This study is a component of the Opti’care project — a mobile clinic intended for pregnant women living in remote rural municipalities covered by the regional of Auvergne perinatal network to promote their access to perinatal care throughout pregnancy. The aim of the study is to characterise the favourable and unfavourable perceptions of women using the Opti’care services in phase 1 (trimester 1), phase 2 (trimesters 2 and 3) and phase 3 (≥ 6 weeks postpartum). This study was a longitudinal qualitative study with repeated interviews. It took place among pregnant and postpartum women using the Opti’care mobile clinic in 4 French districts in the region of Auvergne-Rhône-Alpes (AURA, France. Semi-directive interviews using the e.Photoexpression© tool as support were conducted to obtain the perceptions of pregnant women about the services provided by Opti’care at each phase of the study. The qualitative analysis of the data was performed by categorising the units of meaning derived from the content analysis. We conducted a statistical analysis of this categorisation. The results of this study allowed us to model the perceptions of 50 pregnant women about the Opti’care services through the analysis of 35 dimensions: 19 dimensions of favourable perceptions and 16 dimensions of unfavourable perceptions. We observed changes in these perceptions across the 3 phases. In phase 1, the women's discourse focused mostly (80

Objective To assess depression at 2(M2), 6(M6), and 12(M12) postpartum months among women with postpartum haemorrhage (PPH) compared with women with no PPH and, to describe anxiety and post-traumatic stress disorder (PTSD). Design Repeated cross-sectional study within a prospective cohort of women in the immediate postpartum period. Setting Single-centre study at a French level 3 maternity unit. Population Women who gave birth at ≥22 weeks of gestation were eligible. The exposed group comprised the women who had had a primary PPH (≥500 mL in the 24 hours after delivery) and the unexposed group, which did not. Methods 1298 included women (528 with and 770 without PPH) completed self-administered questionnaires. Main Outcome Measures The prevalence of depression and its mean scores, at M2, M6, and M12 and secondary, the prevalence of anxiety and of PTSD and its mean scores, measured at the same times. Results At M2, the prevalence of depression and PTSD was higher among the women with PPH (24.4% vs 18.2%, p=0.03, and 12.8% vs 7.6%, p=0.02). The prevalence of anxiety at inclusion and M2 was higher in the PPH group (18.1% vs 10.3%, p=0.01, and 20.0% vs 13.3%, p=0.01). At M6, and M12, only the mean adjusted PTSD score was higher in the PPH group (7.6, 95%CI, 6.3-9.1 vs 5.8%, 95%CI, 4.9-6.8, p=0.02). Conclusions Professionals must know these high rates and screen for psychological disorders during the long postpartum period. Funding Grant from the Clermont-Ferrand University Hospital AOI2015. Keywords Postpartum haemorrhage; depression; anxiety; post-traumatic stress disorder, psychological disorder

Objectives To describe the sociodemographic characteristics of mothers of Haitian origin and the obstetric and neonatal outcomes of their newborns born in French Guiana between 2013 and 2021 in order to identify specific vulnerabilities within this population.Design A descriptive, population-based study using data from a comprehensive birth cohort including all deliveries in French Guiana from 2013 to 2021.Setting All maternity units in French Guiana, a French overseas territory located in South America.Participants A total of 66 485 live births were recorded during the study period, including 14 065 (21.2%) births to mothers of Haitian origin.Primary and secondary outcome measures Sociodemographic characteristics, antenatal care indicators and neonatal outcomes were compared between mothers of Haitian origin and mothers of other origins. Adjusted odds ratios (aOR) and 95% CI were calculated for key outcomes.Results Compared with mothers of other origins, Haitian mothers had higher odds of delivering a newborn small for gestational age (aOR=1.41, 95% CI 1.32 to 1.50), neonatal hospitalisation at birth (aOR=1.19, 95% CI 1.11 to 1.28), having an insufficient number of antenatal visits (aOR=1.32, 95% CI 1.26 to 1.38) and lacking health insurance coverage (aOR=2.83, 95% CI 2.52 to 3.17). Conversely, they had a lower risk of adolescent pregnancy (<20 years; aOR=0.24, 95% CI 0.21 to 0.26). The risk of preterm birth did not differ significantly between groups (p=0.24).Conclusion Mothers of Haitian origin in French Guiana experience distinct social and perinatal vulnerabilities. Strengthening equitable access to healthcare and implementing targeted community-based interventions are essential to improve maternal and neonatal health outcomes in this population.

