OBJECTIVE:In women with Group B Streptococcus (GBS) vaginal colonization who report a beta-lactams allergy, the prevention of neonatal GBS early-onset disease (EOD) mainly relies on maternal antibiotic prophylaxis with lincosamides during labor. With approximately 30% of GBS being resistant to macrolides or lincosamides, this antibiotic prophylaxis may be inappropriate, leading to a risk of EOD. We aim to measure the proportion of inappropriate antibiotic prophylaxis despite the existence of an antibiotic susceptibility testing, and its possible impact on the newborn. METHODS:Single-center retrospective study between 2012 and 2021 among women with beta-lactam allergy and GBS vaginal colonization in the 3rd trimester, for whom an antibiotic susceptibility testing had been performed. RESULTS:Among 138 beta-lactam allergic pregnant women with GBS vaginal colonization, 30 carried a strain resistant to clindamycin (21.7%). Eight gave birth before a first antibiotic injection could be administered (labor < 2 h). Of the 130 other women eligible for antibiotic prophylaxis, 17 did not receive appropriate antibiotic treatment (13.1%). Finally, among eight newborns presented with EOD, two had received inappropriate antibiotic prophylaxis. There was no clear evidence of an increased risk of EOD in women who received inappropriate antibiotic prophylaxis (OR 2.9 [0.5; 16.2], P = 0.23), although receiving ineffective treatment intuitively seems more likely to increase the risk. CONCLUSION:Pregnant women colonized with group B streptococcus who report an allergy to beta-lactams may receive inappropriate or ineffective antibiotic prophylaxis, which could potentially lead to a higher risk of EOD.

OBJECTIVE:In our country, the deadline for abortion was recently extended from 14 to 16 weeks of pregnancy. Information about the characteristics of women who have late abortions is limited. This article aims to compare the characteristics of women having a late abortion with those having an abortion before 14 weeks. MATERIALS AND METHODS:A case-control study was conducted on women who had an abortion at our centre between December 2022 and May 2023. The cases were women who had a late abortion and the controls were women who had an abortion before 14 weeks. RESULTS:Of the 422 women treated at our centre during the study period, 323 were included in the study: 30 cases (9.3%) and 293 controls. Women undergoing late abortion were more frequently multiparous (53.3% vs. 28.0%, P=0.004), less frequently students (6.7% vs. 22.9%, P=0.04), and more frequently unemployed (43.3% vs. 26.3%, P=0.05). The pregnancy was more frequently desired or accepted at the time (30.0% vs. 3.8%, P<0.001) but tended to occur more often in the context of separation (31.0% vs. 10.3%, P=0.004) or intimate partner violence (41.4% vs. 25.6%, P=0.07). CONCLUSION:Women who undergo late abortions at our centre tend to be multiparous and more accepting of their pregnancy initially than women who have abortions before 14 weeks of gestation. They are also more likely to experience relationship difficulties and are more likely to be victims of intimate partner violence.

The ARRIVE trial showed that elective induction of labor at 39 weeks for low-risk nulliparous women compared to expectant management reduced cesarean delivery rates with a nonsignificant trend toward decreased perinatal morbidity. However, the generalizability of these findings to other health care systems and obstetric contexts outside of the United States remains uncertain. The FRENCH-ARRIVE multicenter, randomized controlled trial with two parallel groups, modeled on the ARRIVE trial, will include 4200 low-risk nulliparous women with singleton pregnancies from 37 weeks 0 days through 38 weeks 6 days of gestation. Women will be randomized in a 1:1 ratio to either elective induction between 39 weeks 0 days and 39 weeks 4 days of gestation or expectant management. The primary outcome will be the incidence of cesarean deliveries after randomization, regardless of indication. This study will have a power of 80

