Table S3. Comparisons between maternal and neonatal characteristics stratified by median HbA1c va... more Table S3. Comparisons between maternal and neonatal characteristics stratified by median HbA1c values.
Revue Médicale Suisse complications de la pose de stérilet Auteur : V. Di Bernardo, Y. Vial, O. B... more Revue Médicale Suisse complications de la pose de stérilet Auteur : V. Di Bernardo, Y. Vial, O. Bachelard, D. Wirthner et P. De Grandi ... Obstet Gynecol Surv 1996 ; 51 : S25-9. 3 Walsh T, Grimes D, Freziers R. Randomised controlled trial of prophylactic antibiotics before insertion ...
PurposePatient blood management [PBM] has been acknowledged and successfully introduced in a wide... more PurposePatient blood management [PBM] has been acknowledged and successfully introduced in a wide range of medical specialities, where blood transfusions are an important issue, including anaesthesiology, orthopaedic surgery, cardiac surgery, or traumatology. Although pregnancy and obstetrics have been recognized as a major field of potential haemorrhage and necessity of blood transfusions, there is still little awareness among obstetricians regarding the importance of PBM in this area. This review, therefore, summarizes the importance of PBM in obstetrics and the current evidence on this topic.MethodWe review the current literature and summarize the current evidence of PBM in pregnant women and postpartum with a focus on postpartum haemorrhage (PPH) using PubMed as literature source. The literature was reviewed and analysed and conclusions were made by the Swiss PBM in obstetrics working group of experts in a consensus meeting.ResultsPBM comprises a series of measures to maintain a...
La presence d'une hypertension arterielle, qu'elle soit chronique ou nouvellement diagnos... more La presence d'une hypertension arterielle, qu'elle soit chronique ou nouvellement diagnostiquee au cours d'une grossesse, est souvent source d'inquietude pour le praticien. Si cette constellation n'est de loin pas toujours le gage d'une evolution catastrophique et que l'attentisme prevaut parfois sur l'interventionnisme a tout prix, elle doit absolument engager a la mefiance. En effet, ce qui s'avere etre la complication de grossesse la plus frequente prend parfois l'allure d'un syndrome complexe et difficilement maitrisable qu'il convient de ne pas prendre a la legere. Nous proposerons donc dans cet article differentes attitudes a tenir dans ce cas de figure.
La premiere correlation entre trisomie 21 et risque de survenue du syndrome a ete un âge maternel... more La premiere correlation entre trisomie 21 et risque de survenue du syndrome a ete un âge maternel avance. Au cours des annees 1980, on a remarque que certains parametres biologiques presentaient une dispersion differente chez les enfants trisomiques. De cette relation a ete developpe le triple test qui prend en compte l'âge maternel, l'œstriol, la β-hCG et l'AFP serique maternelle entre quinze et dix-neuf semaines. A la fin des annees 1990, Spencer a demontre qu'il etait possible de pratiquer ce depistage des la fin du premier trimestre en associant la clarte nucale, le dosage de la fraction libre de la β-hCG, la PAPP-A et l'âge maternel. Ce test permet le depistage de 85-90% des enfants atteints tout en n'impliquant un diagnostic invasif que chez 5-6% des meres. Toute patiente devrait etre informee des possibilites de depistage et de diagnostic afin de pouvoir choisir librement si elle desire ou non un depistage ou un diagnostic de cette maladie.
Studies report that between 6 and 13% of women experience symptoms of depression during pregnancy... more Studies report that between 6 and 13% of women experience symptoms of depression during pregnancy and the postpartum period. The abundant data available make selective serotonin reuptake inhibitors (SSRIs) the first line treatment in pregnancy when a pharmacological treatment is required. Risks associated with the use of SSRIs during pregnancy are limited (moderate effect size) and are often not distinguishable from those inherent to the mother's disease. Yet, several questions regarding the SSRI safety profile for the unborn child are still under debate or require additional epidemiological data. The decision of SSRI use during pregnancy needs an individual evaluation of the risk-benefit balance.
Actuellement, dans le monde, sept millions de femmes chaque annee sont traitees par tamoxifene po... more Actuellement, dans le monde, sept millions de femmes chaque annee sont traitees par tamoxifene pour un cancer du sein. Les effets secondaires du tamoxifene sont peu nombreux, cependant ils sont responsables d'une augmentation des pathologies endometriales, benignes et malignes. Il est donc judicieux de proposer a ces patientes un suivi medical regulier. Avant de debuter le traitement, puis annuellement, nous proposons un examen gynecologique avec frottis cytologique du col uterin associe a une echographie endovaginale. Une hysteroscopie operatoire et/ou un curetage explorateur sont necessaires lorsque l'epaisseur endometriale est superieure a 10 mm ou que la patiente presente des metrorragies.
