β-Blockers are an essential treatment for cardiovascular disease, the incidence of which is rising among women of childbearing age. Several large cohort and registry studies have reported an association between β-blocker exposure in pregnancy and reduced birth weight, but most have included women with hypertension or structural heart disease. Our study’s primary objective was to evaluate the impact of these medications on the birth weight of infants born to mothers with morphologically normal hearts, including women with long QT syndrome (LQTS) or Marfan syndrome (MFS). Secondary objectives were to evaluate the influence of β-blocker type on birth weight, diagnoses that fetuses were small for gestational age (SGA) or growth-restricted (FGR) during pregnancy and at birth, uterine Doppler abnormalities, and neonatal adverse effects (bradycardia and hypoglycemia), which are expected effects of in utero β-blocker exposure. This retrospective observational single-center study compared pregnancies in patients with LQTS or MFS treated with β-blockers with those of untreated matched control patients. Pregnancies were matched for maternal age, body mass index, parity, gestational age at birth, presence of gestational or pre-existing diabetes, and smoking status. Fifty-seven pregnancies of 40 mothers exposed to β-blockers were matched with 165 control pregnancies. This study’s main finding was that the mean birth weight of infants whose mothers used β-blockers during pregnancy was a significant 442 grams lower (unadjusted 2890 g vs 3285 g; p < 0.001) than that of the control group. SGA/FGR during pregnancy and at birth were diagnosed significantly more often in the treated patients, and their incidence of neonatal bradycardia was higher in the exposed group. Among the uterine Doppler examinations available, no clear differences were observed between groups. Data on neonatal hypoglycemia were inconclusive because of differential screening strategies and a high proportion of missing values, particularly in the control group. To our knowledge, this is the first study specifically focusing on β-blocker use in pregnant women with LQTS or MFS and structurally normal hearts, using matched controls to minimize confounding by underlying cardiac disease. β-Blocker use—mainly nadolol and bisoprolol—was associated with significantly lower birth weight and higher rates of FGR/SGA and neonatal bradycardia. Our findings support the continuation of β-blocker therapy when clinically indicated, combined with careful fetal growth monitoring and targeted neonatal surveillance.

Adequate aponeurotic closure is essential to reduce postoperative complications, particularly incisional hernia. However, maintaining guideline-recommended closure principles such as a suture length-to-wound length (SL/WL) ratio ≥ 4 can be technically demanding and is often performed at the end of long procedures. The SutureTOOL is a handheld device designed to standardize stitch placement, facilitate SL/WL ≥ 4, and potentially reduce operator workload. Sixteen physicians (8 residents, 8 surgeons) performed eight 12-cm aponeurosis closures on silicone models using either the SutureTOOL or a traditional needle driver, under guided and unguided conditions. Upper-limb kinematics and muscle activity were assessed with motion capture and surface electromyography. Primary outcomes were cumulative joint angular displacement (°), integrated muscle activation (

OBJECTIVE:The soluble fms-like tyrosine kinase-1 (sFlt1)/placental growth factor (PlGF) ratio can rule out pre-eclampsia (PE) when negative, but the precise significance of extremely high values is not well known. This study sought to determine the median interval between obtaining an sFlt1/PlGF ratio ≥ 500 and delivery in order to clarify its prognostic contribution. METHODS:Between 2014 and 2021, data were collected from singleton ongoing pregnancies with an sFlt1/PlGF ratio ≥ 500 at Nantes University Hospital. Features able to influence the interval between obtaining an sFlt1/PlGF ratio ≥ 500 and delivery were identified, and maternal and perinatal morbidity and mortality were studied. RESULTS:Among 54 pregnancies, the median interval between obtaining an sFlt1/PlGF ratio ≥ 500 and delivery was 3 days. On multivariate analysis, factors influencing the length of this interval were a diagnosis of PE at the time of ratio collection, and an sFlt1/PlGF ratio ≥ 1000. These rare situations were associated with severe fetal and maternal conditions, delivery at around 28 weeks of gestation, and a perinatal mortality rate of 30 %. CONCLUSION:An sFlt1/PlGF ratio ≥ 500 reflects an extreme perinatal situation with high risk of imminent delivery, often occurring at a very premature gestation. If these findings are confirmed on a broader scale, this situation could result in fast referral to a level 3 maternity unit to manage those patients at imminent risk of delivery.