OBJECTIVE:Symphyseal disjunction is a rare event in childbirth, occurring almost exclusively after vaginal delivery. Radiologically, it is defined by a symphyseal gap greater than 10 mm. No comparative studies have been done on the potential risk factors involved in its development. The aim of the present study was to describe the circumstances of occurrence and risk factors for symphyseal disjunction. METHODS:This was an exploratory case-control study (1:4). Cases were from literature since January 2010 to December 2023 were joined with disjunctions observed in our center between April 2021 and April 2023. Controls were randomly selected from vaginal deliveries in our center during the same period. RESULTS:A total of 20 cases were observed (12 in the literature, 8 in our center). Pain was constant and gait disturbance frequent (85%). Disjunctions were mostly diagnosed a few days after birth (median 3.5 [1; 5.5] [extremes 0.5-90 days]). Surgical osteosynthesis was required in one quarter of the cases. Comparison with controls showed that neither parity, neonatal weight, instrumental delivery nor delivery conditions were associated with the occurrence of these disjunctions. On the other hand, neonatal head circumference at birth was significantly higher in the disjunction group (35 [34; 36] vs. 33 [32; 34] cm, P < 0.001). Significantly higher values of biparietal diameter were also observed in cases of disjunction compared to controls (84.1 [82.0; 86.1] vs. 81.4 [80.0; 82.9] mm, P = 0.005). CONCLUSION:Symphyseal disjunction is a rare event most often presenting with pain and difficulty in walking after vaginal delivery. Its occurrence seems to be related to the fetal head circumference, and not to the conditions of vaginal delivery.

INTRODUCTION:The increase in infant mortality in France, driven by the rise in neonatal mortality, raises concerns about the quality of perinatal care. While better organization is identified as a key improvement strategy, data are sparse on the organizational characteristics of maternity units in France. METHODS:This study describes the organization of perinatal care in mainland France in 2016 and 2021, at both national and regional levels, based on data from the National Perinatal Surveys and Annual Hospital Statistics. Six indicators were analysed: maternity unit volume (annual number of births), authorization type, triple on-call coverage (continuous presence of an obstetrician, anaesthesiologist, and paediatrician), understaffed obstetric teams (fewer than 7 full-time equivalents), midwives' workload (ratio of midwives-to-births), and use of temporary staff. RESULTS:Between 2016 and 2021, the number of maternity units decreased by 8%, and the number of births by 9%. In 2021, 42.5% of maternity units performed fewer than 1000 deliveries per year, 55.4% did not provide triple on-call coverage, 65.9% of obstetric teams were understaffed, 21.1% of midwifery teams had a very high workload, and 68.0% of units used temporary staff at least once a month. These issues varied significantly depending on the region and the unit's level of care. CONCLUSION:A large part of the maternity care system was affected by organizational challenges. Their impact on perinatal health needs to be assessed to propose effective solutions for the upcoming revision of the 1998 perinatal care regulations. Significant regional disparities also call for responses tailored to local specificities.

Introduction : La hausse de la mortalité infantile en France, portée par l’augmentation de la mortalité néonatale, interroge l'organisation des soins périnataux. Certains facteurs d’amélioration sont évoqués, mais les données sur leur application et leur efficacité restent limitées.Méthodes : Cette étude décrit l'organisation des soins périnataux en France métropolitaine en 2016 et 2021, aux échelles nationale et régionale, à partir des Enquêtes Nationales Périnatales et de la Statistique Annuelle des Etablissements. Six indicateurs sont étudiés : taille des maternités (nombre annuel d’accouchements), type d’autorisation, triple permanence des soins (présence continue de médecins obstétricien, anesthésiste et pédiatre), équipes en tension (effectif d’obstétriciens <7 Equivalents temps plein), charge de travail des sages-femmes (ratio sage-femme/accouchement) et recours aux intérimaires.Résultats : Entre 2016 et 2021, le nombre de maternités a diminué de 8%, et celui des accouchements de 9%. En 2021, 42,5% des maternités pratiquaient moins de 1000 accouchements/an, 55,4% n’assuraient pas la triple permanence des soins, 65,9% des équipes obstétricales étaient en tension, 21,1% des équipes de sages-femmes avaient une charge de travail très élevée, et 68,0% des établissements recouraient aux intérimaires au moins une fois par mois. Ces problématiques variaient fortement selon les régions et le type d’établissement.Conclusion : Une grande partie de l’offre de soins était concernée par des enjeux organisationnels, dont l’impact sur la santé périnatale reste à évaluer, afin de guider la révision attendue des décrets de périnatalité de 1998. Les fortes différences régionales appellent également des réponses adaptées aux spécificités territoriales.