The experience of birth may be influenced by the type of pushing used during the second stage of labour — directed open-glottis or closed-glottis pushing. The principal objective was to assess the impact of the type of pushing on women’s experience four weeks postpartum. This is a secondary analysis of a multicentre randomised trial conducted between July 2015 and June 2017, which aimed to compare open-glottis (OG) with closed-glottis (CG) pushing (n = 250 women). Participants have had a specific training, had a planned vaginal birth with a live singleton pregnancy in cephalic presentation ≥ 37 weeks with no uterine scar or fetal heart rate anomaly. The women’s experiences of birth were evaluated four weeks postpartum with the Questionnaire for Assessing the Childbirth Experience (QACE). The principal endpoint was the mean score (from 0 to 10) of the women’s global birth experience. This secondary analysis considered the 199 women who responded to this questionnaire (OG: 98 vs. CG: 101). We did not find any statistically significant difference between the groups for the global birth experience score (OG: 8.0 ± 2.1 vs. CG: 8.2 ± 1.8, p = 0.56) nor in the onset of a bad experience, score ≤ 7 (OG: 33.3% vs. CG: 27.1%, p = 0.35), nor for any of the four dimensions of the questionnaire. The type of directed pushing used did not affect women’s experience of birth with epidural analgesia.

INTRODUCTION:Caesarean section is a frequent procedure in obstetrics, accounting for 21.4% of deliveries in France in 2021. Three months after delivery, 15.4% of these women report they still have pain, which can be associated with psychological disorders (including anxiety and depression). Although the only treatment currently recommended is self-massage of the scar, capacitive and resistive electric transfer (Tecar) therapy could improve healing and reduce pain associated with caesarean scars and, therefore, improve women's health-related quality of life (QoL). We aim to evaluate the analgesic efficacy of Tecar therapy for postoperative scar pain and/or discomfort at 3 months postpartum by comparing it with sham Tecar therapy. METHODS AND ANALYSIS:The NOCEPAIN study is a two-centre, single-blind, two-arm, parallel-group, sham-controlled randomised trial currently underway. A total of 120 women with a caesarean scar still painful at 6-8 weeks postpartum, aged 18-50 years, are being randomly allocated in a ratio of 1:1 to either the active Tecar therapy group (active device group) or the sham Tecar therapy group (placebo device group). The women undergo one Tecar or sham session of 20 min per week for 3 weeks. Women in both groups also receive the recommended standard treatment: manual self-massage of the scar.The primary outcome is the caesarean scar pain and/or discomfort at 3 months postpartum, assessed with a Visual Analogue Scale from 0 (no pain and/or discomfort) to 10 (the worst imaginable). Secondary outcomes include validated self-report questionnaires about pain (French adaptations of the McGill Pain Questionnaire and the Brief Pain Inventory, as well as the 'Douleur Neuropathique en 4 Questions' instrument for neuropathic pain), the interference of pain with activities of daily living (Multidimensional Pain Inventory), anxiety and depression (Hospital Anxiety and Depression Scale), health-related QoL (WHO QoL Brief) and sexual functioning (Female Sexual Function Index). The final secondary outcomes are the quality of skin healing (Vancouver Scar Scale), as well as analgesic use and concomitant treatments for analgesia. ETHICS AND DISSEMINATION:The West III Committee for the Protection of Persons (French Institutional Review Board) approved this study and its compliance with French individual data protection laws (number: 2022-A01492-41, 20 March 2023). All participants provide written informed consent before randomisation. The results will be reported in peer-reviewed journals and at scientific meetings. TRIAL REGISTRATION NUMBER:NCT05696301.

( Acta Obstet Gynecol Scand . 2024;103(12):2465-2474. doi: 10.1111/aogs.14971) A rising percentage of low-risk, spontaneous deliveries take place in midwife-led birth centers (MLBCs) in high-income countries, with up to 1.8% of deliveries in Australia and up to 15% of deliveries in England. Recent studies have shown favorable maternal and neonatal outcomes in these centers when compared with obstetric-led units (OUs), especially lowering the risk of interventions without significant differences in neonatal outcomes such as Apgar scores or death. However, some studies have been criticized due to the population of individuals who typically deliver at MLBCs and the actual morbidity criteria evaluated. This study was designed to evaluate severe adverse maternal and neonatal outcomes as well as mode of birth in low-risk women with a birth planned in an MLBC compared with an OU in France.