Laparoscopic surgery places musculoskeletal demands on surgeons, which may be exacerbated by daily clinical activity. The effect of a workday on simulated laparoscopic performance and musculoskeletal parameters remains poorly understood. To assess the impact of a clinical workday on simulated laparoscopic performance, muscle activation, postural control, and perceived workload. In this randomized controlled crossover study, 29 gynecologic surgeons (16 novices, 13 experts) performed a standardized suturing and knot-tying task on a pelvic simulator during two sessions: morning before clinical duties and evening after a full workday. Surface electromyography assessed muscle activation, and a force platform measured center-of-pressure parameters during the task. Participants completed questionnaires on fatigue, shoulder tension, effort, and workload (NASA-TLX, SURG-TLX). Suturing performance was similar between sessions (698 ± 203 vs 683 ± 212 s; p = 0.54). Participants reported higher perceived effort (p < 0.005), fatigue (p < 0.001), and dominant-shoulder tension (p = 0.019) after the workday. NASA-TLX scores remained unchanged, but SURG-TLX showed a trend toward higher mental demand (p = 0.051) and a significant increase in distraction (p = 0.014). Postural analysis revealed reduced antero-posterior center-of-pressure velocity after the workday (p = 0.017). A clinical workday does not impair technical laparoscopic performance but induces increases in perceived workload, shoulder tension, and postural adaptations during simulated suturing. These findings highlight the hidden ergonomic cost of daily gynecologic surgical activity and support ergonomic training and workload management strategies in minimally invasive gynecology.

OBJECTIVE:Prophylactic oxytocin (5-10 IU) after vaginal birth is a grade A recommendation in France. During cesarean delivery, carbetocin is increasingly used as an alternative to oxytocin to reduce the risk and burden of postpartum hemorrhage (PPH). Its role after vaginal birth remains uncertain, largely because of higher costs. This study assessed the cost-effectiveness of carbetocin for PPH prevention in vaginal deliveries. METHODS:We performed a retrospective single-center, observational before-after cohort study with a medico-economic component in a French tertiary maternity unit. All women who delivered vaginally between January 1 and March 31, 2024 (oxytocin period), and between November 1, 2024, and January 31, 2025 (carbetocin period), were included. These two periods corresponded to the institutional protocol change replacing oxytocin with carbetocin for prophylaxis of postpartum hemorrhage after vaginal delivery. RESULTS:A total of 1404 women were analyzed (702 per group). The overall PPH rate was similar between groups (9.0% vs. 7.8%). Severe PPH (≥1000 mL) occurred less frequently with carbetocin than with oxytocin (1.3% vs. 3.0%, P = 0.0244). Weighted mean costs per patient were €17.28 in the carbetocin group and €9.07 in the oxytocin group, with a mean difference of €8.11 (95% confidence interval [CI]: 0.31-15.48). The incremental cost-effectiveness ratio (ICER) was €511.87 per severe PPH avoided. CONCLUSION:Despite higher drug costs, prophylactic carbetocin significantly reduced severe PPH compared with oxytocin and showed favorable cost-effectiveness in vaginal deliveries. These findings support carbetocin as a valuable alternative for PPH prevention in this setting.

The incidence of neonatal group B streptococcus (GBS) related to early onset sepsis (EOS) has decreased dramatically with antenatal culture screening and intrapartum antibiotic prophylaxis (IAP) implementation during the 1990s. However, while 30 % of women are currently exposed to intrapartum antibiotics, 52 to 82 % of newborns with GBS-EOS were born to mothers with negative antenatal GBS culture screening who did not receive IAP, because of possible intermittent maternal GBS colonization. Intrapartum GBS screening by Polymerase Chain Reaction (PCR) has been suggested as a suitable tool to improve and replace the usual antenatal GBS culture screening between 35 and 38 weeks of amenorrhea for optimizing the IAP indications, but its cost is often cited as an obstacle. Using a cluster crossover randomized controlled trial, we aim i) to conduct a cost-consequence analysis of two screening strategies and ii) to compare newborn and maternal morbi-mortality related to GBS-EOS and antibiotic exposure rate according to an intrapartum screening strategy versus usual antenatal culture screening (DEPIST2P study).