Introduction Chronic Histiocytic Intervillositis (CHI) appears to be among the most severe placental diseases. Its rarity has limited our knowledge of the women in whom it occurs. Objective To search for maternal characteristics linked to the existence of CHI, by first studying the current pregnancy included in the study, then their previous pregnancies. Material and methods We conducted a monocentric case-control study between 2000 and 2020. CHI cases were diagnosed by microscopic examination of the placenta. "Low-risk” controls gave birth just before each case, whatever the outcome. “High-risk” controls benefited from placental microscopy immediately after the case examinations. Results 151 women were included in each group. CHI cases had twice as many previous pregnancies as both controls, but no more living children at home. Regarding obstetric history, fetal losses were significantly higher in CHI cases: compared to “low-risk” controls, there were more early miscarriages (20.0%, OR 2.6 [1.5;4.8]), late miscarriages (4.8%, OR 8.8 [1.1;187]) and in utero deaths (5.4%, OR 5.6 [1.7;19.8]). The risk of fetal loss does not appear to be increased in first pregnancies of CHI cases. However, differences appeared between cases and both “low-risk” and “high-risk” controls with a history of two previous miscarriages (21.7% vs 11.2%, p=0.009 or vs 9.6%, p=0.005) and the outcome of the second pregnancy (number of living children 59.7% vs 78.0%, p=0.033 or vs 63.0%, p=0.71), respectively. Conclusion Women with CHI have a more frequent history of pregnancy failure than other women. This excess fetal loss seems to occur only after the second pregnancy or after two previous miscarriages.

Objective. - To compare the methods of performing scalp sampling before and after training teams in per partum monitoring. Materials and methods. - This was a single center (Lille, France), retrospective, before and after study comparing the period 2017-2018 before training and the period 2019-2020 after training. It consisted of 1/theoretical training with courses on fetal physiology, recognition of risk factors for fetal hypoxia and pathophysiology of fetal acidosis; 2/practical training with analysis of local clinical cases; 3/real-life scenarios within the simulation platform. At the same time, a service protocol for scalp stimulation was established. One hundred patients were randomly selected for each period from those who met the inclusion criteria: at least one scalp sampling, cephalic presentation of the fetus, and singleton. Results. - In the 2016-2017 period, 8.7% of patients had a scalp sample and 1.5% in the 2020-2021 period (P < 0.001). The percentage of patients who had more than one scalp sample (among those who had at least one) was significantly higher in the pre-training group than in the post-training group (36% vs. 11%, P < 0.001). There was no significant difference between the two groups in terms of cervical dilation for pH, time to decision/insertion/result/birth, number of operators and attempts, failure rate and finally in terms of the measured parameters. Conclusion. - Training of professionals in intrapartum monitoring, combined with a protocol for scalp stimulation, resulted in less recourse to second-line investigations, but did not change the how scalp sampling were performed. (C) 2025 The Authors. Published by Elsevier Masson SAS. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Objectif Comparer les modalités de réalisation du prélèvement au scalp avant et après formation des équipes à la surveillance per partum. Matériel et méthodes Il s’agit d’une étude monocentrique (Lille, France), rétrospective, exploratoire de type avant/après comparant la période 2017–2018 avant formation, et la période 2019–2020 après formation. Celle-ci consistait en 1/une formation théorique avec des cours sur la physiologie fœtale, la reconnaissance des facteurs de risques de l’hypoxie fœtale et la physiopathologie de l’acidose fœtale ; 2/une formation pratique avec l’analyse de cas cliniques locaux ; 3/mise en situation réelle avec des scénarii au sein de la plateforme de simulation. Parallèlement un protocole de service a été mis en place sur la stimulation au scalp. Cent patientes pour chaque période ont été tirées au sort parmi les patientes répondant aux critères d’inclusion : avoir eu au moins un prélèvement au scalp, présentation fœtale céphalique et singleton. Résultats Sur la période 2016–2017, 8,7 % des patientes ont eu un prélèvement au scalp et 1,5 % pour la période 2020–2021 (p<0,001). Le pourcentage de patientes ayant bénéficié de plus d’un prélèvement au scalp (parmi celles en ayant eu au moins un) est significativement plus important dans le groupe avant formation que dans celui d’après formation (36 % vs. 11 %, p<0.001). Il n’y a pas de différence significative entre les deux groupes concernant la dilatation cervicale de réalisation du pH, les délais décision/installation/résultat/naissance, le nombre d’opérateurs et de tentatives, le taux d’échec et enfin sur les paramètres mesurés. Conclusion La formation des professionnels à la surveillance per partum associée à un protocole sur la stimulation au scalp permet un moindre recours aux examens de seconde ligne sans toutefois modifier les modalités de réalisation de ces prélèvements au scalp.