OBJECTIVES:Adolescent pregnancies (AP), defined as pregnancies in girls aged 10-19 years, are associated with adverse maternal and neonatal outcomes. They are frequently reported among those with low economic status. French Guiana (FG) is a French overseas territory with important social inequalities in South America, marked by inequalities. Our study aimed to describe the sociodemographic characteristics and use of the healthcare system for AP in FG. STUDY DESIGN:Population based historical cohort. METHODS:This study included all births in FG between 2013 and 2021. Data from each mother-newborn pair ≥22 weeks of gestation and/or weighing ≥500 g were analysed. AP were compared to non-AP. RESULTS:67,962 newborns were included. AP accounted for 8810 pregnancies (13.0 %), which was 10 times more than in France. Newborns from AP were more frequently transferred to neonatal care units when compared to those from non-AP (10.6 % vs 9.5 %, p < 10-3). St-Laurent-du-Maroni hospital (western part of FG) was the main place of delivery for AP with 50.7 % of all AP delivering there. Two countries of origin of the mothers accounted for the majority of AP: FG (65.9 %) and Suriname (17.3 %) (p<10-3). AP were more frequently associated with preterm birth (aOR = 1.09 [1.01-1.18]), small for gestational age newborns (aOR = 1.66 [1.55-1.78]) and lack of health insurance coverage at delivery (aOR = 1.34[1.19-1.49]). CONCLUSIONS:AP in FG is a public health concern. Comprehensive prevention and care approaches are needed given the double burden faced by young mothers and their children.

Introduction La Guyane a une histoire démographique étroitement liée aux flux migratoires en provenance de ses pays voisins. Ce territoire fait face à des défis sociaux et en santé et les femmes d'origine haïtienne vivant en Guyane sont décrites dans la littérature scientifique comme particulièrement vulnérables. Cette étude vise à décrire les paramètres sociodémographiques des mères d'origine haïtienne et les données obstétricales et néonatales de leurs nouveau-nés nés en Guyane entre 2013 et 2021. Méthodes Il s'agissait d'une étude descriptive des données du Registre d'Issues de Grossesses informatisé (RIGi), complétée par des analyses univariées et multivariées des variables. Cette cohorte historique regroupait toutes les naissances survenues en Guyane entre 2013 et 2021. Résultats Cette étude a inclus 66485 naissances en Guyane entre 2013 et 2021, dont 14065 (21 %) issues de mères d'origine haïtienne. Le risque de nouveau-nés nés petits pour l'âge gestationnel (PAG) (aOR = 1,41 [IC95 % : 1,32-1,50]), d'hospitalisation à la naissance (aOR = 1,19 [IC95 % : 1,11-1,28]), d'un nombre insuffisant de consultations anténatales (aOR = 1,32 [IC95 % : 1,26-1,38]) et d'absence de couverture maladie (aOR = 2,83 [IC95 % : 2,52-3,17]) était significativement plus élevé pour les mères d'origine haïtienne et leurs enfants que pour les mères d'autres origines en Guyane. Elles avaient par ailleurs un risque plus faible de grossesse adolescente (aOR = 0,24 [IC95 % : 0,21-0,26]) et n'avaient pas plus de naissances prématurées. Conclusion Un enfant sur cinq né en Guyane entre 2013 et 2021 avait une mère d'origine haïtienne.Ces femmes présentent des vulnérabilités spécifiques : elles ont un plus grand risque d'avoir des nouveau-nés nés PAG et qu'ils soient hospitalisés à la naissance, elles ont un suivi de grossesse insuffisant et sont plus souvent sans couverture maladie. Il semble primordial de porter attention à ces spécificités et de renforcer leur accès aux soins via les acteurs locaux et la médiation en santé, afin de promouvoir le devenir de ces familles.Les auteurs n’ont pas précisé leurs éventuels liens d’intérêts.

