mercredi 22 septembre 2010
The Final Stretch: Range of Normal Perineal Changes During Second Stage Labor in First Vaginal Birth
The Final Stretch: Range of Normal Perineal Changes During Second Stage Labor in First Vaginal Birth: "Purpose: The aim of this descriptive, observational study is to identify the range of perineal changes during second stage labor and associated perineal outcomes. Background: Many women fear pelvic floor damage as a consequence of vaginal birth despite limited evidence of a causal link between vaginal birth and pelvic floor damage. Documentation of the process of perineal stretch, which is presumably when damage would occur, is absent from the literature. Methods: Eighteen nulliparas were observed during second stage labor. Documentation of position, pushing, time of vertex being visible, crowning, rate of distention, color changes and blanching was noted with each push. Descriptive statistics were calculated. Results: Second stage length ranged 15-281 minutes (mean 94). Ratio of time the vertex was visible to a sustained crown was 0% to 75% of the total time in second stage. The ratio of time spent with the vertex in a sustained crown ranged from 3% to 48% of second stage duration. Despite variance in duration of stretch, longer duration did not correlate with perineal trauma. Blanching, duration of active pushing, and rate of distension were associated with increased risk of trauma. Conclusions: A wide range of “normal” perineal changes during second stage was documented that do not lead to lacerations. Future studies should identify opportunities to prevent perineal trauma beyond focusing duration of perineal stretching."
Men Suffer from Prenatal and Postpartum Depression, Too; Rates Correlate with Maternal Depression
Men Suffer from Prenatal and Postpartum Depression, Too; Rates Correlate with Maternal Depression: "Paternal depression has often taken a back seat to the studies of maternal and postpartum depression despite recognition that depression among fathers negatively affects family life. Although the primary focus of our care as midwives and women's health clinicians is directed at women and mothers, we view our work as that which promotes and strengthens families; however, “family” is defined by women in our care. Although depression among fathers is not well understood and the literature on this topic is emerging, Paulson and Bazemore wanted to describe what is known about paternal depression and its association with maternal depression using techniques of metaanalysis. The primary outcome for this study was described as a point prevalence rate, defined by the authors as cases of depression divided by the number of study participants. The rate of depression among female partners was a secondary outcome."
Comfort Measures for Childbirth
Comfort Measures for Childbirth: "Penny Simkin introduces her DVD by stating that her intent is to demonstrate techniques to help laboring women cope with their pain and hence alleviate the concept of suffering. Simkin gives a brief overview of her belief in the 3Rs—Relaxation, Rhythm, and Ritual—and their role in pain management, along with a supportive partner, and a little luck! The organization of the remainder of the DVD is clear and logical, with four distinct sections: 1) basic relaxation and rhythmic breathing; 2) comfort measures, devices, and positions; 3) techniques for back pain and labor progression; and 4) positions and techniques for squatting and birth. Simkin begins each section with a brief introduction. Videos and photographs of actual labors demonstrate the techniques being used. This DVD replaces Simkin's 1995 video of the same name. The DVD is both extended and enhanced, with a seemingly daunting running time of 91 minutes. However, the user-friendly menu allows the viewer to access each section or even each position or technique individually."
jeudi 12 août 2010
The long path to pregnancy: early experience with dual anonymous gamete donation in a European in vitro fertilisation referral centre
The long path to pregnancy: early experience with dual anonymous gamete donation in a European in vitro fertilisation referral centre: "Background:
This investigation describes features of patients undergoing in vitro fertilisation (IVF) and embryo transfer (ET) where both gametes were obtained from anonymous donors. Methods: Gamete unsuitability or loss was confirmed in both members of seven otherwise healthy couples presenting for reproductive endocrinology consultation over a 12-month interval in Ireland. IVF was undertaken with fresh oocytes provided by anonymous donors in Ukraine; frozen sperm (anonymous donor) was obtained from a licensed tissue establishment. For recipients, saline-enhanced sonography was used to assess intrauterine contour with endometrial preparation via transdermal estrogen. Results: Among commissioning couples, mean+/-SD female and male age was 41.9+/-3.7 and 44.6+/-3.5yrs, respectively. During this period, female age for non dual anonymous gamete donation IVF patients was 37.9+/-3yrs (p<0.001). Infertility duration was [greater than or equal to]3yrs for couples enrolling in dual gamete donation, and each had [greater than or equal to]2 prior failed fertility treatments using native oocytes. All seven recipient couples proceeded to embryo transfer, although one patient had two transfers. Clinical pregnancy was achieved for 5/7 (71.4%) patients. Non-transferred cryopreserved embryos were available for all seven couples. Conclusions: Mean age of females undergoing dual anonymous donor gamete donation with IVF is significantly higher than the background IVF patient population. Even when neither partner is able to contribute any gametes for IVF, the clinical pregnancy rate per transfer can be satisfactory if both anonymous egg and sperm donation are used concurrently. Our report emphasises the role of pre-treatment counselling in dual anonymous gamete donation, and presents a coordinated screening and treatment approach in IVF where this option may be contemplated."
This investigation describes features of patients undergoing in vitro fertilisation (IVF) and embryo transfer (ET) where both gametes were obtained from anonymous donors. Methods: Gamete unsuitability or loss was confirmed in both members of seven otherwise healthy couples presenting for reproductive endocrinology consultation over a 12-month interval in Ireland. IVF was undertaken with fresh oocytes provided by anonymous donors in Ukraine; frozen sperm (anonymous donor) was obtained from a licensed tissue establishment. For recipients, saline-enhanced sonography was used to assess intrauterine contour with endometrial preparation via transdermal estrogen. Results: Among commissioning couples, mean+/-SD female and male age was 41.9+/-3.7 and 44.6+/-3.5yrs, respectively. During this period, female age for non dual anonymous gamete donation IVF patients was 37.9+/-3yrs (p<0.001). Infertility duration was [greater than or equal to]3yrs for couples enrolling in dual gamete donation, and each had [greater than or equal to]2 prior failed fertility treatments using native oocytes. All seven recipient couples proceeded to embryo transfer, although one patient had two transfers. Clinical pregnancy was achieved for 5/7 (71.4%) patients. Non-transferred cryopreserved embryos were available for all seven couples. Conclusions: Mean age of females undergoing dual anonymous donor gamete donation with IVF is significantly higher than the background IVF patient population. Even when neither partner is able to contribute any gametes for IVF, the clinical pregnancy rate per transfer can be satisfactory if both anonymous egg and sperm donation are used concurrently. Our report emphasises the role of pre-treatment counselling in dual anonymous gamete donation, and presents a coordinated screening and treatment approach in IVF where this option may be contemplated."
mercredi 11 août 2010
A randomized controlled study investigating the necessity of routine cervical dilatation during elective cesarean section
A randomized controlled study investigating the necessity of routine cervical dilatation during elective cesarean section: "
Abstract
Objective
To investigate if it was necessary to dilate the cervix routinely during elective cesarean section and to determine the effects
of this traditional maneuver on maternal morbidity.
of this traditional maneuver on maternal morbidity.
Methods
A total of 150 patients meeting eligibility criteria were enrolled in this prospective, randomized controlled study. Patients
were allocated randomly into cervical dilatation group or non-dilated group. In the cervical dilatation group, the surgeon
performed cervical dilatation by inserting a double-gloved index finger into the cervical canal of the patients after extraction
of placenta and membranes. Endometrial cavity thickness of the patients at postoperative 24 h, development of postoperative
febrile–infectious morbidity and postoperative hemoglobin levels were evaluated and compared between the groups.
were allocated randomly into cervical dilatation group or non-dilated group. In the cervical dilatation group, the surgeon
performed cervical dilatation by inserting a double-gloved index finger into the cervical canal of the patients after extraction
of placenta and membranes. Endometrial cavity thickness of the patients at postoperative 24 h, development of postoperative
febrile–infectious morbidity and postoperative hemoglobin levels were evaluated and compared between the groups.