Management of patients at high risk of extreme premature birth between 23 and 26 weeks should be ... more Management of patients at high risk of extreme premature birth between 23 and 26 weeks should be performed by an experienced multidisciplinary team. In order to optimize guidance for couples with regard to this complex decision, we developed joint guidelines between obstetricians and neonatologists, in order to standardize practices and insure individualized care plans. Fetal outcome is not solely associated with gestational age but is multifactorial, and this should be considered when counseling parents. Thus, enhancement of fetal lung maturation, a major prognostic factor, should be promptly acted upon when delivery is anticipated. Antenatal corticosteroids should not be withheld while awaiting the parents' ultimate decision on neonatal care.
L’elaboration et la mise en œuvre de ces recommandations pour la pratique clinique (RPC) visent a... more L’elaboration et la mise en œuvre de ces recommandations pour la pratique clinique (RPC) visent a promouvoir l’application pertinente et coordonnee de pratiques de soins optimales d’un diabete par l’ensemble des professionnels des soins concernes. Ces RPC ont egalement pour but de federer et d’harmoniser la prise en charge du diabete qui est actuellement tres variable dans le canton de Vaud. L’ESSENTIEL Conseils preconceptionnels Informer toute femme diabetique en âge de procreer des risques augmentes de complications durant la grossesse et la periode postnatale pour la patiente, le fœtus et le nouveau-ne, de l’importance d’un suivi medical frequent et adapte, et d’un controle glycemique optimal.
The objectives of this study were to (a) assess the utility of fetal anthropometric variables to ... more The objectives of this study were to (a) assess the utility of fetal anthropometric variables to predict the most relevant adverse neonatal outcomes in a treated population with gestational diabetes mellitus (GDM) beyond the known impact of maternal anthropometric and metabolic parameters and (b) to identify the most important fetal predictors. A total of 189 patients with GDM were included. The fetal predictors included sonographically assessed fetal weight centile (FWC), FWC > 90% and <10%, and fetal abdominal circumference centile (FACC), FACC > 90% and < 10%, at 29 0/7 to 35 6/7 weeks. Neonatal outcomes comprising neonatal weight centile (NWC), large and small for gestational age (LGA, SGA), hypoglycemia, prematurity, hospitalization for neonatal complication, and (emergency) cesarean section were evaluated. Regression analyses were conducted. Fetal variables predicted anthropometric neonatal outcomes, prematurity, cesarean section and emergency cesarean section. The...
Introduction Postpartum hemorrhage remains a leading cause of maternal morbidity and mortality wo... more Introduction Postpartum hemorrhage remains a leading cause of maternal morbidity and mortality worldwide. Therefore, cumulative incidence of postpartum hemorrhage and severe postpartum hemorrhage are commonly monitored within and compared across maternity hospitals or countries for obstetrical safety improvement. These indicators are usually based on hospital discharge data though their accuracy is seldom assessed. We aimed to measure postpartum hemorrhage and severe postpartum hemorrhage using electronic health records and hospital discharge data separately and compare the detection accuracy of these methods to manual chart review, and to examine the temporal trends in cumulative incidence of these potentially avoidable adverse outcomes. Materials and methods We analyzed routinely collected data of 7904 singleton deliveries from a large Swiss university hospital for a three year period (2014–2016). We identified postpartum hemorrhage and severe postpartum hemorrhage in electronic h...
Clinicians and patients have traditionally believed that elective cesarean section may protect ag... more Clinicians and patients have traditionally believed that elective cesarean section may protect against certain previously ineluctable consequences of labor, including a plethora of urinary, anorectal and sexual dysfunctions. We aimed to evaluate fecal, urinary and sexual symptoms 6 years postpartum, comparing uncomplicated vaginal delivery and elective cesarean delivery, and to assess their impact on quality of life. We conducted a cross-sectional study to compare perineal functional symptomatology between women having singleton elective cesarean deliveries (eCS) and singleton uncomplicated vaginal deliveries (uVD). Women who delivered 6 years before this study were chosen randomly from our hospital database. This database includes demographic, labor, and delivery information, as well as data regarding maternal and neonatal outcomes, all of which is collected at the time of delivery by the obstetrician. Four validated self-administrated questionnaires were sent by post to the partic...