BACKGROUND:New primary preventive therapeutic strategies for atopic dermatitis (AD) are needed. Atopic diseases are associated with disrupted gut microbial balance in early life, suggesting that optimizing microflora through intervention could improve health. Prebiotics, which are immunomodulatory sugars, promote gut microbiota diversity. Most clinical trials focus on improving postnatal infant gut colonization, but prenatal life is crucial for establishing tolerance mechanisms. Preclinical studies indicate that maternal intake of galacto-oligosaccharide (GOS)/inulin prebiotics decreases the risk of food allergy in offspring. OBJECTIVES:To determine whether antenatal prebiotic intake prevents AD in children at high risk of atopy. METHODS:The multicentre double-blind randomized PREGRALL clinical trial ran from February 2018 to April 2023 (ClinicalTrials.gov NCT03183440). The follow-up period extended from 20 weeks of amenorrhoea in pregnant women to their infants reaching 1 year of age. Women with a physician-diagnosed history of atopy (asthma, allergic rhinitis, AD or food allergy) were selected for inclusion. The women were randomized to daily prebiotic GOS/inulin (n = 188) or placebo (maltodextrin; n = 188 participants) intake from 20 weeks' gestation until delivery. The first outcome was the occurrence of AD at 1 year in children at risk of the disease. Secondary endpoints included AD severity, quality of life, prebiotic tolerance and the prevalence of other atopic diseases. RESULTS:Of 376 pregnant women included in the trial, prebiotic supplementation did not prevent AD at 1 year (intention-to-treat population odds ratio 1.01, 95% confidence interval 0.59-1.74; P = 0.97) or reduce disease severity in their children. Subgroup analyses by breastfeeding status or delivery mode revealed no differences. No effects on allergen sensitization or food allergies were found. CONCLUSIONS:We found no evidence that maternal intervention with prebiotics protects against AD at 1 year of age in infants at risk of allergic diseases.

OBJECTIVE:In obstetrics, walking or ambulatory epidural analgesia (APDD) represents an evolution of non-ambulatory epidural analgesia (APD), allowing women to maintain mobility during labor. In a context of increasing demand for more physiological childbirth, it is important to assess its impact on maternal satisfaction and obstetric safety. This article aims to compare maternal satisfaction and obstetric outcomes between women who received APDD and those who received non-ambulatory APD. METHODS:We conducted an ambispective cross-sectional cohort study in a tertiary maternity unit between June and November 2024. Women who delivered vaginally with either APDD or non-ambulatory APD were invited to complete the French Questionnaire d'Évaluation du Vécu de l'Accouchement (QEVA), supplemented by six items specifically addressing pain management. Obstetric and neonatal outcomes were collected from medical records. RESULTS:A total of 217 women were included (48 in the APDD group and 169 in the APD group). APDD was associated with lower maternal dissatisfaction: no women reported feeling "not at all active" or "not at all autonomous" during childbirth, nor that they would not recommend the technique, whereas dissatisfaction rates reached up to 5.9% in the APD group. The overall QEVA score did not significantly differ between groups (60.9±5.3 vs. 60.2±6.1; P=0.44). Among extreme responses (value=1), only the frequency of "unusual sensations" differed significantly (4.2 vs. 18.9%; P=0.012). Obstetric and neonatal outcomes (cesarean rate, instrumental delivery, postpartum hemorrhage, neonatal complications) were comparable between groups. CONCLUSION:APDD appears to be a safe technique that improves maternal satisfaction without compromising obstetric or neonatal outcomes. Its broader implementation, supported by national guidelines, could better meet women's growing expectations for a more physiological childbirth.

Introduction Les grossesses chez les femmes transplantées pulmonaires sont considérées à haut risque du fait de la fréquence élevée d’hypertension artérielle, de diabète et d’infections. Il existe par ailleurs un risque certain d’allo-immunisation HLA lié à la grossesse, pouvant potentiellement aboutir chez les patientes greffées à un rejet humoral. Quelques cas ont été décrits chez des femmes transplantées rénales, hépatiques et cardiaques, mais ce risque n’avait jamais été étudié en transplantation pulmonaire. L’objectif de notre étude est d’étudier le risque d’apparition d’un rejet humoral dans l’année suivant la grossesse, celui-ci associant l’apparition d’anticorps anti-HLA dirigés contre le donneur (Donnor Specific Antibodies, DSA) et une dégradation de la fonction respiratoire. Méthodes Il s’agit d’une étude rétrospective multicentrique menée dans les 11 centres de transplantation pulmonaire français. Elle concernait les femmes transplantées pulmonaires ayant présenté une grossesse, aboutie ou non, entre le 1er janvier 2012 et le 31 décembre 2021. Résultats Soixante-seize grossesses ont été incluses chez 52 patientes. Il s’agissait principalement de femmes transplantées bi-pulmonaires (n=43 ; 82,7 %), sur mucoviscidose (n=40 ; 76,9 %) ou hypertension pulmonaire (n=11 ; 21 %), dont l’âge moyen à la transplantation était de 24±5 ans, et au début de la grossesse de 31±5 ans. Sur l’ensemble des grossesses, 43 (56,6 %) ont abouti à la naissance d’enfants, dont une grossesse gémellaire, tandis que les autres ont mené à une interruption de grossesse (n=8 ; 10,5 %) ou une fausse couche (n=25 ; 32,9 %). Cinq rejets humoraux (6,6 %) ont été identifiés dans l’année suivant la grossesse, avec un délai moyen de survenue de 6,24±6,02 mois. Deux des 5 grossesses ont abouti à la naissance d’un nouveau-né et 3 à une interruption de grossesse. Ces 5 rejets humoraux ont abouti à la perte du greffon avec 2 décès et 3 retransplantations. Concernant les critères de jugements secondaires, 17 grossesses (22,4 %) ont entraîné une allo-immunisation de novo et 2 autres (2,6 %) une majoration d’une allo-immunisation préexistante. Quand les anticorps anti-HLA étaient des DSA de novo (n=5), un rejet humoral apparaissait dans tous les cas. Trois grossesses ont été suivies d’un rejet aigu cellulaire sans rejet humoral et une grossesse suivie d’un rejet réversible neutrophilique. Aucun facteur de risque de développer un rejet humoral n’a été identifié. Une analyse de survie exploratoire n’a pas montré de différence significative dans une situation d’allo-immunisation. Conclusion La grossesse chez les femmes transplantées pulmonaires semble être à risque d’allo-immunisation HLA et d’apparition de rejet humoral dans l’année qui la suit. Le rejet humoral post grossesse a été responsable d’une perte du greffon pulmonaire dans 100 % des cas de notre étude. Le suivi des anticorps anti-HLA doit donc être rapproché et prolongé durant l’année suivant la grossesse. Une évaluation du risque de rejet humoral par un typage HLA du père en préconceptionnel comparé à celui du greffon peut se discuter. Un typage HLA de l’enfant sur sang ombilical peut également être proposé afin de renforcer l’immunosuppression en cas d’antigènes HLA communs entre le greffon et l’enfant.