Results
The two groups were comparable with regard to demographic and clinical properties. Mean postoperative endometrial cavity thickness
of the dilated group was significantly less than the non-dilated group (6.87 ± 2.50, 9.51 ± 3.35 respectively, p < 0.0001). The level of hemoglobin reduction was comparable between the groups (p = 0.37). Febrile morbidity was seen in one patient in the dilated group. Endometritis or wound infection was not encountered
in either group during the puerperium.
of the dilated group was significantly less than the non-dilated group (6.87 ± 2.50, 9.51 ± 3.35 respectively, p < 0.0001). The level of hemoglobin reduction was comparable between the groups (p = 0.37). Febrile morbidity was seen in one patient in the dilated group. Endometritis or wound infection was not encountered
in either group during the puerperium.
Conclusions
Cervical dilatation seems to be an unnecessary intervention during the cesarean section.
- Content Type Journal Article
- DOI 10.1007/s00404-010-1608-9
- Authors
- Miğraci Tosun, Ondokuz Mayıs University Medical Faculty Department of Obstetrics and Gynecology 55139 Kurupelit, Samsun Turkey
- Mehmet Sakinci, Ondokuz Mayıs University Medical Faculty Department of Obstetrics and Gynecology 55139 Kurupelit, Samsun Turkey
- Handan Çelik, Ondokuz Mayıs University Medical Faculty Department of Obstetrics and Gynecology 55139 Kurupelit, Samsun Turkey
- Burcu Torumtay, Aksaray Şambaz Vehbi Ekecik Maternity Hospital Aksaray Turkey
- Eren Yazici, Ondokuz Mayıs University Medical Faculty Department of Obstetrics and Gynecology 55139 Kurupelit, Samsun Turkey
- Tayfun Alper, Ondokuz Mayıs University Medical Faculty Department of Obstetrics and Gynecology 55139 Kurupelit, Samsun Turkey
- Erdal Malatyalioğlu, Ondokuz Mayıs University Medical Faculty Department of Obstetrics and Gynecology 55139 Kurupelit, Samsun Turkey
- Journal Archives of Gynecology and Obstetrics
- Online ISSN 1432-0711
- Print ISSN 0932-0067
dimanche 1 août 2010
Stress périnatal et développement neuropsychologique
Stress périnatal et développement neuropsychologique: "
Résumé
Depuis deux décennies, la recherche expérimentale s’est efforcée de modéliser le stress périnatal et ses conséquences cliniques
et biologiques. En laboratoire, l’effet du stress s’apparente à celui d’une programmation développementale et peut rendre
compte de la survenue ultérieure de pathologies neuropsychologiques. Si un tel niveau de preuve n’est pas établi en clinique
humaine, plusieurs observations suggèrent l’intervention modulatrice du stress périnatal dans le développement à court et
long terme de l’enfant, ainsi qu’une vulnérabilité accrue aux troubles psychopathologiques. Après avoir rappelé les principaux
modèles, cette revue présente quelques stratégies cliniques intégrant la gestion du stress dans l’objectif d’en limiter le
retentissement.
et biologiques. En laboratoire, l’effet du stress s’apparente à celui d’une programmation développementale et peut rendre
compte de la survenue ultérieure de pathologies neuropsychologiques. Si un tel niveau de preuve n’est pas établi en clinique
humaine, plusieurs observations suggèrent l’intervention modulatrice du stress périnatal dans le développement à court et
long terme de l’enfant, ainsi qu’une vulnérabilité accrue aux troubles psychopathologiques. Après avoir rappelé les principaux
modèles, cette revue présente quelques stratégies cliniques intégrant la gestion du stress dans l’objectif d’en limiter le
retentissement.
- Content Type Journal Article
- Category Article De Synthèse / Review Article
- DOI 10.1007/s12611-010-0072-x
- Authors
- G. Cambonie, hôpital Arnaud-de-Villeneuve, CHU de Montpellier Service de pédiatrie néonatale et de réanimations, département de pédiatrie, pôle Enfant 371, avenue du Doyen-G. Giraud F-34295 Montpellier cedex 5 France
- A. Rideau, hôpital Arnaud-de-Villeneuve, CHU de Montpellier Service de pédiatrie néonatale et de réanimations, département de pédiatrie, pôle Enfant 371, avenue du Doyen-G. Giraud F-34295 Montpellier cedex 5 France
- M. Bienfait, hôpital Arnaud-de-Villeneuve, CHU de Montpellier Service de pédiatrie néonatale et de réanimations, département de pédiatrie, pôle Enfant 371, avenue du Doyen-G. Giraud F-34295 Montpellier cedex 5 France
- O. Pidoux, hôpital Arnaud-de-Villeneuve, CHU de Montpellier Service de pédiatrie néonatale et de réanimations, département de pédiatrie, pôle Enfant 371, avenue du Doyen-G. Giraud F-34295 Montpellier cedex 5 France
- R.-M. Toubin, CHU de Montpellier Médecine psychologique pour enfants et adolescents, clinique Peyre-Plantade Montpellier France
- J.-C. Picaud, hôpital de la Croix-Rousse, CHU de Lyon Service de néonatologie Lyon France
- G. Barbanel, université de Montpellier-II, institut Max-Mousseron des biomolécules de Montpellier Laboratoire stress oxydant et neuroprotection bâtiment 24, 3e étage, place Eugène-Bataillon-cc 2400 F-34095 Montpellier cedex 5 France
- Journal Revue de médecine périnatale
- Online ISSN 1965-0841
- Print ISSN 1965-0833
TheLancet: New issue of The Lancet online. Home birth Editorial proving controversial! http://bit.ly/cITaNr
TheLancet: New issue of The Lancet online. Home birth Editorial proving controversial! http://bit.ly/cITaNr: "TheLancet: New issue of The Lancet online. Home birth Editorial proving controversial!
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61165-8/fulltext
The increased demand to give birth outside hospital has increased the rate of home delivery. In the Netherlands, a third of women now have home births. In the UK, 3% of total births occur at home, while in the USA home delivery accounts for 1% of births or 25 000 deliveries per year.
Home birth rates have been increasing in the USA partly because of the increasing proportion of births by caesarean delivery (currently contributing a third of all births, with nine out of ten women who have a caesarean going on to have repeated caesareans). This is because doctors and hospitals opt not to do a vaginal birth after a caesarean to avoid liability lawsuits. This July, however, the American College of Obstetricians and Gynecologists (ACOG) issued a new caesarean guideline specifically aimed at putting more emphasis on respecting women's wishes to have a vaginal birth after one or two previous caesarean sections, or when expecting twins.
Although home birth seems to be safe for low-risk mothers and, when compared with hospital delivery, is associated with a shorter recovery time and fewer lacerations, post-partum haemorrhages, retained placentae and infections, the evidence is contradictory for outcomes of newborn babies delivered at home. These data come from small observational studies that are subject to confounding. Data also frequently include misclassified cases, since studies usually look at newborn outcomes in relation to the actual rather than planned delivery location. The problem arises when planned home births become hospital births when complications arise, and this can then lead to an underestimation of the risk and overestimation of the benefit of home births. Data from the Netherlands, for example, suggest that up to 40% of nulliparous women who start labour at home are transferred to the hospital. Most studies also rely on different midwifery models for home delivery, which are not generalisable.
Professional organisations, perhaps unsurprisingly, have issued contradictory policy statements regarding home deliveries. The Department of Health of South Australia has a detailed policy for home birth among women with low-risk, singleton term pregnancies, while the UK's Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives jointly support home birth in women with uncomplicated pregnancies. By contrast, ACOG does not support home birth, citing safety concerns and the lack of rigorous scientific evidence. Choosing to deliver a baby at home, states ACOG, is to show preference for the process of giving birth over the goal of having a healthy baby.
