J Gynecol Obst Bio R
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J Gynecol Obst Bio R · Feb 2008
Review[Modality of fetal heart monitoring during labor (continuous or intermittent), telemetry and central fetal monitoring].
Fetal heart monitoring during labor is almost systematic today. Continuous monitoring decreases neonatal convulsions, but increases caesarean section and forceps deliveries without impact on long term neonatal prognosis. Overall, there is no proved impact of cardiac fetal monitoring (continuous or intermittent) on perinatal mortality. ⋯ Telemetry has been poorly evaluated to date but experiences are currently undertaken. Central fetal monitoring does not improve neonatal issue but could increase caesarean section rate. Central of fetal monitoring could help in the organisation and the conservation of fetal heart monitoring.
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J Gynecol Obst Bio R · Feb 2008
Review[Emergency caesarean delivery: is there an ideal decision-to-delivery interval?].
Among data on medical liability for obstetrical practice in labour ward, one of the claims concerns the decision-to-delivery interval during emergency caesarean section, for which an optimal time is frequently advocated. A realistic review on this subject is needed. ⋯ A detailed analysis of obstetrical context and of each sequence of the decision-to-delivery interval is more efficient and realistic for evaluation in medical liability cases than an optimal "gold standard". In addition, it allows a prophylactic reflexion for a risk management approach in each labour ward.
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This review aims to evaluate, in France, oocyte donation, an assisted reproductive technique (ART), for which 25 years of experience have shown its efficacy for the palliative treatment of infertility caused by ovarian exocrine failure. Its indications have since been expanded to cover certain genetic diseases and document failures of other ART attempts. Oocyte donation is performed within the framework of French legislation - bioethics laws 94-653 and 94-654 of 29 July 1994, and the revised bioethics law 2004-800 of 6 August 2004. ⋯ The major difficulties encountered in the daily practice of oocyte donation concern the recruitment and management of donors, but also, and above all, the lack of optimal means to exercise this medical specialty, due to the lack of recognition of the organizational duties incurred, which are the cornerstone of the character-specific functioning of this type of ART. In comparison, we foresee that the discrepancies of this ART practice in Europe, with it differential facets, will lead to medical nomadism for those couples financially able to do so, when national conditions of access fail because of prohibitions but also as a consequence of insufficient means to perform the inherent tasks. Today, it seems essential to provide information on the particularity and practice of oocyte donation required for the comprehension of its obligations for the different players with the aim of obtaining the means necessary for the perpetuation of its practice.
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Pregnancy has an important impact on thyroid homeostasis. The main hormonal criteria of the thyroid function are modified particularly in case of low iodine supply. ⋯ However, to date, there are no convincing trials assessing the efficacy levothyroxine in subclinical hypothyroidism all the more when TSH levels are between 3 and 4 mU/l. Therefore routine screening for and treatment of subclinical hypothyroidism during pregnancy are unwarranted.
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J Gynecol Obst Bio R · Oct 2007
Review[Psychological and pharmacological treatments of mood and anxiety disorders during pregnancy and postpartum. Review and synthesis].
The aim of this article is to review the main methods of treatment of anxious and depressive disorders during pregnancy and the postpartum. To this end, we analyse recent publications about the use and efficacy of psychotherapy and psychosocial interventions (cognitive behavioural therapy, interpersonal psychotherapy, psychoanalytical therapy) in the perinatal period. We also review recent papers about the use of psychotropic medication during pregnancy and breast-feeding, with special emphasis on clinical trials. ⋯ Psychopharmacological treatment is indicated for severe anxious and depressive disorders. The risks of such medication, especially antidepressants, may have been overestimated in the past. Provided reasonable precautions are taken and mothers and future mothers receive clear information on the potential risks and benefits, psychotropic medication could be more broadly prescribed during pregnancy and the breast-feeding period.