PROBLEM:Midwife-led birth centres (MLBCs) offer an alternative to obstetric-led units (OUs) for low-risk women. Despite positive assessments, their development still remains controversial. AIM:To assess the appropriateness of care, intrapartum and childbirth care, and outcomes of women with a planned birth in MLBCs and to describe transfers to OUs and their risk factors. METHODS:This was a 2-year (2018-2019) nationwide population-based retrospective cohort involving women with a planned birth in all eight French MLBCs. We described the appropriateness of care, intrapartum and childbirth care, maternal and neonatal outcomes and causes of transfers to OUs. We calculated adjusted odds ratios to identify risk factors for transfers during labour and after birth. RESULTS:Among 1313 women with a planned MLBC birth, the appropriateness of care was high, with 99.3 % of women meeting low-risk criteria. Intrapartum care in MLBCs featured few interventions (2.2 % artificial membrane ruptures and 1.1 % episiotomies). Regardless of the final place of birth, there were 90.8 % spontaneous vaginal births, 2.6 % caesarean births, 6.6 % operative vaginal births, 2.4 % severe postpartum haemorrhages, 0.4 % Apgar scores < 7 at 5 min and one neonatal death. Transfers to an OU involved 21 % of women with a planned birth in an MLBC during labour and 5.8 % after birth, mainly due to postpartum haemorrhage; 4.6 % of newborns were transferred, often for monitoring. CONCLUSION:With appropriate selection of women and low-intervention care, French MLBCs achieve salutogenic outcomes. We identified risk factors for transfers. Further research is needed to assess safety comprehensively with comparative studies.

Objective: To investigate first, the association between endometriosis and preterm birth; second, the associations between endometriosis and preeclampsia, placenta previa, postpartum hemorrhage, stillbirth, and small-for-gestational-age infants (assessed by birthweight); and third, the risk of these adverse pregnancy outcomes with and without the use of medically assisted reproduction. Design:Multicenter retrospective cohort study Patients: Deliveries by 368,935 women (377,338 infants) from 1999 through 2016. Exposure: Endometriosis, defined as a single disease entity (endometriosis and/or ademyosis) Main Outcomes Measures: The main outcome was the preterm birth rate (both <37 and <33 weeks). The secondary outcomes were rates of preeclampsia, placenta previa, postpartum hemorrhage, stillbirth, and small-for-gestational-age neonates. Results: Women in the endometriosis group had more frequent histories of infertility before the included pregnancy (34.7 vs. 5.0%), more hospitalizations during the pregnancy (27.4 vs. 19.8%), and more planned cesarean sections (14.0 vs. 8.7); they more often were nulliparous (51.7 vs. 43.4%). The prevalence of preterm birth at <37 weeks was 11.1% in the endometriosis group and 7.7% in the unexposed group, and for <33 weeks, it was 3.1% and 2.2%, respectively. The adjusted relative risk for confounding factors was higher in the endometriosis than the unexposed group for preterm delivery <37 weeks (1.40, 95% confidence interval, 1.18-1.67) or <33 weeks (1.53, 95% confidence interval, 1.08-2.16). For the secondary outcomes, the adjusted risk ratios for preeclampsia, placenta previa, postpartum hemorrhage, and small-for-gestational-age status of <10th and <5th percentiles were higher in the endometriosis group. The adjusted risk ratios for stillbirth and small-for-gestational-age status of <3rd percentile did not differ between the two groups, and those after stratification by medically assisted reproduction for preterm birth at <37 and <33 weeks did not differ statistically significantly between them, for the secondary outcomes, only the risk of placenta previa was higher in the medically assisted reproduction and non-medically assisted reproduction subgroups. Conclusion: Pregnant women with endometriosis had higher risks of preterm birth and other poor pregnancy outcomes than women without endometriosis. (Fertil Steril (R) 2025;123:137-47. (c) 2024 by American Society for Reproductive Medicine.) El resumen est & aacute; disponible en Espa & ntilde;ol al final del art & iacute;culo.

INTRODUCTION:The establishment of midwife-led birth centers (MLBCs) is still being debated. The study aimed to compare severe adverse outcomes and mode of birth in low-risk women according to their birth planned in MLBCs or in obstetric-led units (OUs) in France. MATERIAL AND METHODS:We used nationwide databases to select low-risk women at the start of care in labor in MLBCs (n = 1294) and in OUs (n = 5985). Using multilevel logistic regression, we compared severe adverse maternal and neonatal morbidity as a composite outcome and as individual outcomes. These include severe postpartum hemorrhage (≥1000 mL of blood loss), obstetrical anal sphincter injury, maternal admission to an intensive care unit, maternal death, a 5-minute Apgar score <7, neonatal resuscitation at birth, neonatal admission to an intensive care unit, and stillbirth or neonatal death. We also studied the mode of birth and the role of prophylactic administration of oxytocin at birth in the association between birth settings and severe postpartum hemorrhage. RESULTS:Severe adverse maternal and neonatal outcome indicated a slightly higher rate in women in MLBCs compared to OUs according to unadjusted analyses (4.6% in MLBCs vs. 3.4% in OUs; cOR 1.36; 95%CI [1.01-1.83]), but the difference was not significant between birth settings after adjustment (aOR 1.37 [0.92-2.05]). Severe neonatal morbidity alone was not different (1.7% vs. 1.6%; aOR 1.17 [0.55-2.47]). However, severe maternal morbidity was significantly higher in MLBCs than in OUs (3.0% vs. 1.9%; aOR 1.61 [1.09-2.39]), mainly explained by higher risks of severe postpartum hemorrhage (2.4 vs. 1.1%; aOR 2.37 [1.29-4.36]), with 2 out of 5 in MLBCs partly explained by the low use of prophylactic oxytocin. Cesarean and operative vaginal births were significantly decreased in women with a birth planned in MLBCs. CONCLUSIONS:In France, 3 to 4% of low-risk women experienced a severe adverse maternal or neonatal outcome regardless of the planned birth setting. Results were favorable for MLBCs in terms of mode of birth but not for severe postpartum hemorrhage, which could be partly addressed by revising practices of prophylactic administration of oxytocin.