A recent meta-analysis published in the American Journal of Obstetrics & Gynecology provides the strongest evidence so far that home birth can, after all, be harmful to newborn babies. The research incorporated 12 studies and 500 000 births from several industrialised nations (USA, Canada, Australia, Sweden, the Netherlands, and Switzerland). The data show that planned home births to healthy and low-risk mothers compared with planned hospital births in the same group of women doubled the risk of neonatal deaths (0·2% vs 0·09%). And when infants with congenital defects were excluded, the risk of neonatal mortality tripled. The main attributable factors for the increase in mortality were the occurrence of breathing difficulties and failed attempts at resuscitation—two factors associated with poor midwife training and a lack of access to hospital equipment. In the USA, for example, only a third of home births are accompanied by a certified midwife.
Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk. There are competing interests that need to be weighed carefully. Hospital delivery should be the preferred method of delivery for high-risk pregnancies, even though it is not without risks—a recent study from Scotland showed that rates of neonatal death are higher in hospitals when births occur outside normal working hours. Home delivery is an option for mothers with uncomplicated pregnancies, provided they are advised of the risks involved, have one-to-one midwife care (that includes good resuscitation skills and accreditation by a local regulatory body), and live in a location that allows quick access to obstetric care. The ongoing multiyear cohort study, Birthplace in England Research Programme, aims to compare birth outcomes in different settings, and the results are expected to provide additional valuable data later this year.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61165-8/fulltext
The increased demand to give birth outside hospital has increased the rate of home delivery. In the Netherlands, a third of women now have home births. In the UK, 3% of total births occur at home, while in the USA home delivery accounts for 1% of births or 25 000 deliveries per year.
Home birth rates have been increasing in the USA partly because of the increasing proportion of births by caesarean delivery (currently contributing a third of all births, with nine out of ten women who have a caesarean going on to have repeated caesareans). This is because doctors and hospitals opt not to do a vaginal birth after a caesarean to avoid liability lawsuits. This July, however, the American College of Obstetricians and Gynecologists (ACOG) issued a new caesarean guideline specifically aimed at putting more emphasis on respecting women's wishes to have a vaginal birth after one or two previous caesarean sections, or when expecting twins.
Although home birth seems to be safe for low-risk mothers and, when compared with hospital delivery, is associated with a shorter recovery time and fewer lacerations, post-partum haemorrhages, retained placentae and infections, the evidence is contradictory for outcomes of newborn babies delivered at home. These data come from small observational studies that are subject to confounding. Data also frequently include misclassified cases, since studies usually look at newborn outcomes in relation to the actual rather than planned delivery location. The problem arises when planned home births become hospital births when complications arise, and this can then lead to an underestimation of the risk and overestimation of the benefit of home births. Data from the Netherlands, for example, suggest that up to 40% of nulliparous women who start labour at home are transferred to the hospital. Most studies also rely on different midwifery models for home delivery, which are not generalisable.
Professional organisations, perhaps unsurprisingly, have issued contradictory policy statements regarding home deliveries. The Department of Health of South Australia has a detailed policy for home birth among women with low-risk, singleton term pregnancies, while the UK's Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives jointly support home birth in women with uncomplicated pregnancies. By contrast, ACOG does not support home birth, citing safety concerns and the lack of rigorous scientific evidence. Choosing to deliver a baby at home, states ACOG, is to show preference for the process of giving birth over the goal of having a healthy baby.
A recent meta-analysis published in the American Journal of Obstetrics & Gynecology provides the strongest evidence so far that home birth can, after all, be harmful to newborn babies. The research incorporated 12 studies and 500 000 births from several industrialised nations (USA, Canada, Australia, Sweden, the Netherlands, and Switzerland). The data show that planned home births to healthy and low-risk mothers compared with planned hospital births in the same group of women doubled the risk of neonatal deaths (0·2% vs 0·09%). And when infants with congenital defects were excluded, the risk of neonatal mortality tripled. The main attributable factors for the increase in mortality were the occurrence of breathing difficulties and failed attempts at resuscitation—two factors associated with poor midwife training and a lack of access to hospital equipment. In the USA, for example, only a third of home births are accompanied by a certified midwife.
Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk. There are competing interests that need to be weighed carefully. Hospital delivery should be the preferred method of delivery for high-risk pregnancies, even though it is not without risks—a recent study from Scotland showed that rates of neonatal death are higher in hospitals when births occur outside normal working hours. Home delivery is an option for mothers with uncomplicated pregnancies, provided they are advised of the risks involved, have one-to-one midwife care (that includes good resuscitation skills and accreditation by a local regulatory body), and live in a location that allows quick access to obstetric care. The ongoing multiyear cohort study, Birthplace in England Research Programme, aims to compare birth outcomes in different settings, and the results are expected to provide additional valuable data later this year.
BJOG study: Acupuncture not helpful for inducing labour
BJOG study: Acupuncture not helpful for inducing labour: "The study: Modlock J, Nielsen B, Uldbjerg N. Acupuncture for the induction of labour: a double-blind randomised controlled study. BJOG 2010; DOI: 10.1111/j.1471-0528.2010.02647.x. "
Full-size image (18K) CorbisDownload to PowerPoint
The increased demand to give birth outside hospital has increased the rate of home delivery. In the Netherlands, a third of women now have home births. In the UK, 3% of total births occur at home, while in the USA home delivery accounts for 1% of births or 25 000 deliveries per year.
Home birth rates have been increasing in the USA partly because of the increasing proportion of births by caesarean delivery (currently contributing a third of all births, with nine out of ten women who have a caesarean going on to have repeated caesareans). This is because doctors and hospitals opt not to do a vaginal birth after a caesarean to avoid liability lawsuits. This July, however, the American College of Obstetricians and Gynecologists (ACOG) issued a new caesarean guideline specifically aimed at putting more emphasis on respecting women's wishes to have a vaginal birth after one or two previous caesarean sections, or when expecting twins.
Although home birth seems to be safe for low-risk mothers and, when compared with hospital delivery, is associated with a shorter recovery time and fewer lacerations, post-partum haemorrhages, retained placentae and infections, the evidence is contradictory for outcomes of newborn babies delivered at home. These data come from small observational studies that are subject to confounding. Data also frequently include misclassified cases, since studies usually look at newborn outcomes in relation to the actual rather than planned delivery location. The problem arises when planned home births become hospital births when complications arise, and this can then lead to an underestimation of the risk and overestimation of the benefit of home births. Data from the Netherlands, for example, suggest that up to 40% of nulliparous women who start labour at home are transferred to the hospital. Most studies also rely on different midwifery models for home delivery, which are not generalisable.
Professional organisations, perhaps unsurprisingly, have issued contradictory policy statements regarding home deliveries. The Department of Health of South Australia has a detailed policy for home birth among women with low-risk, singleton term pregnancies, while the UK's Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives jointly support home birth in women with uncomplicated pregnancies. By contrast, ACOG does not support home birth, citing safety concerns and the lack of rigorous scientific evidence. Choosing to deliver a baby at home, states ACOG, is to show preference for the process of giving birth over the goal of having a healthy baby.
A recent meta-analysis published in the American Journal of Obstetrics & Gynecology provides the strongest evidence so far that home birth can, after all, be harmful to newborn babies. The research incorporated 12 studies and 500 000 births from several industrialised nations (USA, Canada, Australia, Sweden, the Netherlands, and Switzerland). The data show that planned home births to healthy and low-risk mothers compared with planned hospital births in the same group of women doubled the risk of neonatal deaths (0·2% vs 0·09%). And when infants with congenital defects were excluded, the risk of neonatal mortality tripled. The main attributable factors for the increase in mortality were the occurrence of breathing difficulties and failed attempts at resuscitation—two factors associated with poor midwife training and a lack of access to hospital equipment. In the USA, for example, only a third of home births are accompanied by a certified midwife.
Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk. There are competing interests that need to be weighed carefully. Hospital delivery should be the preferred method of delivery for high-risk pregnancies, even though it is not without risks—a recent study from Scotland showed that rates of neonatal death are higher in hospitals when births occur outside normal working hours. Home delivery is an option for mothers with uncomplicated pregnancies, provided they are advised of the risks involved, have one-to-one midwife care (that includes good resuscitation skills and accreditation by a local regulatory body), and live in a location that allows quick access to obstetric care. The ongoing multiyear cohort study, Birthplace in England Research Programme, aims to compare birth outcomes in different settings, and the results are expected to provide additional valuable data later this year.
Full-size image (18K) CorbisDownload to PowerPoint
The increased demand to give birth outside hospital has increased the rate of home delivery. In the Netherlands, a third of women now have home births. In the UK, 3% of total births occur at home, while in the USA home delivery accounts for 1% of births or 25 000 deliveries per year.
Home birth rates have been increasing in the USA partly because of the increasing proportion of births by caesarean delivery (currently contributing a third of all births, with nine out of ten women who have a caesarean going on to have repeated caesareans). This is because doctors and hospitals opt not to do a vaginal birth after a caesarean to avoid liability lawsuits. This July, however, the American College of Obstetricians and Gynecologists (ACOG) issued a new caesarean guideline specifically aimed at putting more emphasis on respecting women's wishes to have a vaginal birth after one or two previous caesarean sections, or when expecting twins.
Although home birth seems to be safe for low-risk mothers and, when compared with hospital delivery, is associated with a shorter recovery time and fewer lacerations, post-partum haemorrhages, retained placentae and infections, the evidence is contradictory for outcomes of newborn babies delivered at home. These data come from small observational studies that are subject to confounding. Data also frequently include misclassified cases, since studies usually look at newborn outcomes in relation to the actual rather than planned delivery location. The problem arises when planned home births become hospital births when complications arise, and this can then lead to an underestimation of the risk and overestimation of the benefit of home births. Data from the Netherlands, for example, suggest that up to 40% of nulliparous women who start labour at home are transferred to the hospital. Most studies also rely on different midwifery models for home delivery, which are not generalisable.
Professional organisations, perhaps unsurprisingly, have issued contradictory policy statements regarding home deliveries. The Department of Health of South Australia has a detailed policy for home birth among women with low-risk, singleton term pregnancies, while the UK's Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives jointly support home birth in women with uncomplicated pregnancies. By contrast, ACOG does not support home birth, citing safety concerns and the lack of rigorous scientific evidence. Choosing to deliver a baby at home, states ACOG, is to show preference for the process of giving birth over the goal of having a healthy baby.
A recent meta-analysis published in the American Journal of Obstetrics & Gynecology provides the strongest evidence so far that home birth can, after all, be harmful to newborn babies. The research incorporated 12 studies and 500 000 births from several industrialised nations (USA, Canada, Australia, Sweden, the Netherlands, and Switzerland). The data show that planned home births to healthy and low-risk mothers compared with planned hospital births in the same group of women doubled the risk of neonatal deaths (0·2% vs 0·09%). And when infants with congenital defects were excluded, the risk of neonatal mortality tripled. The main attributable factors for the increase in mortality were the occurrence of breathing difficulties and failed attempts at resuscitation—two factors associated with poor midwife training and a lack of access to hospital equipment. In the USA, for example, only a third of home births are accompanied by a certified midwife.
Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk. There are competing interests that need to be weighed carefully. Hospital delivery should be the preferred method of delivery for high-risk pregnancies, even though it is not without risks—a recent study from Scotland showed that rates of neonatal death are higher in hospitals when births occur outside normal working hours. Home delivery is an option for mothers with uncomplicated pregnancies, provided they are advised of the risks involved, have one-to-one midwife care (that includes good resuscitation skills and accreditation by a local regulatory body), and live in a location that allows quick access to obstetric care. The ongoing multiyear cohort study, Birthplace in England Research Programme, aims to compare birth outcomes in different settings, and the results are expected to provide additional valuable data later this year.
Prospective study of determinants and costs of home births in Mumbai slums
Prospective study of determinants and costs of home births in Mumbai slums: "Background:
Around 86% of births in Mumbai, India, occur in healthcare institutions, but this aggregate figure hides substantial variation and little is known about urban home births. We aimed to explore factors influencing the choice of home delivery, care practices and costs, and to identify characteristics of women, households and the environment which might increase the likelihood of home birth.
Methods:
As part of the City Initiative for Newborn Health, we used a key informant surveillance system to identify births prospectively in 48 slum communities in six wards of Mumbai, covering a population of 280 000. Births and outcomes were documented prospectively by local women and mothers were interviewed in detail at six weeks after delivery. We examined the prevalence of home births and their associations with potential determinants using regression models.
Results:
We described 1708 (16%) home deliveries among 10 754 births over two years, 2005-2007. The proportion varied from 6% to 24%, depending on area. The most commonly cited reasons for home birth were custom and lack of time to reach a healthcare facility during labour. Seventy percent of home deliveries were assisted by a traditional birth attendant (dai), and 6% by skilled health personnel. The median cost of a home delivery was US$ 21, of institutional delivery in the public sector US$ 32, and in the private sector US$ 118. In an adjusted multivariable regression model, the odds of home delivery increased with illiteracy, parity, socioeconomic poverty, poorer housing, lack of water supply, population transience, and hazardous location.
Conclusions:
We estimate 32 000 annual home births to residents of Mumbai's slums. These are unevenly distributed and cluster with other markers of vulnerability. Since cost does not appear to be a dominant disincentive to institutional delivery, efforts are needed to improve the client experience at public sector institutions. It might also be productive to concentrate on intensive outreach in vulnerable areas by community-based health workers, who could play a greater part in helping women plan their deliveries and making sure that they get help in time."
Around 86% of births in Mumbai, India, occur in healthcare institutions, but this aggregate figure hides substantial variation and little is known about urban home births. We aimed to explore factors influencing the choice of home delivery, care practices and costs, and to identify characteristics of women, households and the environment which might increase the likelihood of home birth.
Methods:
As part of the City Initiative for Newborn Health, we used a key informant surveillance system to identify births prospectively in 48 slum communities in six wards of Mumbai, covering a population of 280 000. Births and outcomes were documented prospectively by local women and mothers were interviewed in detail at six weeks after delivery. We examined the prevalence of home births and their associations with potential determinants using regression models.
Results:
We described 1708 (16%) home deliveries among 10 754 births over two years, 2005-2007. The proportion varied from 6% to 24%, depending on area. The most commonly cited reasons for home birth were custom and lack of time to reach a healthcare facility during labour. Seventy percent of home deliveries were assisted by a traditional birth attendant (dai), and 6% by skilled health personnel. The median cost of a home delivery was US$ 21, of institutional delivery in the public sector US$ 32, and in the private sector US$ 118. In an adjusted multivariable regression model, the odds of home delivery increased with illiteracy, parity, socioeconomic poverty, poorer housing, lack of water supply, population transience, and hazardous location.