OBJECTIVE:Postpartum hemorrhage (PPH) is a leading cause of maternal death worldwide. We aimed to determine whether placement of a non-previa placenta on the lower uterine segment is associated with an increased risk of PPH. METHODS:This is a single-center observational study of pregnant women attending a third trimester screening ultrasound. As the distance from the internal cervical os to the lower edge of the placenta is not routinely measurable, we approximated it by systematic measurement between the postero-inferior point of the bladder and the lower edge of the placenta (PLA-B). Placentas lying on the lower uterine segment were defined as PLA-B <100 mm. The primary outcome was occurrence of moderate PPH (≥500 mL). RESULTS:A total of 560 pregnant women were included in the study; 216 (38.6%) had placental placement on the lower segment (<100 mm), mostly distant from the internal cervical os: 129 between 80 and 99 mm (23.0%), 61 between 60 and 79 mm (10.9%), 18 between 40 and 59 mm (3.2%) and eight between 20 and 39 mm (1.4%). Eighty-five women had moderate PPH (15.2%) and 22 had severe PPH (≥1000 mL) or were transfused (3.9%). Lower segment placental placement (≥100 mm) was not associated with a significant increase in PPH risk, whether moderate (13.4% vs. 16.3%, OR = 0.80 [CI 95% 0.47-1.34]) or severe (2.3% vs. 4.9%, OR = 0.46 [CI 95% 0.14-1.35]). Within those with lower segment placement, there was no trend toward increased bleeding risk according to threshold (<40, <60, or <80 mm). CONCLUSION:Placenta placement between 20 and 100 mm does not appear to increase PPH risk relative to placenta placement >100 mm.

L’amyotrophie spinale infantile (ASI) complique la grossesse en raison de l’atteinte motrice et respiratoire associée à la maladie. Une enquête menée par des patientes a recueilli les données de 30 grossesses menées par 22 femmes atteintes d’ASI en France. La capacité vitale (CV) était de 40 % [25-81 %] (médiane [quartiles]) de la valeur théorique témoignant d’un risque respiratoire accru. Cinq mères (23 %) ont eu recours à la procréation médicalement assistée (PMA) pour leur projet de parentalité, dont une à l’étranger et une pour des raisons éthiques d’accès à la PMA (en lien avec la sévérité de son atteinte respiratoire). Il y a eu des adaptations de durée de ventilation mécanique pour six grossesses (cinq patientes). La quasi-totalité des accouchements a eu lieu sous césarienne programmée. Sept accouchements (23 %) ont eu lieu sans anesthésie générale et cinq enfants (23 %) sont nés prématurément entre 30 et 35 semaines d’aménorrhée. Une patiente a été trachéotomisée de manière brève en post-partum (10 jours, CV à 18 % de la théorique) tandis qu’une autre patiente, non suivie en centre de référence, a gardé une trachéotomie de post-partum pendant neuf mois (CV à 40 % de la théorique). Aucun décès maternel ni de trachéotomie définitive n’ont été observés, malgré des profils respiratoires parfois sévères et certains suivis hors de centres experts. Ces résultats confirment la faisabilité d’une grossesse avec un accompagnement spécialisé et appellent à mieux former les équipes médicales et paramédicales de maternité aux problématiques de ces patientes, et à intégrer l’expertise de ces dernières dans la prise en charge.