Objectives: Small for gestational age (SGA) newborns have a higher risk of poor outcomes. French Guiana (FG) is a territory in South America with poor living conditions. The objectives of this study were to describe risk factors associated with SGA newborns in FG.Methods: We used the birth cohort that compiles data from all pregnancies that ended in FG from 2013 to 2021. We analysed data of newborns born after 22 weeks of gestation and/or weighing more than 500 g and their mothers.Results: 67,962 newborns were included. SGA newborns represented 11.7% of all newborns. Lack of health insurance was associated with SGA newborns (p < 0.001) whereas no difference was found between different types of health insurance and the proportion of SGA newborns (p = 0.86). Mothers aged less than 20 years (aOR = 1.65 [1.55–1.77]), from Haiti (aOR = 1.24 [1.11–1.39]) or Guyana (aOR = 1.30 [1.01–1.68]) and lack of health insurance (aOR = 1.24 [1.10–1.40]) were associated with SGA newborns.Conclusion: Immigration and precariousness appear to be determinants of SGA newborns in FG. Other studies are needed to refine these results.

BACKGROUND:Few pregnant women in France wrote birth plans as in many other countries. The literature stresses the heterogeneity of birth plan content, which limits the utility of assessing the effects of birth plans on women's experience of childbirth. This study aimed to obtain a French national consensus on the structure and content of birth plans. METHODS:A multidisciplinary steering committee was established. An electronic modified Delphi study was conducted to develop a structure and content for birth plans between November 2022 and June 2023. During three Delphi consensus rounds, panellists, including perinatal health care professionals and user representatives, were asked to rate individually and independently each proposed section and subsection formulation of the birth plan for its appropriateness. An external board assessed the understandability of the final birth plan's preamble and content. RESULTS:The steering committee proposed 103 formulations corresponding to items to be covered in a birth plan, categorized into 8 sections and 30 subsections, for evaluation in the Delphi rounds. The first round was completed by 42 panellists (mainly midwives), the second by 39, and the third by 36. Finally, the steering committee approved the final components of the structured birth plan in 8 sections and 19 subsections, after its reviewing by the 21 members of the external board. CONCLUSION:A French national Delphi process, after three rounds and validation by an external board, made it possible to reach a consensus on the structure and content of a birth plan in 8 sections and 19 subsections. PATIENT OR PUBLIC CONTRIBUTION:User representatives were included as experts in the Delphi rounds, and in the external board to approve the final version of the structured birth plan.

This study aimed to identify the risk factors for placenta accreta spectrum (PAS) in women who had at least one previous cesarean delivery and a placenta previa or low-lying. The PACCRETA prospective population-based study took place in 12 regional perinatal networks from 2013 through 2015. All women with one or more prior cesareans and a placenta previa or low lying were included. Placenta accreta spectrum (PAS) was diagnosed at delivery according to standardized clinical and histological criteria. Of the 520,114 deliveries, 396 fulfilled inclusion criteria; 108 were classified with PAS at delivery. Combining the number of prior cesareans and the placental location yielded a rate ranging from 5% for one prior cesarean combined with a posterior low-lying placenta to 63% for three or more prior cesareans combined with placenta previa. The factors independently associated with PAS disorders were BMI ≥ 30, previous uterine surgery, previous postpartum hemorrhage, a higher number of prior cesareans, and a placenta previa. Finally, in this high-risk population, the rate of PAS disorders varies greatly, not only with the number of prior cesareans but also with the exact placental location and some of the women's individual characteristics. Risk stratification is thus possible in this population.