Conclusions:
We estimate 32 000 annual home births to residents of Mumbai's slums. These are unevenly distributed and cluster with other markers of vulnerability. Since cost does not appear to be a dominant disincentive to institutional delivery, efforts are needed to improve the client experience at public sector institutions. It might also be productive to concentrate on intensive outreach in vulnerable areas by community-based health workers, who could play a greater part in helping women plan their deliveries and making sure that they get help in time."
jeudi 29 juillet 2010
The other side of caring: abuse in a South African maternity ward
The other side of caring: abuse in a South African maternity ward
The abuse of women by nurses in maternity units of hospitals world-wide has been documented in research conducted by universities, non-governmental organisations and government agencies. In the current paper, patients and nurses of a maternity unit of one particular South African hospital are interviewed about their experiences of childbirth and their experiences of being nurses in a maternity unit. Interviews were analysed using social constructionist grounded theory and Foucauldian discourse analysis. It was found that in both sets of interviews, patient abuse (as experienced or witnessed) was a prominent theme. Accounts of satisfactory nursing were rare. Previous findings about abuse and ritualised abuse of patients by nurses were thus corroborated. In analysing how such problematic interactions constitute an integral part of medical care in a particular maternity ward, and, as such have become ritualised, sanctioned, normalised and ultimately institutionalised, it was found that nurses (who are typically disempowered in the hierarchy of the medical system) and patients (often considered to be docile passive bodies in the context of a medical ward) oscillate between being passive and active, powerless and powerful in the construction of the nurse-patient relationship. It is suggested that both nurses and patients feel frustrated, disappointed, resentful and even enraged in a context where they cannot be in control and cannot care or be cared for. The study seems to suggest that the empowerment of nurses and patients is necessary in order for the abuse to stop. It is further recommended that future research explore cases where nurses and patients are satisfied with the caring that they have given or received; such studies will illuminate the conditions which make good nursing possible in a different way.
The abuse of women by nurses in maternity units of hospitals world-wide has been documented in research conducted by universities, non-governmental organisations and government agencies. In the current paper, patients and nurses of a maternity unit of one particular South African hospital are interviewed about their experiences of childbirth and their experiences of being nurses in a maternity unit. Interviews were analysed using social constructionist grounded theory and Foucauldian discourse analysis. It was found that in both sets of interviews, patient abuse (as experienced or witnessed) was a prominent theme. Accounts of satisfactory nursing were rare. Previous findings about abuse and ritualised abuse of patients by nurses were thus corroborated. In analysing how such problematic interactions constitute an integral part of medical care in a particular maternity ward, and, as such have become ritualised, sanctioned, normalised and ultimately institutionalised, it was found that nurses (who are typically disempowered in the hierarchy of the medical system) and patients (often considered to be docile passive bodies in the context of a medical ward) oscillate between being passive and active, powerless and powerful in the construction of the nurse-patient relationship. It is suggested that both nurses and patients feel frustrated, disappointed, resentful and even enraged in a context where they cannot be in control and cannot care or be cared for. The study seems to suggest that the empowerment of nurses and patients is necessary in order for the abuse to stop. It is further recommended that future research explore cases where nurses and patients are satisfied with the caring that they have given or received; such studies will illuminate the conditions which make good nursing possible in a different way.
Accouchement avec utérus cicatriciel
Accouchement avec utérus cicatriciel: "
Résumé
L’utérus cicatriciel est devenu le premier motif de césarienne itérative. Le risque de rupture utérine est estimé autour de
0,7 ‰, et environ 600 césariennes seraient nécessaires pour éviter une complication néonatale grave. Parallèlement, la morbidité
maternelle a augmenté par les anomalies d’insertions placentaires, responsables de complications hémorragiques graves. Il
convient de discuter avec le couple de la voie d’accouchement en cherchant d’abord à identifier d’emblée toute contre-indication
à la voie basse, puis les arguments favorables au succès de celle-ci. En cas de césarienne prophylactique, on attendra 39
SA pour diminuer la morbidité respiratoire fœtale. En cas de déclenchement, il faudra respecter les recommandations de la
Haute Autorité de Santé (HAS) et informer la patiente du risque majoré de rupture utérine.
0,7 ‰, et environ 600 césariennes seraient nécessaires pour éviter une complication néonatale grave. Parallèlement, la morbidité
maternelle a augmenté par les anomalies d’insertions placentaires, responsables de complications hémorragiques graves. Il
convient de discuter avec le couple de la voie d’accouchement en cherchant d’abord à identifier d’emblée toute contre-indication
à la voie basse, puis les arguments favorables au succès de celle-ci. En cas de césarienne prophylactique, on attendra 39
SA pour diminuer la morbidité respiratoire fœtale. En cas de déclenchement, il faudra respecter les recommandations de la
Haute Autorité de Santé (HAS) et informer la patiente du risque majoré de rupture utérine.
- Content Type Journal Article
- Category Article Original / Original Article
- DOI 10.1007/s12611-010-0056-x
- Authors
- J. Niro, CHU de Clermont-Ferrand, pôle de gynéco-obstétrique-reproduction humaine boulevard Léon-Malfreyt, Hôtel-Dieu F-63058 Clermont-Ferrand cedex 01 France
- L. Velemir, CHU de Clermont-Ferrand, pôle de gynéco-obstétrique-reproduction humaine boulevard Léon-Malfreyt, Hôtel-Dieu F-63058 Clermont-Ferrand cedex 01 France
- F. Vendittelli, CHU de Clermont-Ferrand, pôle de gynéco-obstétrique-reproduction humaine boulevard Léon-Malfreyt, Hôtel-Dieu F-63058 Clermont-Ferrand cedex 01 France
- B. Jacquetin, CHU de Clermont-Ferrand, pôle de gynéco-obstétrique-reproduction humaine boulevard Léon-Malfreyt, Hôtel-Dieu F-63058 Clermont-Ferrand cedex 01 France
- D. Gallot, CHU de Clermont-Ferrand, pôle de gynéco-obstétrique-reproduction humaine boulevard Léon-Malfreyt, Hôtel-Dieu F-63058 Clermont-Ferrand cedex 01 France
- D. Lemery, CHU de Clermont-Ferrand, pôle de gynéco-obstétrique-reproduction humaine boulevard Léon-Malfreyt, Hôtel-Dieu F-63058 Clermont-Ferrand cedex 01 France
- Journal Revue de médecine périnatale
- Online ISSN 1965-0841
- Print ISSN 1965-0833
- Journal Volume Volume 2
- Journal Issue Volume 2, Number 1 / March, 2010
Colombo and the clitoris
Colombo and the clitoris: "Abstract: In 1559, the Italian anatomist Realdo Colombo (1515/6-1559) claimed to have “discovered” the clitoris. Closer scrutiny reveals that whilst he certainly emphasized the role of the clitoris in female sexuality, his claim to priority is unfounded. The clitoris had been known to Greek, Persian, and Arabic writers on medicine and surgery, albeit with misconceptions about its function. Colombo is best known for his definitive description of the pulmonary circulation but here too the question of priority is mired in controversy. Whilst Colombo was an extremely accomplished and successful anatomist, contemporary professional rivalry probably encouraged exaggerated claims of priority. Modern anatomical studies have greatly advanced our understanding of the surgical anatomy of the clitoris, optimising the ability to preserve its function during genital surgery."
Antenatal and intrapartum prediction of shoulder dystocia
Antenatal and intrapartum prediction of shoulder dystocia: "Abstract: Objectives: To (1) develop algorithms to calculate the risk of shoulder dystocia at individual deliveries; (2) evaluate screening for shoulder dystocia.Study design: Retrospective analysis of 40284 consecutive term cephalic singleton pregnancies using a ‘train and test’ method. Four models were derived using logistic regression and tested (birthweight alone; birthweight and other independent antenatal variables; birthweight and all independent antenatal and intrapartum variables; and all independent variables excluding birthweight).Results: Shoulder dystocia occurred in 240 deliveries (0.6%). Birthweight was the most important risk factor although 98 cases (41%) occurred in babies weighing <4.0kg. Birthweight and maternal height were the only independent antenatal variables; for intrapartum use, only these and instrumental delivery were independent. The antenatal model could calculate an individual's risk; the intrapartum model could also calculate the risk if an instrumental delivery were undertaken. Both showed 0.7% women to have a risk of shoulder dystocia of >10%. Although the antenatal model had high predictability (area under curve 0.89), it was no better than birthweight alone and had a sensitivity of 52.4%. Where birthweight was excluded, prediction of shoulder dystocia was poor.Conclusion: Antepartum and labour calculation of the risk of shoulder dystocia is possible. Whilst greatly hindered by the inaccuracy of estimating weight, it allows due weight to be given to factors which may already be influencing clinical practice. However, shoulder dystocia cannot be predicted with sufficient accuracy to allow universal screening."