Monoamniotic twins is rare and associated with a high rate of perinatal morbidity and mortality. In addition to the common risks, more specific complications, cord entanglement in particular, worsen their prognosis. The literature about the optimal gestational age for birth and mode of delivery is still conflicting. To evaluate strategy used in France for the prenatal and intrapartum management monoamniotic twin pregnancies in France. This retrospective multicenter study retrieved the strategies and outcomes for 149 monoamniotic twin pregnancies from 10 university hospitals in France over an 18-year period. Two methods of managing the follow-up methods of these pregnancies with a propensity score were distinguished: follow-up in a participating maternity unit as an inpatient or outpatient. Two populations were analyzed: inpatients and outpatients were compared among all pregnancies and fetuses from 260/7 to 346/7 weeks of gestation (n = 92). All pregnancies and fetuses not born after 350/7 weeks of gestation (n = 57) were analyzed separately. The primary endpoints were intrauterine and perinatal mortality rates. Perinatal mortality didn't differ between the 38 inpatient and 54 outpatient pregnancies (15.8 vs. 14.8%). The same was true for all fetuses and newborns with 7 deaths out of 76 (9.2% for inpatients) and 10 deaths out of 108 (9.2% for outpatients, p = 0.99). Finally, 57 pregnancies (33%) continued past 35 weeks. One death in utero was observed at 20 weeks and only one other at 35 weeks (1.5%). This study shows no differences between inpatient and outpatient management and suggests that some perinatal centers envision continuing these pregnancies past 35 weeks. Vaginal delivery is not strictly contraindicated, although cesarean delivery is safe and most often recommended.

BACKGROUND:We are lacking data with a high level of evidence on the use of episiotomy during instrumental delivery to prevent anal sphincter injury, which nonetheless presents the highest risk. OBJECTIVE:Our main objective was to assess the protective effect of episiotomy against obstetric anal sphincter injury in nulliparous women during instrumental delivery according to type of instrument. We also investigated its impact on immediate maternal and neonatal morbidity. STUDY DESIGN:We conducted a prospective comparative cohort study for clinical trial emulation by means of propensity score weighting. The study was especially designed for consideration of possible confounders. This was a nationwide observational multicenter study including 111 French public and private maternity units between April 2021 and March 2022. We included nulliparous women, with singleton cephalic fetus, at more than 34 weeks of gestation. We considered vacuum, forceps, and spatula deliveries. We proceeded to a comparative analysis between women with and without episiotomy. The main outcome was obstetric anal sphincter injury occurrence. We used composite criteria for both maternal and neonatal immediate morbidity. RESULTS:The analyses pertained to 11,013 women. Overall prevalence of episiotomy was 23%: 17% for vacuum (N=7007), 37% for forceps (N=2378), and 29% in case of spatula-assisted (N=1628) delivery. Episiotomy was not associated with significantly decreased obstetric anal sphincter injury occurrence in vacuum delivery (from 5.2% without episiotomy to 3.8%, odds ratio=0.73 [0.48-1.03]) or forceps delivery (from 10.9% without episiotomy to 8.8%, odds ratio=0.81 [0.56-1.14]). In contrast, we observed significantly decreased obstetric anal sphincter injury occurrence (from 9.4% without episiotomy to 5.6%) in spatula delivery (odds ratio=0.60 [0.37-0.87]). Episiotomy was associated with increased maternal morbidity using forceps (from 13.6%-18.3%, odds ratio=1.35 [1.01-1.73]) and spatulas (from 9.0%-13.4%, odds ratio=1.51 [1.11-2.00]). We also observed increased neonatal morbidity in vacuum delivery associated with episiotomy (from 9.1%-13.6%, odds ratio=1.49 [1.21-1.79]), but a decrease in case of forceps delivery with episiotomy (from 12.6%-9.2%, odds ratio=0.74 [0.55-0.95]). CONCLUSION:Episiotomy was not associated with a decreased risk of obstetric anal sphincter injury in vacuum or forceps delivery, and a marginal reduction was achieved using spatulas. Our results do not favor extensive episiotomy during instrumental delivery. TRIAL REGISTRATION:ClinicalTrial NCT04446780.

