L. Vandenbroucke

Screening for Chlamydia trachomatis using self-collected vaginal swabs at a public pregnancy termination clinic in France: results of a screen-and-treat policy.

Objective: To assess the prevalence of Chlamydia trachomatis (CT) infection and the risk factors for CT infection among women presenting for abortion at a clinic in France. Methods: Women seeking surgically induced abortions were systematically screened by PCR on self-collected vaginal swabs between January 1, 2010, and September 30, 2010. CT-positive women were treated with oral azithromycin (1 g) before the surgical procedure. Results: Of the 978 women included in the study, 66 were CT positive. The prevalence was 6.7% (95% confidence intervals [CI] 5.1%–8.3%). The risk factors for CT infection were the following: age <30 years (Odds ratio [OR]: 2.0 [95% CI: 1.2–3.5]), a relationship status of single (OR: 2.2 [95% CI: 1.2–4.0]), having 0 or 1 child (OR: 5.2 [95% CI: 2.0–13.0]), not using contraception (OR: 2.4 [95% CI: 1.4–4.1]), and completing 11 weeks or more of gestation (OR: 2.1 [95% CI: 1.3–3.6]). Multiple logistic regression indicated that 4 factors—having 0 or 1 child, a single relationship status, no contraceptive use, and a gestation of 11 weeks or more—were independently associated with CT infection. The rate of postabortion infection among all patients was 0.4% (4/978). Conclusions: These results reveal a high prevalence (6.7%) of CT-positive patients among French women seeking induced abortions. Because it is not common practice to screen the general population for CT, screening before induced abortions seems relevant. A cost-effectiveness study is required to evaluate this screen-and-treat policy.

Recommandations françaises pour les critères diagnostiques d’arrêt de grossesse au premier trimestre et stratégie de prise en charge des patientes présentant une menace de fausse couche ou une grossesse arrêtée (hors évacuation utérine)

OBJECTIVE To assess value of sonography, hCG and progesterone for diagnosis of first trimester nonviable pregnancy and to assess first trimester miscarriage management (except evacuation). METHODS French and English publications were searched using PubMed, Cochrane Library and international learned societies recommendations. RESULTS First trimester nonviable pregnancy is established with gestational sac mean diameter and embryo crown-rump length. Mean sac diameter≥25mm without embryo (LE2) or embryo crown-rump length≥7mm without heartbeat (LE2) by transvaginal sonography allows to diagnose pregnancy failure. Intrauterine pregnancy of uncertain viability is defined by intra-uterine gestational sac without embryo with heartbeat or without pregnancy diagnosis failure and requires a new transvaginal sonography. The delay for this second sonography depends on the aspect of intrauterine picture (i.e. presence of yolk sac or not, presence of embryo or not) (LE4). Human chorionic gonadotropin (hCG) and progesterone are useful for pregnancy of unknown location (i.e. no gestational sac at transvaginal sonography): hCG ratio<15% between two-day serum samples when first hCG is<2000UI/mL (LE2) or low serum progesterone level (<3.2ng/mL) (LE2) exclude viable intrauterine pregnancy. There is not known prevention strategy for threatened miscarriage.

Pertes de grossesseRecommandations françaises pour les critères diagnostiques d’arrêt de grossesse au premier trimestre et stratégie de prise en charge des patientes présentant une menace de fausse couche ou une grossesse arrêtée (hors évacuation utérine)French guidelines for diagnostic criteria for nonviable pregnancy early in the first trimester and for management of threatened miscarriage and nonviable pregnancy (except uterine evacuation)