Use of the Internet by women seeking information about potentially teratogenic agents
Use of the Internet by women seeking information about potentially teratogenic agents: "Abstract: Objective: The aim of this study was to evaluate if the Internet provides evidence-based information to women seeking information about teratogenic risk factors and women's risk perception. Furthermore, we evaluated the possible risk related to teratogen exposure in the study sample and analysed age, gravidity, educational level, geographic location, marital status and type of exposure compared to a control group made up of women who did not use the Internet to search for teratogen-related information.Study design: Between October 2008 and June 2009, a questionnaire was administered to pregnant women calling our Teratology Information Service concerning a suspected teratogenic exposure.Results: Fifty-seven percent (n=116) of callers had used the Internet to find medical information about their exposure, while 43% (n=87) had not. Internet users had a medium-high level of education and consulted the Internet because of its convenience, usually early in their pregnancy. We verified the accuracy of the information the women obtained from the Internet and found that 59.5% (n=69) of women received evidence-based answers; 18.1% (n=21) were informed that their exposure was dangerous when it was not; 4.3% (n=5) were wrongly reassured; and the rest (n=18) were not able to interpret the data they found or found no relevant information.Conclusions: Internet use during pregnancy is a widespread phenomenon as the Internet offers the opportunity to share apprehensions and doubts with other women, but it can often lead to increased and unjustified anxiety. Medical information published on websites cannot be considered a substitute for informed medical advice, and patients should not take any action before consulting with a health care professional."
Body Mass Index and spontaneous miscarriage
Body Mass Index and spontaneous miscarriage: "Abstract: Objective: We compared the incidence of spontaneous miscarriage in women categorised as obese, based on a Body Mass Index (BMI) >29.9kg/m2, with women in other BMI categories.Study design: In a prospective observational study conducted in a university teaching hospital, women were enrolled at their convenience in the first trimester after a sonogram confirmed an ongoing singleton pregnancy with fetal heart activity present. Maternal height and weight were measured digitally and BMI calculated. Maternal body composition was measured by advanced bioelectrical impedance analysis.Results: In 1200 women, the overall miscarriage rate was 2.8% (n=33). The mean gestational age at enrolment was 9.9 weeks. In the obese category (n=217), the miscarriage rate was 2.3% compared with 3.3% in the overweight category (n=329), and 2.3% in the normal BMI group (n=621). There was no difference in the mean body composition parameters, particularly fat mass parameters, between those women who miscarried and those who did not.Conclusions: In women with sonographic evidence of fetal heart activity in the first trimester, the rate of spontaneous miscarriage is low and is not increased in women with BMI>29.9kg/m2 compared to women in the normal BMI category."
Trends in caesarean section and instrumental deliveries in relation to Body Mass Index: a clinical survey during 1978 - 2001
Trends in caesarean section and instrumental deliveries in relation to Body Mass Index: a clinical survey during 1978 - 2001: "Background:
During the last 20 years the rate of CS has increased in Sweden as it has in many other countries. The proportion of pregnant women suffering from a high BMI has also increased rapidly during the same time period. It would therefore be of interest to study both how and if these two observations are related to each other. The aim was therefore to study trends in mode of caesarean section (CS) and instrumental deliveries among women in three BMI groups over a time span of almost 25 years with special focus on the observed body weight of pregnant women.MethodThe design is a retrospective cohort study using medical records of consecutively delivered women at two delivery wards in South East Sweden during the years 1978, 1986, 1992, 1997 and 2001.
Results:
No significant time-trends were found for CS and instrumental delivery within each BMI-group for the time period studied. The proportion of women with BMI [greater than or equal to] 25 delivered by means of CS or instrumental delivery increased quite dramatically from 1978 to 2001 (chi2 test for trend; p < 0.001 for both CS and instrumental deliveries). The mean birth weight in relation to BMI and year of study among women delivered by means of CS decreased, a trend that was most evident between 1997 and 2001 (F-test; p = 0.005, p = 0.004, and p = 0.003 for BMI < 20, 20-24.9, and [greater than or equal to] 25, respectively).
Conclusion:
Overweight and obese pregnant women constitute a rapidly growing proportion of the total number of CS and instrumental deliveries. Planning and allocation of health resources must be adjusted to this fact and its implications."
During the last 20 years the rate of CS has increased in Sweden as it has in many other countries. The proportion of pregnant women suffering from a high BMI has also increased rapidly during the same time period. It would therefore be of interest to study both how and if these two observations are related to each other. The aim was therefore to study trends in mode of caesarean section (CS) and instrumental deliveries among women in three BMI groups over a time span of almost 25 years with special focus on the observed body weight of pregnant women.MethodThe design is a retrospective cohort study using medical records of consecutively delivered women at two delivery wards in South East Sweden during the years 1978, 1986, 1992, 1997 and 2001.
Results:
No significant time-trends were found for CS and instrumental delivery within each BMI-group for the time period studied. The proportion of women with BMI [greater than or equal to] 25 delivered by means of CS or instrumental delivery increased quite dramatically from 1978 to 2001 (chi2 test for trend; p < 0.001 for both CS and instrumental deliveries). The mean birth weight in relation to BMI and year of study among women delivered by means of CS decreased, a trend that was most evident between 1997 and 2001 (F-test; p = 0.005, p = 0.004, and p = 0.003 for BMI < 20, 20-24.9, and [greater than or equal to] 25, respectively).
Conclusion:
Overweight and obese pregnant women constitute a rapidly growing proportion of the total number of CS and instrumental deliveries. Planning and allocation of health resources must be adjusted to this fact and its implications."
Respiratory Morbidity in Late Preterm Births [Original Contribution]
Respiratory Morbidity in Late Preterm Births [Original Contribution]: "
Context Late preterm births (340/7-366/7 weeks) account for an increasing proportion of prematurity-associated short-term morbidities, particularly respiratory, that require specialized care and prolonged neonatal hospital stays.
Objective To assess short-term respiratory morbidity in late preterm births compared with term births in a contemporary cohort of deliveries in the United States.
Design, Setting, and Participants Retrospective collection of electronic data from 12 institutions (19 hospitals) across the United States on 233 844 deliveries between 2002 and 2008. Charts were abstracted for all neonates with respiratory compromise admitted to a neonatal intensive care unit (NICU), and late preterm births were compared with term births in regard to resuscitation, respiratory support, and respiratory diagnoses. A multivariate logistic regression analysis compared infants at each gestational week, controlling for factors that influence respiratory outcomes.
Main Outcome Measures Respiratory distress syndrome, transient tachypnea of the newborn, pneumonia, respiratory failure, and standard and oscillatory ventilator support.
Results Of 19 334 late preterm births, 7055 (36.5%) were admitted to a NICU and 2032 had respiratory compromise. Of 165 993 term infants, 11 980 (7.2%) were admitted to a NICU, 1874 with respiratory morbidity. The incidence of respiratory distress syndrome was 10.5% (390/3700) for infants born at 34 weeks' gestation vs 0.3% (140/41 764) at 38 weeks. Similarly, incidence of transient tachypnea of the newborn was 6.4%(n = 236) for those born at 34 weeks vs 0.4% (n = 155) at 38 weeks, pneumonia was 1.5% (n = 55) vs 0.1% (n = 62), and respiratory failure was 1.6% (n = 61) vs 0.2% (n = 63). Standard and oscillatory ventilator support had similar patterns. Odds of respiratory distress syndrome decreased with each advancing week of gestation until 38 weeks compared with 39 to 40 weeks (adjusted odds ratio [OR] at 34 weeks, 40.1; 95% confidence interval [CI], 32.0-50.3 and at 38 weeks, 1.1; 95% CI, 0.9-1.4). At 37 weeks, odds of respiratory distress syndrome were greater than at 39 to 40 weeks (adjusted OR, 3.1; 95% CI, 2.5-3.7), but the odds at 38 weeks did not differ from 39 to 40 weeks. Similar patterns were noted for transient tachypnea of the newborn (adjusted OR at 34 weeks, 14.7; 95% CI, 11.7-18.4 and at 38 weeks, 1.0; 95% CI, 0.8-1.2), pneumonia (adjusted OR at 34 weeks, 7.6; 95% CI, 5.2-11.2 and at 38 weeks, 0.9; 95% CI, 0.6-1.2), and respiratory failure (adjusted OR at 34 weeks, 10.5; 95% CI, 6.9-16.1 and at 38 weeks, 1.4; 95% CI, 1.0-1.9).