Objectif: En obstétrique, l’analgésie péridurale déambulatoire (APDD) constitue une évolution de l’analgésie péridurale (APD) non déambulatoire, permettant aux parturientes de conserver leur mobilité durant le travail. Dans un contexte où la demande des femmes pour des accouchements plus physiologiques est croissante, il est important d’évaluer son impact sur la satisfaction maternelle et la sécurité obstétricale.Cet article a pour objectif de comparer la satisfaction maternelle et les issues obstétricales entre les femmes ayant bénéficié d’une APDD et celles ayant reçu une APD non déambulatoire.Méthodes: Il s’agit d’une étude de cohorte transversale ambispective menée dans une maternité de type III entre juin et novembre 2024. Les femmes ayant accouché par voie basse avec APDD ou APD non déambulatoire ont été invitées à répondre au questionnaire QEVA (Questionnaire d’Évaluation du Vécu de l’Accouchement), enrichi de six items spécifiques à la gestion de la douleur. Les issues obstétricales et néonatales ont été recueillies à partir des dossiers médicaux.Résultats: Au total, 217 patientes ont été incluses : 48 APDD et 169 APD non déambulatoire. L’APDD était associée à une moindre insatisfaction maternelle : aucune patiente n’a déclaré ne pas s’être sentie actrice ou autonome, ni ne pas recommander l’APDD, contrairement au groupe APD non déambulatoire (jusqu’à 5,9 % d’insatisfaction selon les items). Le score QEVA global ne différait pas significativement entre les groupes (60,9 ± 5,3 vs 60,2 ± 6,1 ; p = 0,44). Parmi les réponses extrêmes (valeur = 1), seule la fréquence des « sensations bizarres » différait significativement (4,2 % vs 18,9 % ; p = 0,012). Les issues obstétricales et néonatales (taux de césarienne, d’accouchement instrumental, d’hémorragie du post-partum, complications néonatales) étaient comparables entre les groupes.Conclusion: L’APDD apparaît comme une technique sûre, offrant une meilleure satisfaction maternelle sans compromettre la sécurité obstétricale ou néonatale. Son intégration plus large, appuyée par des protocoles nationaux, pourrait répondre aux attentes croissantes des femmes pour un accouchement plus physiologique.

OBJECTIVE:The objective is to determine the circumstances in which feto-maternal hemorrhage (FMH) should be investigated, and how to assess its volume and whether it is acute or chronic, in order to build guidelines for appropriate management. METHODS:The French College of Obstetricians and Gynecologists (CNGOF) conducted a formalized expert consensus method. RESULTS:Feto-maternal hemorrhage (FMH) is defined as the passage of fetal blood into the maternal circulation through a breach in the feto-placental barrier during pregnancy or childbirth. For the diagnosis of FMH, it is recommended that a Kleihauer-Betke (KB) test be performed as a first-line test, with a positivity threshold of 5 fetal red blood cells per 10,000 adult red blood cells. The volume of fetal blood lost in mL is calculated by dividing the TB test result by 2. Flow cytometry can also be used as a supplement in specialized laboratories if the TB test is difficult to interpret. In the context of FMH, to screen for fetal anemia, it is suggested to perform an ultrasound scan with measurement of the peak systolic velocity in the middle cerebral artery and, depending on the gestational age, to monitor the fetal heart rate. Normal results from these tests do not rule out the presence of fetal anemia. It is suggested that a KB test be performed in cases of decreased fetal movement with abnormal initial assessment, ultrasound signs of fetal anemia, sinusoidal fetal heart rate, or fetal death, in order to detect FMH. It is suggested that a KB test not be performed routinely in cases of ovular sampling, external version or bleeding during pregnancy. In cases of abdominal trauma, it is suggested that a KB test be performed, depending on the characteristics of the shock (high intensity, direct abdominal trauma). In cases of FMH, it is suggested that the severity be assessed based on the estimated volume transfused, the presence or absence of ultrasound signs of fetal anemia, and the presence or absence of fetal heart rate abnormalities. To estimate the volume of transfused blood, it is suggested to use the KB test, the result of which will be related to the estimated fetal weight based on ultrasound measurements. The medical care and follow-up will then depend on the level of risk. In cases where there is a history of FMH in a previous pregnancy, it is suggested to reassure the patient about the risk of FMH recurrence and not to perform any specific monitoring during a subsequent pregnancy.

