal circulation from multiple arteries over several days to improve evaluation of fetal prognosis]. / Monitoring Doppler de la circulation foetale sur plusieurs artères et sur plusieurs jours pour une meilleure prédiction du devenir foetal.

Intrauterine growth retardation and fetal hypoxia are currently related to placental insufficiency. Fetal biometry assessed by echography is entirely adapted to follow the growth and integrity of the principal fetal organs. Hypoxia induces an hemodynamic adaptation which can be detected and quantified by Doppler. The objective of this article is to review the evolution of the fetal Doppler practice for the last 20 years and especially to show that isolated Doppler measurement and only from one site (umbilical or cerebral or aortic) have a moderate negative predictive value of fetal outcome, compared to the study of the fetal hemodynamic evolution (degradation) from several sites and during several days. We will insist on the fact that (a) umbilical Doppler only gives information on placental blood flow and this information does not reflect neither the adaptation to hypoxia nor the consequences of this adaptation, (b) cerebral Doppler accounts for the vascular response to the pO(2) reduction but it does not allow to predict the consequences of this response, (c) the simultaneous study of the placental hemodynamic time course degradation and the cerebral vascular response to hypoxia allows quantification of the cumulative deficit of fetal oxygenation during this period and evaluation the adverse consequences of a sustained flow redistribution toward the brain. Finally, if cerebral vasodilation in response to hypoxia can be considered as a physiological compensatory mechanism, it is associated after several days to the appearance of irreversible fonctional (abnormal fetal heart rate) or organic (cerebral lesions) abnormalities. Adverse effects of this process are illustrated during episodes of acute hypoxia (malaria crisis of several days) or during sustained exposure of the fetus to hypoxia (pregnancy-induced hypertension).