Conclusion In a contemporary cohort, late preterm birth, compared with term delivery, was associated with increased risk of respiratory distress syndrome and other respiratory morbidity.
"Accouchement avec utérus cicatriciel
Accouchement avec utérus cicatriciel: "
Résumé
L’utérus cicatriciel est devenu le premier motif de césarienne itérative. Le risque de rupture utérine est estimé autour de
0,7 ‰, et environ 600 césariennes seraient nécessaires pour éviter une complication néonatale grave. Parallèlement, la morbidité
maternelle a augmenté par les anomalies d’insertions placentaires, responsables de complications hémorragiques graves. Il
convient de discuter avec le couple de la voie d’accouchement en cherchant d’abord à identifier d’emblée toute contre-indication
à la voie basse, puis les arguments favorables au succès de celle-ci. En cas de césarienne prophylactique, on attendra 39
SA pour diminuer la morbidité respiratoire fœtale. En cas de déclenchement, il faudra respecter les recommandations de la
Haute Autorité de Santé (HAS) et informer la patiente du risque majoré de rupture utérine.
0,7 ‰, et environ 600 césariennes seraient nécessaires pour éviter une complication néonatale grave. Parallèlement, la morbidité
maternelle a augmenté par les anomalies d’insertions placentaires, responsables de complications hémorragiques graves. Il
convient de discuter avec le couple de la voie d’accouchement en cherchant d’abord à identifier d’emblée toute contre-indication
à la voie basse, puis les arguments favorables au succès de celle-ci. En cas de césarienne prophylactique, on attendra 39
SA pour diminuer la morbidité respiratoire fœtale. En cas de déclenchement, il faudra respecter les recommandations de la
Haute Autorité de Santé (HAS) et informer la patiente du risque majoré de rupture utérine.
- Content Type Journal Article
- Category Article Original / Original Article
- DOI 10.1007/s12611-010-0056-x
- Authors
- J. Niro, CHU de Clermont-Ferrand, pôle de gynéco-obstétrique-reproduction humaine boulevard Léon-Malfreyt, Hôtel-Dieu F-63058 Clermont-Ferrand cedex 01 France
- L. Velemir, CHU de Clermont-Ferrand, pôle de gynéco-obstétrique-reproduction humaine boulevard Léon-Malfreyt, Hôtel-Dieu F-63058 Clermont-Ferrand cedex 01 France
- F. Vendittelli, CHU de Clermont-Ferrand, pôle de gynéco-obstétrique-reproduction humaine boulevard Léon-Malfreyt, Hôtel-Dieu F-63058 Clermont-Ferrand cedex 01 France
- B. Jacquetin, CHU de Clermont-Ferrand, pôle de gynéco-obstétrique-reproduction humaine boulevard Léon-Malfreyt, Hôtel-Dieu F-63058 Clermont-Ferrand cedex 01 France
- D. Gallot, CHU de Clermont-Ferrand, pôle de gynéco-obstétrique-reproduction humaine boulevard Léon-Malfreyt, Hôtel-Dieu F-63058 Clermont-Ferrand cedex 01 France
- D. Lemery, CHU de Clermont-Ferrand, pôle de gynéco-obstétrique-reproduction humaine boulevard Léon-Malfreyt, Hôtel-Dieu F-63058 Clermont-Ferrand cedex 01 France
- Journal Revue de médecine périnatale
- Online ISSN 1965-0841
- Print ISSN 1965-0833
- Journal Volume Volume 2
- Journal Issue Volume 2, Number 1 / March, 2010
Controversies in hybrid banking: attitudes of Swiss public umbilical cord blood donors toward private and public banking
Controversies in hybrid banking: attitudes of Swiss public umbilical cord blood donors toward private and public banking: "
Abstract
Purpose
Umbilical cord blood (UCB) stored in public inventories has become an alternative stem cell source for allogeneic stem cell
transplantation. The potential use of autologous UCB from private banks is a matter of debate. In the face of the limited
resources of public inventories, a discussion on “hybrid” public and private UCB banking has evolved. We aimed to explore
the attitudes of the donating parents toward public and private UCB banking.
transplantation. The potential use of autologous UCB from private banks is a matter of debate. In the face of the limited
resources of public inventories, a discussion on “hybrid” public and private UCB banking has evolved. We aimed to explore
the attitudes of the donating parents toward public and private UCB banking.
Study design and methods
A standardized, anonymous questionnaire was sent to the most recent 621 public UCB donors including items regarding satisfaction
with recruitment process, the need for a second consent before release of the UCB unit for stem cell transplantation, and
the donors’ views on public and private UCB banking. Furthermore, we asked about their views on UCB research.
with recruitment process, the need for a second consent before release of the UCB unit for stem cell transplantation, and
the donors’ views on public and private UCB banking. Furthermore, we asked about their views on UCB research.
Results
Of the questionnaires, 48% were returned, and 16% were lost due to mail contact. Of our donors, 95% would donate to the public
bank again. As much as 35% of them were convinced that public banking was useful. Whereas 27% had never heard about private
UCB banking, 34% discussed both options. Nearly 70% of donors opted for public banking due to altruism and the high costs
of private banking. Of our public UCB donors, 81% stated that they did not need a re-consent before UCB release for stem cell
transplantation. In case of sample rejection, 53.5% wanted to know details about the particular research project. A total
of 9% would not consent.
bank again. As much as 35% of them were convinced that public banking was useful. Whereas 27% had never heard about private
UCB banking, 34% discussed both options. Nearly 70% of donors opted for public banking due to altruism and the high costs
of private banking. Of our public UCB donors, 81% stated that they did not need a re-consent before UCB release for stem cell
transplantation. In case of sample rejection, 53.5% wanted to know details about the particular research project. A total
of 9% would not consent.
Conclusions
Almost all donors would choose public banking again due to altruism and the high costs of private banking. Shortly after donation,
mail contact with former UCB donors was difficult. This might be a relevant issue in any sequential hybrid banking.
mail contact with former UCB donors was difficult. This might be a relevant issue in any sequential hybrid banking.