Objectif: L’objectif est de déterminer les circonstances dans lesquelles une hémorragie fœto-maternelle (HFM) doit être recherchée, de préciser comment évaluer son volume, son caractère aigu ou chronique, et sa potentielle sévérité de façon à proposer une prise en charge adaptée.Méthodes: Le Collège des Gynécologues Obstétriciens Français (CNGOF) a appliqué une méthode de Consensus Formalisé d’ExpertsRésultats: L’hémorragie fœto-maternelle (HFM) est définie par un passage de sang fœtal dans la circulation maternelle par effraction de la barrière fœto-placentaire, au cours de la grossesse ou de l’accouchement.Pour le diagnostic d’HFM, il est proposé de réaliser en première intention un test de Kleihauer (TK) dont le seuil de positivité est de 5 hématies fœtales / 10 000 hématies adultes. Le calcul du volume sanguin fœtal perdu en mL est estimé en divisant le résultat du TK par 2. La cytométrie en flux réalisée dans des laboratoires spécialisés peut également être utilisée en complément, en cas de difficulté d’interprétation du TK.Dans un contexte d’HFM, pour dépister une anémie fœtale, il est proposé de réaliser une échographie avec mesure du pic systolique de vélocité dans l’artère cérébrale moyenne et de réaliser, selon l’âge gestationnel, un enregistrement du rythme cardiaque fœtal. La normalité de ces examens n’exclut pas la présence d’une anémie fœtale.Il est proposé de réaliser un test de Kleihauer (TK) en cas de diminution des mouvements actifs fœtaux avec évaluation initiale anormale, de signes échographiques d’anémie fœtale, de rythme cardiaque fœtal sinusoïdal, ou en cas de mort fœtale ou en cas d’anémie néonatale, dans le but de rechercher une HFM. Il est proposé de ne pas réaliser de façon systématique un test de Kleihauer en cas de prélèvement ovulaire, de version par manœuvres externes ou de métrorragies en cours de grossesse. En cas de traumatisme abdominal, il est proposé de réaliser un test de Kleihauer, en fonction des caractéristiques du choc (forte intensité, traumatisme abdominal direct).En cas d’HFM, il est proposé d’évaluer la gravité en fonction de l’estimation du volume transfusé, de la présence ou non de signes échographiques d’anémie fœtale, et de la présence ou non d’anomalies du rythme cardiaque fœtal (RCF). Pour estimer le volume d’HFM, il est proposé d’utiliser le test de Kleihauer (TK) dont le résultat sera rapporté à l’estimation échographique du poids fœtal. La conduite à tenir dépendra alors du niveau de risque.En cas d’antécédent d’HFM, le risque de récidive ne semble pas augmenté et il est proposé de ne pas réaliser de surveillance particulière pour une nouvelle grossesse.

OBJECTIVES:To compare survival and neurodevelopmental outcomes at 2 years' corrected age for preterm twins (≤33+0 weeks) with the first twin in breech presentation, according to planned mode of delivery (planned vaginal delivery [PVD] vs planned caesarean delivery [PCD]). Secondary objectives were survival at discharge, survival without morbidity at discharge, neonatal outcomes, and maternal morbidity. METHODS:We conducted a retrospective cohort study of women with preterm breech first twins born after preterm labour (≤33+0 weeks) at Nantes University Hospital (2008-2019). A propensity score estimated each mother's risk of caesarean. Outcomes (survival at discharge, survival at discharge without morbidity, and survival with normal neurodevelopment at 2 years) were adjusted for gestational age, sex, and propensity score. Sensitivity analyses included multiple imputation for missing data and exclusion of births < 26+0 weeks. RESULTS:Among 413 preterm twin deliveries, 61 women were included: 15 in the PVD group (30 newborns) and 46 in the PCD group (92 newborns). After adjustment for propensity score and gestational age, no significant differences were observed in survival at discharge (aOR 1.9, 95 % CI 0.28-12.7, P = 0.51) or survival without morbidity (aOR 0.3, 95 % CI 0.06-2.21, P = 0.27). Survival with normal neurodevelopment at 2 years trended lower with PVD (aOR 0.3, 95 % CI 0.07-1.22, P = 0.09). Maternal morbidity was higher in the PCD group. CONCLUSION:Planned mode of delivery did not significantly influence survival in preterm breech-first twins, but confidence intervals were wide. A trend toward poorer neurodevelopment at 2 years was observed after planned vaginal delivery, whereas maternal morbidity was higher after planned caesarean delivery. These findings support individualized decision-making, balancing neonatal and maternal risks.

