E. Closset

Signs, symptoms and complications of complete and partial uterine ruptures during pregnancy and delivery

OBJECTIVES Uterine rupture is a rare but potentially catastrophic complication of pregnancy that requires rapid diagnosis. Classically, its signs and symptoms combine pain, fetal heart rate (FHR) abnormalities, and vaginal bleeding. The purpose of this study is to identify these signs and symptoms as well as the immediate complications of complete and incomplete (partial) ruptures of the uterine wall, whether or not they follow a previous cesarean delivery. STUDY DESIGN Retrospective study of case records from two university hospital maternity units, from 1987 to 2008. RESULTS In a total of 97,028 births during the study period, we identified 52 uterine ruptures (0.05%): 25 complete and 27 partial. Most (89%) occurred in women with a previous cesarean delivery. In complete ruptures, FHR abnormalities were the most frequent sign (82%), while the complete triad of FHR abnormalities-pain-vaginal bleeding was present in only 9%. The signs and symptoms of partial ruptures were very different; these were asymptomatic in half the cases (48%). Neonatal mortality reached 13.6% among the complete ruptures; 27 and 40% of these newborns had pH<6.80 and pH<7.0, respectively. Among the incomplete ruptures, only 7.7% of the newborns had a pH<7.0 and there were no deaths. CONCLUSION Although complete rupture of the uterus has a severe neonatal prognosis, the complete set of standard symptoms is present in less than 10% of cases. FHR abnormalities are by far the most frequent sign.

Surveillance du travail dans les situations à risque

Intrapartum asphyxia is increased in several situations such as intrauterine growth retardation, preterm labor, postdate pregnancy or maternal diabetes. In all these cases, fetal heart rate monitoring should be preferred to intermittent auscultation. Fetal scalp blood pH or lactates can be used to identify fetuses at risk of intrapartum asphyxia. However, fetal scalp blood sampling should not delay delivery in case of severe abnormal fetal heart rate as fetal asphyxia could occur rapidly in theses high-risk pregnancies. Data is insufficient to recommend fetal pulse oximetry or ECG analysis. Research should be undertaken to evaluate their performance in these situations.

Dix questions pratiques concernant l’intoxication aiguë au monoxyde de carbone chez la femme enceinte

BACKGROUND The poisoning of carbon monoxide (CO) is the leading cause of death by poisoning in France. Its consequences are potentially serious to the fetus. Literature is ancient and little known. PURPOSE AND METHOD Make an inventory of knowledge about carbon monoxide poisoning during pregnancy. RESULT The CO causes maternal then fetal tissue hypoxia primarily by binding to hemoglobin with which it has a high affinity. Its transplacental passage may cause fetal harm, predominantly in the brain. Severity seems correlated with maternal symptoms during exposure. In the absence of maternal symptoms, however, the available data are reassuring. Hyperbaric oxygen therapy may reduce the risk to the fetus. DISCUSSION Oxygen therapy should be offered in all cases of CO poisoning, especially if there are maternal symptoms during exposure. In addition, a fetal echography directed on the cephalic pole - even a fetal magnetic resonance imaging three weeks after exposure - should also be proposed.

Development and assessment of a workshop on repair of third and fourth degree obstetric tears

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 42 - N° 2 - p. 184-190OBJECTIVES To evaluate the educational interest of a workshop on diagnosis and repair of obstetric anal sphincter injuries (OASIS). To evaluate the theoretical and anatomical knowledge of OASIS repair by French residents in obstetrics and gynecology. MATERIALS AND METHODS The workshop was composed of slides, video of repair and training using cadaveric sows anal sphincters. All subjects were tested with a questionnaire before and after the course. RESULTS Thirty residents participated. Classification of OASIS was known by 13.3% of the residents before the training versus 93.3% after the workshop (P<0.001). Initially, only 6.7% correctly classified operative procedures of OASIS versus 86.7% after the workshop (P<0.001). Per pre-test, 90% of residents did not know how to identify the internal anal sphincter (IAS) versus 3% at post-test (P<0.001). Seventy percent of trainees correctly identified the external anal sphincter (EAS) at the beginning of training. Before the course, no resident knew the repair of the IAS and only one third knew the technical repair of the EAS. After the workshop, the theoretical knowledge of EAS and IAS repair were acquired by all (P<0.001). CONCLUSION Structured hands-on training improves significantly the knowledge of OASIS diagnosis and repair.

Étude comparative de deux ventouses à usage unique

OBJECTIVE To compare the effectiveness of two single-use vacuum devices, the Kiwi Omnicup and the Mitysoft Bell. MATERIAL AND METHODS This retrospective study was conducted during two different periods: from January 15th to March 14th to assess the Kiwi Omnicup and from March 15th to June 15th for the Mitysoft Bell. The primary outcome was the successful completion of delivery with the allocated instrument. Secondary outcomes were fetal scalp trauma and maternal perineal lesions. All deliveries were performed by similar teams. RESULTS Thirty-nine patients were included in the Kiwi Omnicup group and 48 in the Mitysoft Bell group. Compared to the Kiwi Omnicup, the Mitysoft Bell was associated with a greater number of cup detachments (41.7% vs. 10.3%; p<0.01) and a significantly higher rate of failure (31.3% vs. 12.8%). Rates of substantial scalp trauma and maternal trauma were similar in both groups. CONCLUSION The Mitysoft Bell is not as successful at achieving a vaginal delivery as the Kiwi Omnicup. This could be explained by the shape of the cup.