[Record of the role given to members of the psychological professions in the French Multidisciplinary Prenatal Diagnosis Centers (CPDPN)]. / Place de l'accompagnement psychologique dans les CPDPN de France: état des lieux.

AIM: Create a record of the role given to members of the psychological professions in CPDPN Centers (multidisciplinary prenatal diagnosis). After more than 10 years in operation, describe the work methods of the different centers and their members, evaluate the possible diversity of practices and clarify the scope of interventions used by psychologists with patients and members of the CPDPN. METHOD: A descriptive survey consisting of 71 questions sent to psychologists, paediatricians and psychiatrists involved with the 48 CPDPN Centers in France. The main parameters studied are the means used by the CPDPN and their organization in the field of psychology, pre-medical counseling for the termination of pregnancy (IMG), conditions of hospitalization and post-IMG counseling. RESULTS: The survey revealed a high-level of homogeneous practices in the French CPDPN Centers between members of the medical and psychological professions, through joint consultations, ethical committees or specific case meetings for complex fetal pathologies. CONCLUSIONS AND PERSPECTIVES: This study has established a working relationship between members of the psychological professions working in the French CPDPN Centers and has led to the creation of a listing/directory, which facilitates the exchange of information. Video-conferencing is currently being considered in order to share respective practices.

[Rupture of membranes in case of internal podalic version: a risk for cesarean section on the second twin]. / Non-intégrité des membranes en cas de manœuvres : facteur de risque de césarienne sur deuxième jumeau.

OBJECTIVES: To evaluate if internal version with ruptured membranes is a risk factor of cesarean section for the second twin. PATIENTS AND METHODS: Two hundred and fifty-nine twins vaginal deliveries after 33 weeks of gestation from 1997 to 2009 in a level 3 maternity. A retrospective case-control study comparing two groups: cases of cesarean section on second twin and five twins vaginal deliveries following the case. Active management of the second twin delivery was performed with a short intertwin delivery. RESULTS: Eleven cesarean sections on the second twin were performed (4.2%). The main indication was failure of internal version. The risk of cesarean section was significantly greater when the internal version was performed with ruptured membranes (OR: 25.4 IC 95% [2.3-275.7] P<0.003) and when intertwin time delivery interval was increased (8.1±5.1 vs 16.7±6.3, P<0.001). DISCUSSION AND CONCLUSION: The rupture of amniotic membranes before or during the internal podalic version is associated with a risk of failure and cesarean for the second twin. We recommend to perform the internal podalic version with unruptured membranes according to the French recommendations.

[Anal sphincter injury during operative vaginal delivery using spatulas. What are the risk factors?]. / Lésions périnéales sévères liées à une extraction fœtale par spatules. Quels facteurs de risques ?

OBJECTIVE: To assess risk factors for anal sphincter injury during operative vaginal delivery using spatulas. PATIENTS AND METHODS: A monocentric retrospective study of all assisted vaginal deliveries using Thierry and Teissier's spatulas between January 1st, 2008 and December 31st, 2009 in a teaching level III maternity. We studied risk factors such as primiparity, gestational age, maternal age, previous perineal laceration, level and type of presentation, type of expulsion, unsuccessful extraction and successive use of tools, episiotomy, type of anaesthesia and birth weight. RESULTS: There were 346 perineal tears (60.5%); among them, 175 (31%) were type 1, 131 (23%) type 2, 35 (6.1%) type 3 and five (0.9%) type 4. There were 235 episiotomy (41.1%). There was no statistically significant difference between all the supposed risk factors and the severe perineal tears. CONCLUSION: There are no relationship between third and fourth degree perineal lesions during spatula's delivery and supposed risk factors of anal sphincter injury. Only statistical tendances between first vaginal delivery and anal sphincter injury and between occipitosacral delivery and anal sphincter injury were found. We need further randomized studies comparing assisted births using spatulas, forceps and vacuum extractors to better assess perineal tears risk factors.

Prenatal management of congenital infantile fibrosarcoma: unexpected outcome.

We report the case of a large leg tumor in a fetus at 36 weeks of gestation. The tumor's location, ultrasound characteristics and magnetic resonance imaging (MRI) findings enabled a prenatal diagnosis of congenital fibrosarcoma and allowed us to establish the prognosis. After multidisciplinary discussion, it was decided that the pregnancy should continue to 38 weeks, with surgery or neo-adjuvant chemotherapy scheduled after delivery. Unfortunately, the tumor unexpectedly burst in utero and the newborn died of the consequences of hemorrhagic shock, despite rapid amputation. Histological examination confirmed the nature of the tumor. The prognosis of congenital fibrosarcoma is generally good when there are no metastases. MRI is key to establishing a prenatal diagnosis. However, rupture of the tumor can result in fatal hemorrhaging and the pregnancy should be monitored closely before scheduled delivery.