IntroductionLaparoscopy has become a fundamental aspect of surgery, presenting new challenges such as fatigue, encompassing both muscular and cognitive components. Given its potential to affect surgical precision and create difficulties for the surgeon, it is crucial to study the mechanisms of fatigue for patient safety and the well-being of surgeons. This study aims to demonstrate the influence of general fatigue on surgeons’ performance, incorporating assessments of movement quality through balance, kinematics, and muscle activation, as well as perceived workload. Additionally, the study seeks to evaluate how surgeons’ experience may affect fatigue outcomes.Methods and analysisA controlled cross-over laboratory trial involving 29 residents and surgeons from the obstetrics and gynecology department of Nantes University Hospital is underway. Recruitment started in March 2023 and ended in September 2023. Participants with varying levels of experience perform two one-hour sessions of training box exercises, one in the morning (control condition) and the other at the end of a workday. The primary outcome is a composite score derived from the time to complete the Suturing and Knot Tying Training and Testing (SUTT) exercise, along with the number and quality of stitches. Secondary outcomes include perceived fatigue, discomfort, physical strain, muscle tension, mental workload, muscle activation (measured by surface electromyography), balance (measured using a force platform), and kinematics (measured using motion capture).Ethics and disseminationThe study received ethical approval from the local ethics committee CERNI in December 2022 (n°13,122,022). Results will be presented in international conferences, submitted to peer-reviewed journals, and serve as a feasibility study for subsequent publications.

Introduction (contexte de la recherche) La dermatite atopique (DA) est associée à des dysfonctionnements du système immunitaire et des épithélias avec un déséquilibre du microbiote intestinal. Ces troubles débutent très tôt dans la vie et certains sont présents dès la naissance. Des stratégies de prévention primaire de cette pathologie ciblant la nutrition dès la vie fœtale sont donc pertinentes. Les prébiotiques sont des oligosaccharides non digestibles favorisant la croissance de bactéries bénéfiques pour l’hôte et un environnement tolérogène. Objectif Nos études précliniques ont montré que l’apport maternel de prébiotiques GOS/inuline réduisait le risque d’allergie alimentaire chez la descendance. Nous avons voulu confirmer ces données pour la DA dans un essai clinique. Méthodes PREGRALL (NCT03183440), un essai randomisé contrôlé versus placebo, a évalué la capacité d’une supplémentation en GOS/inuline chez 376 femmes enceintes allergiques recrutées dans 4 centres français à prévenir la DA chez les enfants à haut risque à l’âge d’un an (Cabridain et al., 2019). Une biocollection (sang, selles, lait maternel) a été générée chez 126 dyades mère-enfant pour élucider les mécanismes impliqués dans la DA et médiés par les prébiotiques (CIMMAP). Résultats La supplémentation en prébiotiques n’a pas protégé les enfants de la DA à 1 an ni diminué la gravité de la maladie. La prévalence de la DA était faible par rapport à nos estimations dans une population à haut risque. L’apport de prébiotiques a modulé la composition du microbiote intestinal maternel, augmentant les bifidobactéries. De plus, le taux de bactéries maternelles liées aux IgA sécrétoires tendait à diminuer dans le groupe prébiotique par rapport au placebo. Ce phénotype a été transmis aux enfants dans la 1ère semaine de vie. Conclusions Ainsi, l’apport de prébiotiques chez les mères pendant la grossesse modifie leur microbiote intestinal et leur immunité et les effets sont transmis à leurs enfants au début de leur vie. La modulation de ces paramètres biologiques chez les mères et les enfants par le prébiotique n’a pas permis de protéger de la DA à un an mais nous incite à penser que cette stratégie pourrait avoir un effet à long terme sur la prévention d’autres maladies atopiques.