Table S3. Comparisons between maternal and neonatal characteristics stratified by median HbA1c va... more Table S3. Comparisons between maternal and neonatal characteristics stratified by median HbA1c values.
Revue Médicale Suisse complications de la pose de stérilet Auteur : V. Di Bernardo, Y. Vial, O. B... more Revue Médicale Suisse complications de la pose de stérilet Auteur : V. Di Bernardo, Y. Vial, O. Bachelard, D. Wirthner et P. De Grandi ... Obstet Gynecol Surv 1996 ; 51 : S25-9. 3 Walsh T, Grimes D, Freziers R. Randomised controlled trial of prophylactic antibiotics before insertion ...
PurposePatient blood management [PBM] has been acknowledged and successfully introduced in a wide... more PurposePatient blood management [PBM] has been acknowledged and successfully introduced in a wide range of medical specialities, where blood transfusions are an important issue, including anaesthesiology, orthopaedic surgery, cardiac surgery, or traumatology. Although pregnancy and obstetrics have been recognized as a major field of potential haemorrhage and necessity of blood transfusions, there is still little awareness among obstetricians regarding the importance of PBM in this area. This review, therefore, summarizes the importance of PBM in obstetrics and the current evidence on this topic.MethodWe review the current literature and summarize the current evidence of PBM in pregnant women and postpartum with a focus on postpartum haemorrhage (PPH) using PubMed as literature source. The literature was reviewed and analysed and conclusions were made by the Swiss PBM in obstetrics working group of experts in a consensus meeting.ResultsPBM comprises a series of measures to maintain a...
La presence d'une hypertension arterielle, qu'elle soit chronique ou nouvellement diagnos... more La presence d'une hypertension arterielle, qu'elle soit chronique ou nouvellement diagnostiquee au cours d'une grossesse, est souvent source d'inquietude pour le praticien. Si cette constellation n'est de loin pas toujours le gage d'une evolution catastrophique et que l'attentisme prevaut parfois sur l'interventionnisme a tout prix, elle doit absolument engager a la mefiance. En effet, ce qui s'avere etre la complication de grossesse la plus frequente prend parfois l'allure d'un syndrome complexe et difficilement maitrisable qu'il convient de ne pas prendre a la legere. Nous proposerons donc dans cet article differentes attitudes a tenir dans ce cas de figure.
La premiere correlation entre trisomie 21 et risque de survenue du syndrome a ete un âge maternel... more La premiere correlation entre trisomie 21 et risque de survenue du syndrome a ete un âge maternel avance. Au cours des annees 1980, on a remarque que certains parametres biologiques presentaient une dispersion differente chez les enfants trisomiques. De cette relation a ete developpe le triple test qui prend en compte l'âge maternel, l'œstriol, la β-hCG et l'AFP serique maternelle entre quinze et dix-neuf semaines. A la fin des annees 1990, Spencer a demontre qu'il etait possible de pratiquer ce depistage des la fin du premier trimestre en associant la clarte nucale, le dosage de la fraction libre de la β-hCG, la PAPP-A et l'âge maternel. Ce test permet le depistage de 85-90% des enfants atteints tout en n'impliquant un diagnostic invasif que chez 5-6% des meres. Toute patiente devrait etre informee des possibilites de depistage et de diagnostic afin de pouvoir choisir librement si elle desire ou non un depistage ou un diagnostic de cette maladie.
Studies report that between 6 and 13% of women experience symptoms of depression during pregnancy... more Studies report that between 6 and 13% of women experience symptoms of depression during pregnancy and the postpartum period. The abundant data available make selective serotonin reuptake inhibitors (SSRIs) the first line treatment in pregnancy when a pharmacological treatment is required. Risks associated with the use of SSRIs during pregnancy are limited (moderate effect size) and are often not distinguishable from those inherent to the mother's disease. Yet, several questions regarding the SSRI safety profile for the unborn child are still under debate or require additional epidemiological data. The decision of SSRI use during pregnancy needs an individual evaluation of the risk-benefit balance.
Actuellement, dans le monde, sept millions de femmes chaque annee sont traitees par tamoxifene po... more Actuellement, dans le monde, sept millions de femmes chaque annee sont traitees par tamoxifene pour un cancer du sein. Les effets secondaires du tamoxifene sont peu nombreux, cependant ils sont responsables d'une augmentation des pathologies endometriales, benignes et malignes. Il est donc judicieux de proposer a ces patientes un suivi medical regulier. Avant de debuter le traitement, puis annuellement, nous proposons un examen gynecologique avec frottis cytologique du col uterin associe a une echographie endovaginale. Une hysteroscopie operatoire et/ou un curetage explorateur sont necessaires lorsque l'epaisseur endometriale est superieure a 10 mm ou que la patiente presente des metrorragies.