Spinal muscular atrophy (SMA) complicates pregnancy due to motor and respiratory impairment associated with the disease. A patient-led survey collected data from 30 pregnancies carried out by 22 women with SMA in France. The median vital capacity (VC) was 40% [25-81%] (median [quartiles]) of the theoretical value. Five mothers (23%) resorted to assisted reproductive technology (ART) for their parenthood, including one abroad and one who experienced ethical issues accessing ART given the severity of her respiratory impairment. The duration of mechanical ventilation was adjusted for six pregnancies (five patients). Almost all deliveries were by planned cesarean section. Seven deliveries (23%) took place without general anesthesia, and five infants (23%) were born prematurely between 30 and 35 weeks of amenorrhea. One patient underwent a brief postpartum tracheostomy (10 days, VC at 18% of theoretical), while another patient, not monitored at a referral center, retained a postpartum tracheostomy for nine months (VC at 40% of theoretical). No maternal deaths or permanent tracheostomies were observed, despite sometimes severe respiratory profiles and some follow-up outside of expert centers. These results confirm the feasibility of pregnancy with specialized support and call for better training of maternity medical and paramedical teams in the specific challenges faced by these patients, and for the integration of their expertise into care.

Objectifs Analyser le parcours des gynécologues-obstétriciens pour identifier les facteurs qui les poussent à arrêter l’obstétrique ou la permanence des soins. Matériel et méthodes Un questionnaire a été envoyé à 162 gynécologues-obstétricien(ne)s ayant débuté leur internat dans les Hauts-de-France entre 2003 et 2014. Les questions portaient sur leur vie personnelle et leur parcours professionnel. Résultats Les répondants étaient en grande majorité des femmes (83 %) et avec un âge médian de 37 ans. Ils exerçaient principalement dans le public (64 %), à temps plein (77 %), en pratiquant l’obstétrique (80 %). La participation à l’activité d’obstétrique diminuait avec le temps de manière significative (p<0,001) : 95 % en pratiquaient lors de leur 1er poste et 43 % au 4e poste. Quatre-vingt pour cent d’entre eux participaient encore à la permanence des soins, mais 40 % envisageaient de l’arrêter (dans les 5 ans à venir pour presque la moitié). Les facteurs significatifs associés à l’arrêt de l’obstétrique sont l’avancée en âge, le sexe masculin et la pratique de la chirurgie. L’arrêt de la permanence des soins est aussi lié de manière significative à l’âge, au nombre d’enfants, à la pratique de l’assistance médicale à la procréation (AMP), de la gynécologie médicale, ou à un exercice en cabinet libéral. Conclusion Les gynécologues-obstétricien(ne)s de cette enquête ont encore en majorité une pratique obstétricale avec une participation à la permanence des soins après une activité médiane de 7 ans. Toutefois l’une comme l’autre diminue au fur et à mesure du temps, ce qui pose un problème de démographie médicale avec un risque majeur quant au maintien des plateaux techniques d’obstétrique.

Background For the past three decades, researchers have proposed an association between bacterial vaginosis (BV) and preterm birth. This association has been questioned since treating BV with antibiotics during pregnancy hasn't led to a decreased risk of preterm birth. Objective To re-assess the connection between BV and preterm birth by reviewing existing literature. Search strategy A systematic search was conducted on PubMed and Web of Science using the keywords "bacterial vaginosis" and "preterm birth" up to November 2020. The protocol followed PRISMA guidelines and was registered with PROSPERO (CRD42022337806). Selection criteria Studies were included if they: 1) explored the link BV and preterm birth, 2) used diagnostic criteria based on Nugent, Amsel or Spiegel methods, 3) defined preterm birth at <37, 35, or 32 weeks, and 4) involved patients without impending preterm labor symptoms when sampled. Data collection and analysis Data were extracted and analyzed by region, BV diagnosis method, study period, and quality score. Mains results A total of 28 studies were included in the analysis (comprising 50,466 patients). There was a significant link between BV and preterm birth, with an overall OR of 1.60 [95% CI, 1.36–1.89]. Heterogeneity was high (I²=67%). The elevated risk remained consistent across geographic areas, diagnostic procedures, study periods, and study quality scale (Newcastle-Ottawa score). Conclusion Our meta-analysis confirms the association between bacterial vaginosis and preterm birth. However, the connection appears to be weaker than previously documented. This observation may offer insight into the ineffectiveness of BV treatments in reducing preterm birth risk.