- Content Type Journal Article
- Category General Gynecology
- DOI 10.1007/s00404-010-1607-x
- Authors
- Gwendolin Manegold, University Hospital Basel Department of Obstetrics and Gynecology Spitalstrasse 21 4031 Basel Switzerland
- Sandrine Meyer-Monard, Central Institute of the Valais Hospitals Hematology Unit Sion Switzerland
- André Tichelli, University Hospital Basel Department of Hematology Spitalstrasse 21 4031 Basel Switzerland
- Christina Granado, University Hospital Basel Department of Obstetrics and Gynecology Spitalstrasse 21 4031 Basel Switzerland
- Irene Hösli, University Hospital Basel Department of Obstetrics and Gynecology Spitalstrasse 21 4031 Basel Switzerland
- Carolyn Troeger, University Hospital Basel Department of Obstetrics and Gynecology Spitalstrasse 21 4031 Basel Switzerland
- Journal Archives of Gynecology and Obstetrics
- Online ISSN 1432-0711
- Print ISSN 0932-0067
La remise en cause de pratiques médicales professionnelles de la part des usagers de la périnatalité. Quels en sont les origines historiques, la légit
La remise en cause de pratiques médicales professionnelles de la part des usagers de la périnatalité. Quels en sont les origines historiques, la légitimité et les moyens aujourd’hui ?: "
Résumé
de la partie II La question de la légitimité de l’attitude des usagers qui consiste à remettre en cause des pratiques médicales,
en s’appuyant sur la connaissance critique des données publiées, amène plusieurs points que nous développons en nous référant
à l’expérience du Collectif interassociatif autour de la naissance (Ciane). La remise en cause de pratiques par les usagers
est une conséquence inévitable de l’évolution des moyens d’accès aux connaissances (Internet), ce qui a conduit certaines
personnes à s’investir dans la défense des usagers en périnatalité, non pas par conviction première, mais parce qu’elles ont
constaté le décalage entre les pratiques médicales et les données publiées. Le contexte légal français permet aux usagers
de saisir les organismes experts, ce qui a permis l’élaboration des référentiels nationaux sur des sujets demandés par les
usagers en raison de leur connaissance, à la fois, du vécu des parents et des données factuelles. Dans le cadre de la représentation
des usagers dans le système de santé, il est nécessaire que les associations voient leur légitimité reconnue: l’étude critique
des données académiques assure aux représentants des usagers une formation sur des faits et des connaissances médicales objectives
qu’ils sont capables d’acquérir de façon autonome; elle permet aussi la distanciation nécessaire à l’expression d’un point
de vue collectif et l’instauration d’un dialogue de qualité avec les professionnels de santé. Pourtant, ce positionnement
n’emporte pas inconditionnellement les suffrages des autres acteurs: des associations de patients, dans le champ de la périnatalité
ou non, se refusent à parler de médecine; des acteurs associatifs peinent à envisager des formes d’actions qui sortent de
la sphère privée; des professionnels, même favorables à une certaine participation des usagers, cherchent à leur désigner
la place qu’ils doivent occuper; et le grand public conteste une quelconque capacité des profanes à porter tout regard critique
sur les pratiques des médecins. L’action des usagers ne se limite pas aux critiques de certaines pratiques médicales. La publication,
par des organismes experts, de recommandations de pratique est souvent un résultat intéressant, mais ne garantit pas que les
droits des usagers soient effectivement respectés jusque dans les salles de naissance. Les associations du Ciane exercent
une vigilance particulière à cet égard.
en s’appuyant sur la connaissance critique des données publiées, amène plusieurs points que nous développons en nous référant
à l’expérience du Collectif interassociatif autour de la naissance (Ciane). La remise en cause de pratiques par les usagers
est une conséquence inévitable de l’évolution des moyens d’accès aux connaissances (Internet), ce qui a conduit certaines
personnes à s’investir dans la défense des usagers en périnatalité, non pas par conviction première, mais parce qu’elles ont
constaté le décalage entre les pratiques médicales et les données publiées. Le contexte légal français permet aux usagers
de saisir les organismes experts, ce qui a permis l’élaboration des référentiels nationaux sur des sujets demandés par les
usagers en raison de leur connaissance, à la fois, du vécu des parents et des données factuelles. Dans le cadre de la représentation
des usagers dans le système de santé, il est nécessaire que les associations voient leur légitimité reconnue: l’étude critique
des données académiques assure aux représentants des usagers une formation sur des faits et des connaissances médicales objectives
qu’ils sont capables d’acquérir de façon autonome; elle permet aussi la distanciation nécessaire à l’expression d’un point
de vue collectif et l’instauration d’un dialogue de qualité avec les professionnels de santé. Pourtant, ce positionnement
n’emporte pas inconditionnellement les suffrages des autres acteurs: des associations de patients, dans le champ de la périnatalité
ou non, se refusent à parler de médecine; des acteurs associatifs peinent à envisager des formes d’actions qui sortent de
la sphère privée; des professionnels, même favorables à une certaine participation des usagers, cherchent à leur désigner
la place qu’ils doivent occuper; et le grand public conteste une quelconque capacité des profanes à porter tout regard critique
sur les pratiques des médecins. L’action des usagers ne se limite pas aux critiques de certaines pratiques médicales. La publication,
par des organismes experts, de recommandations de pratique est souvent un résultat intéressant, mais ne garantit pas que les
droits des usagers soient effectivement respectés jusque dans les salles de naissance. Les associations du Ciane exercent
une vigilance particulière à cet égard.
- Content Type Journal Article
- Category Article Original / Original Article
- DOI 10.1007/s12611-010-0057-9
- Authors
- E. Phan, CA du collectif interassociatif autour de la naissance (Ciane) Alliance francophone pour l’accouchement respecté (AFAR) 103, rue de la Turmelière F-49530 Liré France
- Journal Revue de médecine périnatale
- Online ISSN 1965-0841
- Print ISSN 1965-0833
- Journal Volume Volume 2
- Journal Issue Volume 2, Number 1 / March, 2010
mardi 27 juillet 2010
Benefits of introducing universal umbilical cord blood gas and lactate analysis into an obstetric unit
Benefits of introducing universal umbilical cord blood gas and lactate analysis into an obstetric unit: "Background: Current evidence suggests that umbilical arterial pH analysis provides the most sensitive reflection of birth asphyxia. However, there's debate whether umbilical cord blood gas analysis (UC-BGA) should be conducted on some or all deliveries.Aim: The aim of this study was to evaluate the impact of introducing universal UC-BGA at delivery on perinatal outcome.Methods: An observational study of all deliveries [ge]20 weeks' gestation at a tertiary obstetric unit between January 2003 and December 2006. Paired UC-BGA was performed on 97% of deliveries (n = 19,646). Univariate and adjusted analysis assessed inter-year UC-BGA differences and the likelihood of metabolic acidosis and nursery admission.Results: There was a progressive improvement in umbilical artery pH, pO2, pCO2, base excess and lactate values in univariate and adjusted analyses (P < 0.001). There was a significant reduction in the newborns with an arterial pH <7.10 (OR = 0.71; 95%CI 0.53[ndash]0.95) and lactate >6.1 mmol/L (OR = 0.37; 95%CI 0.30[ndash]0.46). Utilising population specific 5th and 95th percentiles, there was a reduction in newborns with arterial pH less than 5th percentile (pH 7.12; OR = 0.75; 95%CI 0.59[ndash]0.96) and lactate levels greater than 95th percentile (6.7 mmol/L; OR = 0.37; 95%CI 0.29[ndash]0.49). There was a reduction in term (OR = 0.65; 95%CI 0.54[ndash]0.78), and overall (OR = 0.75; 95%CI 0.64[ndash]0.87) nursery admissions. These improved perinatal outcomes were independent of intervention rates.Conclusions: These data suggest that introduction of universal UC-BGA may result in improved perinatal outcomes, which were observed to be independent of obstetric intervention. We suggest that these improvements might be attributed to provision of biochemical data relating to foetal acid-base status at delivery influencing intrapartum care in subsequent cases."
The Apparently Stillborn Infant: Risk Factors, Incidence, and Neonatal Outcome
The Apparently Stillborn Infant: Risk Factors, Incidence, and Neonatal Outcome: "Amer J PerinatolDOI: 10.1055/s-0030-1262906ABSTRACTWe evaluated neonatal outcomes of apparently stillborn infants. The apparently stillborn neonate is born with an unexpected Apgar score of 0 at 1 minute and is subsequently successfully resuscitated. A retrospective cohort study was performed using electronic medical records for neonates >24 weeks' gestation born between 2002 and 2007. Adverse outcome was defined by the presence of seizures, encephalopathy, or death prior to hospital discharge. Differences in maternal demographics and clinical characteristics were compared between neonates with and without adverse outcomes at varying hospital settings. Ninety-three neonates were identified as apparently stillborn. Adverse outcomes occurred in 31.2% of neonates; 83.9% survived from birth..."
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