Introduction De nouvelles stratégies de prévention primaire de la dermatite atopique (DA) sont nécessaires dans le but de réduire la fréquence et la sévérité de cette maladie. Les maladies atopiques sont associées à une perturbation de l’équilibre microbien intestinal au début de la vie. Les prébiotiques sont des sucres aux propriétés immunomodulatrices qui stimulent la diversité du microbiote digestif. Jusqu’à présent, la plupart des essais cliniques de prévention primaire se sont concentrés sur l’amélioration de la colonisation intestinale postnatale des nourrissons. Cependant, la vie prénatale est une période cruciale au cours de laquelle différents mécanismes de tolérance sont mis en place et des études précliniques chez la souris ont montré que l’apport maternel en prébiotique réduisait le risque d’allergie alimentaire chez la progéniture. Nous avons cherché à déterminer si la supplémentation anténatale en prébiotiques pendant la grossesse était susceptible de prévenir la DA chez les enfants à risque. Matériel et méthodes Cet essai randomisé, en groupe parallèle, multicentrique, en double aveugle a évalué l’efficacité d’une supplémentation maternelle anténatale en prébiotiques (galacto-oligosaccharides (GOS)-inuline) par rapport à un placebo chez les femmes enceintes sur la survenue de la DA à l’âge d’un an chez les enfants à risque (définis comme ayant des antécédents maternels de maladie atopique). Les participantes ont été randomisées entre l’ingestion quotidienne de prébiotiques ou d’un placebo (maltodextrine) à partir de la 20e semaine de gestation jusqu’à l’accouchement. Les principaux critères d’évaluation secondaires étaient la gravité de la DA, la qualité de vie rapportée par les parents, la tolérance aux prébiotiques et la prévalence d’autres maladies atopiques. Une biocollection de sang, de selles et de lait maternel a été réalisée dans 126 dyades mère-enfant afin d’élucider les mécanismes impliqués dans le développement de la DA ainsi que l’impact des prébiotiques chez la mère et ses enfants à l’âge d’un an. Résultats Nous avons recruté 376 femmes enceintes (188 dans le groupe prébiotique et 188 dans le groupe témoin). La supplémentation en prébiotiques n’a pas protégé contre l’apparition de la DA à l’âge d’un an (analyse en intention de traiter : OR [IC95 %] 1,01 [0,59 ; 1,74] p=0,97), et n’a pas réduit la gravité de la maladie. Discussion Les analyses de sous-groupes pré-spécifiées selon le statut d’allaitement ou le mode d’accouchement n’ont montré aucune différence entre les deux groupes. Il est intéressant de noter que la prise de prébiotiques a modulé la composition du microbiote intestinal maternel, en augmentant notamment les bifidobactéries. En outre, l’abondance relative de Bidfidobacterium longum était plus élevée chez les enfants exposés au prébiotique par leur mère au cours des 5 premiers jours de vie. Conclusion Dans notre étude, une intervention nutritionnelle maternelle avec des prébiotiques n’a pas protégé contre la DA à l’âge d’un an, mais la modulation des paramètres biologiques chez la mère et l’enfant pourrait avoir un impact positif sur les maladies atopiques plus tard dans la vie.

Anti-D alloimmunization in the first trimester of pregnancy has long been the subject of prevention with anti-D immunoglobulins during events at risk of fetomaternal hemorrhage. Although the efficacy of preventing anti-D alloimmunization by an injection of immunoglobulin at 28 weeks of gestation (WG) is obvious, the literature provides little evidence of the effectiveness before 12+ 6 WG and several countries have modified their recommendations. In the presumed absence of a difference in alloimmunization risk between early and late prevention, our objective was to evaluate and compare the cost of treatment for 3 alloimmunization prevention strategies in France, the United Kingdom, and the Netherlands. This was a single-center retrospective study. Our target population included all women who received anti-D immunoglobulins (Rhophylac) in the first trimester of pregnancy before 12+ 6 WG at Nantes University Hospital in 2018 ( N = 356). Within the target population, 2 other populations were constituted based on British ( N = 145) and Dutch ( N = 142) clinical practice guidelines (CPG). These 3 populations were analyzed for the comparative cost of treatment for prevention from a health system perspective. The average cost of Rhophylac alloimmunization prevention for 1 episode was euro117.8 from a health system perspec-tive. The total cost attributed to prevention in 2018 at Nantes University Hospital ( N = 356) was euro41,931.4 according to this perspective. If the UK CPG or Dutch CPG had been applied to the Nantes target pop-ulation, a saving of around 60% would have been achieved. At the national level, the cost according to the health system perspective specifically attributable to induced abortion ( N estimated = 26,916) could represent a total cost of euro3,170,704. This study highlighted the high cost of the French prevention strategy in the first trimester of pregnancy compared with British or Dutch strategies. The modification of our practices would allow substantial financial savings to the French health system but would also avoid the nonrecommended exposure to a blood product at this term, would allow a faster medical management and a relief of the care system. (c) 2023 Elsevier Inc. All rights reserved.