OBJECTIVES:To analyze the career paths of gynecologists-obstetricians to identify the factors that lead them to stop practicing obstetrics or on-call duties. MATERIAL AND METHODS:A questionnaire was sent to 162 gynecologists-obstetricians who began their residency in the Hauts-de-France region between 2003 and 2014. The questions covered their personal life and professional background. RESULTS:The respondents were predominantly women (83%) with a median age of 37 years. The respondents mostly worked in the public sector (64%), full-time (77%), and practiced obstetrics (80%). Participation in obstetric activities significantly decreases over time (P<0.001): 95% practiced it in their first position, 43% did so in their fourth position. Eighty percent still participated in on-call duties, but 40% were considering stopping (almost half of them within the next 5 years). Significant factors associated with stopping obstetrics included older age, being male, and practicing surgery. The cessation of on-call duties was significantly associated with age, number of children, involvement in assisted reproductive technology, medical gynecology, or private practice. CONCLUSION:The obstetricians and gynecologists in this study still predominantly practice obstetrics and participate in on-call duties after a median of 7 years in practice. However, both activities decrease over time, which is a challenge for medical demographics and represents a major risk to the sustainability of obstetrics services.

OBJECTIVES:To evaluate the rate of vaginal delivery attempts (VDA) in breech presentation according to the criteria used to authorize vaginal delivery. METHODS:The different protocols used in French university hospitals to allow VDA in breech presentation were tested. The rates of VDA were calculated according to the different acceptance criteria in our population. RESULTS:Two hundred and seventy-six patients with a single fetus with an estimated weight>2500g, in breech presentation underwent VDA at Lille University Hospital between 2019 and 2021. The local protocol based on cephalo-pelvic confrontation (comparison of biparietal diameter with maternal pelvic measurements) and the estimated fetal weight (EFW) allowed VDA in 55% of patients. When applied to our population, only 3 combinations of criteria « Magnin≥230mm and EFW<3800g », « Magnin≥230mm and EFW<4000g » and « Magnin≥230mm, BIP<100mm, EFW<4000g » allowed TAVB in more patients: 81%, 76% and 74% of patients, respectively. The combined use of a Magnin≥230mm and cephalo-pelvic confrontation in the case of a Magnin<230mm allowed VDA in 86% of cases. CONCLUSIONS:The combined use of Magnin≥230mm and cephalo-pelvic confrontation in the case of Magnin<230mm is the combination of acceptance criteria that allows a maximum of VDA.

IntroductionThe use of different growth charts can lead to confusion in discussions between professionals. There are obstetric charts (of fetal growth) and neonatal charts (of measurements at birth and of postnatal growth). These charts can be descriptive (derived from an unselected population) or prescriptive (derived from of a population at low risk and with optimal conditions for growth).Objectives(1) To describe available charts for infants at birth and in the neonatal period and compare them, and (2) to recommend one or more charts for use in neonatology in France.MethodsBibliographic research was conducted on MEDLINE and completed by the guidelines of professional societies.ResultsAntenatal information about fetal growth restriction (FGR) or fetuses identified as small-for-gestational-age using Intrauterine charts must be integrated into the identification of newborns at risk, but the use of Intrauterine charts to evaluate birthweight is not recommended to allow consistency with postnatal charts used in neonatal practice. Z-score variations using the updated Fenton postnatal charts are the most appropriate for the assessment of birthweight and postnatal growth for infants born preterm. These charts are sex-specific, include the three measurements (length, weight, and head circumference) and enable longitudinal follow-up of growth up to 50 weeks of corrected age and are linked to the WHO charts at term. The French Audipog charts, although are individualized, accessible online and can be used in maternity units to evaluate birthweight for term infants, but do not allow the follow-up of postnatal growth, while Fenton charts may be used to evaluate birthweight and postnatal growth in the first month for hospitalized term infants.ConclusionThe updated Fenton charts are the neonatal charts that best suit the objectives of pediatricians in France for monitoring the growth of preterm newborns. The use of the Audipog charts at term remains an alternative in maternity wards, while Fenton charts can be used for hospitalized term newborns. What is Known The choice of a growth chart is fundamental for identifying newborns at particular neonatal risk. The availability of multiple intrauterine, birthweight, or postnatal growth chart in the literature makes comparisons difficult.What is New The most appropriate birthweight and postnatal charts for monitoring the growth of preterm newborns in the French population are the Fenton charts. The Audipog charts are French birthweight charts that can be used in maternity wards to identify term newborns at risk, while Fenton charts may be used for assessing growth at birth and in the first month among hospitalized term newborns.

