J Gynecol Obst Bio R
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J Gynecol Obst Bio R · Oct 2008
Review[Complications and monitoring of the latency period after a preterm premature rupture of the fetal membranes: literature review].
Preterm premature rupture of the membranes (PPROM) begins a high-risk period for both mother and fetus. This literature review updates the knowledge on latency-period complications and proposed monitoring strategies. Four latency-period complications are described: spontaneous onset of labor, infection (chorioamnionitis), abruptio placentae, and fetal, distress which can be linked to umbilical cord prolapse. ⋯ The prediction of infection seems to be essential; classical markers, such as blood count and reactive C protein are not very effective. New markers have been tested, with IL-6 appearing to be one of the best infection markers. Fetal pulmonary maturity can be evaluated with a rapid screening test and can yield arguments for the management strategy.
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J Gynecol Obst Bio R · May 2008
[Prevention and early management of immediate postpartum haemorrhage: policies in six perinatal networks in France].
Postpartum haemorrhage (PPH) constitutes the leading cause of maternal deaths in France, and the majority of these deaths are preventable. The objective of this study was to ascertain policies for prevention and early management of PPH in maternity units, and to compare the results with scientific evidence. The survey was part of the Euphrates European project, and was conducted in France in 2003 before national recommendations for clinical practice related to PPH were launched. ⋯ Variations in policies show firstly that evidence-based improvement in practice is possible, and secondly that further research is needed on poorly documented aspects of PPH management.
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J Gynecol Obst Bio R · Apr 2008
[Assisted vaginal delivery using the vacuum extractor in frank breech presentation].
When all the breech conditions for the acceptance of a vaginal breech birth are present, we occasionally practise a total breech extraction for non frank breech presentations. Similarly, for frank breech presentations, instead of using the fetal leg as tractor, we sometimes apply the vacuum extractor on the breech presentation in order to perform the first step of the total breech extraction. The vacuum extractor is not traumatic for the fetus and enable a quick extraction. This study was conducted to describe the technique we use in our ward. ⋯ Obstetricians should know several techniques to accept and to manage breech deliveries. Indications for assisted vaginal delivery using the vacuum extractor in frank breech presentation are unusual, concerning delay in the second stage with an engaged foetus. This technique may avoid some cesarean sections. Nevertheless vaginal breech delivery try should be happening with great caution and with a strict patient's eligibility.
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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 Comparative Study[Effects of maternal analgesia and anesthesia on the fetus and the newborn].
Continuous electronic fetal heart rate (FHR) monitoring is part of routine care for laboring patients under either systemic or locoregional analgesia. Opioid systemic analgesia (mainly meperidine in early labor), yet less frequently used in our country, is associated with a decrease in FHR-variability and worse acid-base and neonatal status compared to epidural or combined spinal epidural analgesia. ⋯ All these undesirable side effects which may induce severe intrapartum fetal distress must be adequately detected and treated with intrauterine resuscitation techniques, including correction of maternal hypotension and/or the use of tocolytics agents. Reinstallation of electronic fetal monitoring at arrival in the operating room before cesarean section for suspected fetal hypoxia may be helpful to choose better anesthetic technique and try to avoid general anesthesia associated with increased maternal morbidity and mortality.