OBJECTIVE To assess value of sonography, hCG and progesterone for diagnosis of first trimester nonviable pregnancy and to assess first trimester miscarriage management (except evacuation). METHODS French and English publications were searched using PubMed, Cochrane Library and international learned societies recommendations. RESULTS First trimester nonviable pregnancy is established with gestational sac mean diameter and embryo crown-rump length. Mean sac diameter≥25mm without embryo (LE2) or embryo crown-rump length≥7mm without heartbeat (LE2) by transvaginal sonography allows to diagnose pregnancy failure. Intrauterine pregnancy of uncertain viability is defined by intra-uterine gestational sac without embryo with heartbeat or without pregnancy diagnosis failure and requires a new transvaginal sonography. The delay for this second sonography depends on the aspect of intrauterine picture (i.e. presence of yolk sac or not, presence of embryo or not) (LE4). Human chorionic gonadotropin (hCG) and progesterone are useful for pregnancy of unknown location (i.e. no gestational sac at transvaginal sonography): hCG ratio<15% between two-day serum samples when first hCG is<2000UI/mL (LE2) or low serum progesterone level (<3.2ng/mL) (LE2) exclude viable intrauterine pregnancy. There is not known prevention strategy for threatened miscarriage.

Malformations artérioveineuses endo-utérines acquises

Uterine arteriovenous malformations (AVM) may be responsible for vaginal bleeding potentially life-threatening. They are most often acquired following uterine trauma (curettage, cesarean section, artificial delivery/uterus examination) in association with pregnancy or gestational trophoblastic disease. We report three cases of patients having uterine AVM after curettage. The diagnostic management is important to avoid differential diagnoses (intra-uterine retention, hemangioma, gestational trophoblastic disease). It is based on serum hCG measurement and Doppler ultrasound, then confirmed on dynamic angio-MRI, which tends to replace angiography as first-line. The therapeutic management in cases of symptomatic AVMs is mostly embolization which offers the possibility for childbearing. Current data on subsequent pregnancies is reassuring even if they remain limited.

L’interruption volontaire de grossesse médicamenteuse de 12 à 14 semaines d’aménorrhée : étude rétrospective portant sur 126 patientes

OBJECTIVE To assess the efficacy of medical abortion performed according to a single protocol from 12 through 14 weeks. STUDY DESIGN Retrospective observational study of medical abortions from 12 through 14 weeks performed from January 2007 through March 2009. The protocol combined 600 mg de mifepristone orally, followed 48 h later by 400 μg of misoprostol, administered orally, and repeated after 3h, four times a day (during two days), if patient did not begin to abort. Outcome measures were the abortion rate, the rate of complication, the rate of manual uterine revision or vacuum aspiration, the time of expulsion and the misoprostol dose. RESULTS The study included 126 medical abortions. The abortion rate was 98% and the secondary manual revision or vacuum aspiration rate was 41%. The mean time to expulsion was 10.4 (±8.8)h, and the mean misoprostol dose 1040 (±420) μg. Higher parity was significantly correlated with shorter time to expulsion (P=0.02). CONCLUSION Medical abortion was consistently effective from 12 through 14 weeks but with high rate of secondary manual revision or vacuum aspiration.

L'interruption volontaire de grossesse médicamenteuse de 12 à 14 semaines d'aménorrhée : étude rétrospective portant sur 126 patientes. [Medical abortion from 12 through 14 weeks' gestation: a retrospective study with 126 patients].

OBJECTIVE To assess the efficacy of medical abortion performed according to a single protocol from 12 through 14 weeks. STUDY DESIGN Retrospective observational study of medical abortions from 12 through 14 weeks performed from January 2007 through March 2009. The protocol combined 600 mg de mifepristone orally, followed 48 h later by 400 μg of misoprostol, administered orally, and repeated after 3h, four times a day (during two days), if patient did not begin to abort. Outcome measures were the abortion rate, the rate of complication, the rate of manual uterine revision or vacuum aspiration, the time of expulsion and the misoprostol dose. RESULTS The study included 126 medical abortions. The abortion rate was 98% and the secondary manual revision or vacuum aspiration rate was 41%. The mean time to expulsion was 10.4 (±8.8)h, and the mean misoprostol dose 1040 (±420) μg. Higher parity was significantly correlated with shorter time to expulsion (P=0.02). CONCLUSION Medical abortion was consistently effective from 12 through 14 weeks but with high rate of secondary manual revision or vacuum aspiration.

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