OBJECTIVE:To assess the association between clinical chorioamnionitis and neurodevelopmental disorders at 5 years of age in children born preterm. STUDY DESIGN:EPIPAGE 2 is a national, population-based cohort study of children born before 35 weeks of gestation in France in 2011. We included infants born alive between 240/7 and 346/7 weeks after preterm labor or preterm premature rupture of membranes. Clinical chorioamnionitis was defined as maternal fever before labor (>37.8°C) with ≥2 of the following criteria: maternal tachycardia, hyperleukocytosis, uterine contractions, purulent amniotic fluid, or fetal tachycardia. The primary outcome was a composite, including cerebral palsy, coordination disorders, cognitive disorders, sensory disorders, or behavioral disorders. We also analyzed each of these disorders separately as secondary outcomes. We performed a multivariable analysis using logistic regression models. We accounted for the nonindependence of twins and missing data by generalized estimating equation models and multiple imputations, respectively. RESULTS:Among 2927 children alive at 5 years of age, 124 (3%) were born in a context of clinical chorioamnionitis. Overall, 8.2% and 9.6% of children exposed and unexposed, respectively, to clinical chorioamnionitis had moderate-to-severe neurodevelopmental disorders. After multiple imputations and multivariable analysis, clinical chorioamnionitis was not associated with the occurrence of moderate-to-severe neurodevelopmental disorders (aOR, 0.9; 95% CI, 0.5-1.8). CONCLUSIONS:We did not find any association between clinical chorioamnionitis and neurodevelopmental disorders at 5 years of age in children born at <35 weeks of gestation after preterm labor or preterm premature rupture of membrane.

OBJECTIVE:If a small for gestational age (SGA) foetus needs to be delivered because of severity (<3rd centile) attempting induction of labor theoretically increases the risk of caesarean section and neonatal acidosis, but these risks are poorly understood. This article aims to assess the risk of caesarean section and neonatal acidosis in attempted vaginal birth of a moderately preterm foetus in the setting of severe SGA. METHOD:A single-centre hospital-based observational study conducted over a period of 17 consecutive years in mothers with a single foetus in cephalic presentation with severe SGA (<3rd centile) needing foetal extraction. Neonatal acidosis was considered moderate if pH<7.10 and severe if pH<7.0. The degree of severity of SGA was estimated according to the birth weight ratio. RESULTS:Four hundred and thirty-four foetuses with severe SGA were included during the period, 140 of whom were born after induction (32.3%). In this group, 66.4% of women achieved a vaginal birth (66.4%; 95% CI [58.0-74.2]) and the risk of moderate or severe acidosis was doubled compared with the group of foetuses who had undergone a planned caesarean section (7.9% vs. 3.1%, OR=2.7 [1.1-6.7]). Neither gestational age nor the degree of growth restriction was significantly related to the risk of caesarean section or to the risk of moderate or severe neonatal acidosis. CONCLUSION:In cases of severe SGA before 37weeks' gestation, induction of labour allows vaginal delivery in two-thirds of cases. It is accompanied by a doubling of the risk of moderate or severe neonatal acidosis.