Management of patients at high risk of extreme premature birth between 23 and 26 weeks should be ... more Management of patients at high risk of extreme premature birth between 23 and 26 weeks should be performed by an experienced multidisciplinary team. In order to optimize guidance for couples with regard to this complex decision, we developed joint guidelines between obstetricians and neonatologists, in order to standardize practices and insure individualized care plans. Fetal outcome is not solely associated with gestational age but is multifactorial, and this should be considered when counseling parents. Thus, enhancement of fetal lung maturation, a major prognostic factor, should be promptly acted upon when delivery is anticipated. Antenatal corticosteroids should not be withheld while awaiting the parents' ultimate decision on neonatal care.
L’elaboration et la mise en œuvre de ces recommandations pour la pratique clinique (RPC) visent a... more L’elaboration et la mise en œuvre de ces recommandations pour la pratique clinique (RPC) visent a promouvoir l’application pertinente et coordonnee de pratiques de soins optimales d’un diabete par l’ensemble des professionnels des soins concernes. Ces RPC ont egalement pour but de federer et d’harmoniser la prise en charge du diabete qui est actuellement tres variable dans le canton de Vaud. L’ESSENTIEL Conseils preconceptionnels Informer toute femme diabetique en âge de procreer des risques augmentes de complications durant la grossesse et la periode postnatale pour la patiente, le fœtus et le nouveau-ne, de l’importance d’un suivi medical frequent et adapte, et d’un controle glycemique optimal.
The objectives of this study were to (a) assess the utility of fetal anthropometric variables to ... more The objectives of this study were to (a) assess the utility of fetal anthropometric variables to predict the most relevant adverse neonatal outcomes in a treated population with gestational diabetes mellitus (GDM) beyond the known impact of maternal anthropometric and metabolic parameters and (b) to identify the most important fetal predictors. A total of 189 patients with GDM were included. The fetal predictors included sonographically assessed fetal weight centile (FWC), FWC > 90% and <10%, and fetal abdominal circumference centile (FACC), FACC > 90% and < 10%, at 29 0/7 to 35 6/7 weeks. Neonatal outcomes comprising neonatal weight centile (NWC), large and small for gestational age (LGA, SGA), hypoglycemia, prematurity, hospitalization for neonatal complication, and (emergency) cesarean section were evaluated. Regression analyses were conducted. Fetal variables predicted anthropometric neonatal outcomes, prematurity, cesarean section and emergency cesarean section. The...
Introduction Postpartum hemorrhage remains a leading cause of maternal morbidity and mortality wo... more Introduction Postpartum hemorrhage remains a leading cause of maternal morbidity and mortality worldwide. Therefore, cumulative incidence of postpartum hemorrhage and severe postpartum hemorrhage are commonly monitored within and compared across maternity hospitals or countries for obstetrical safety improvement. These indicators are usually based on hospital discharge data though their accuracy is seldom assessed. We aimed to measure postpartum hemorrhage and severe postpartum hemorrhage using electronic health records and hospital discharge data separately and compare the detection accuracy of these methods to manual chart review, and to examine the temporal trends in cumulative incidence of these potentially avoidable adverse outcomes. Materials and methods We analyzed routinely collected data of 7904 singleton deliveries from a large Swiss university hospital for a three year period (2014–2016). We identified postpartum hemorrhage and severe postpartum hemorrhage in electronic h...
Clinicians and patients have traditionally believed that elective cesarean section may protect ag... more Clinicians and patients have traditionally believed that elective cesarean section may protect against certain previously ineluctable consequences of labor, including a plethora of urinary, anorectal and sexual dysfunctions. We aimed to evaluate fecal, urinary and sexual symptoms 6 years postpartum, comparing uncomplicated vaginal delivery and elective cesarean delivery, and to assess their impact on quality of life. We conducted a cross-sectional study to compare perineal functional symptomatology between women having singleton elective cesarean deliveries (eCS) and singleton uncomplicated vaginal deliveries (uVD). Women who delivered 6 years before this study were chosen randomly from our hospital database. This database includes demographic, labor, and delivery information, as well as data regarding maternal and neonatal outcomes, all of which is collected at the time of delivery by the obstetrician. Four validated self-administrated questionnaires were sent by post to the partic...
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