Dupuis O, Audibert F, Fernandez H, Frydman R.Obstet Gynecol. 1999 Nov;94(5 Pt 2):810-2. doi: 10.1016/s0029-7844(99)00292-6.PMID: 10546737
https://pubmed.ncbi.nlm.nih.gov/10546737/
Abstract:
Background: Although polymerase chain reaction (PCR) can detect herpes simplex virus (HSV) in the cerebrospinal fluid (CSF), HSV encephalitis remains a significant cause of neurologic impairment in pregnant women. Assessment of fetal contamination also remains a problem.
Cases: We report two cases in which HSV encephalitis initially was not suspected and led to significant maternal neurologic impairment. In both cases, HSV PCR of CSF confirmed the diagnosis. In one case, fetal serum HSV PCR excluded fetal contamination.
Conclusion: As soon as encephalitis in pregnancy is suspected, a combination of acyclovir and penicillin is recommended because the potential benefits far outweigh the risks. Using the HSV PCR, HSV infection in the fetus can be diagnosed.
(Article in French)
Dupuis O. Obstet Gynecol. 1999 Nov;94(5 Pt 2):810-2. doi: 10.1016/s0029-7844(99)00292-6.
Olivier Dupuis, Silveira Ruimark, Dupont Corinne, Thevenet Simone, Dittmar André, Rudigoz René-Charles.
Eur J Obstet Gynecol Reprod Biol.2005 ; 123 :193-197.
https://doi.org/10.1016/j.ejogrb.2005.04.009
Abstract :
Objective To study the correlation between digital vaginal and transabdominal ultrasonographic examination of the fetal head position during the second stage of labor.
Methods Patients (n = 110) carrying a singleton fetus in a vertex position were included. Every patient had ruptured membranes and a fully dilated cervix. Transvaginal examination was randomly performed either by a senior resident or an attending consultant. Immediately afterwards, transabdominal ultrasonography was performed by the same sonographer (OD). Both examiners were blind to each other’s results. Sample size was determined by power analysis. Confidence intervals around observed rates were compared using chi-square analysis and Cohen’s Kappa test. Logistic regression analysis was performed.
Results In 70% of cases, both clinical and ultrasound examinations indicated the same position of the fetal head (95% confidence interval, 66–78). Agreement between the two methods reached 80% (95% CI, 71.3–87) when allowing a difference of up to 45° in the head rotation. Logistic regression analysis revealed that gestational age, parity, birth weight, pelvic station and examiner’s experience did not significantly affect the accuracy of the examination. Caput succedaneum tended to diminish (p = 0.09) the accuracy of clinical examination. The type of fetal head position significantly affected the results. Occiput posterior and transverse head locations were associated with a significantly higher rate of clinical error (p = 0.001).
Conclusion In 20% of the cases, ultrasonographic and clinical results differed significantly (i.e., >45°). This rate reached 50% for occiput posterior and transverse locations. Transabdominal ultrasonography is a simple, quick and efficient way of increasing the accuracy of the assessment of fetal head position during the second stage of labor.
(Article in French)
O Dupuis 1, B Brocco 2, E Decullier 1, L Coulange-Benevise J Gynecol Obstet Biol Reprod (Paris). 2016 Oct;45(8):924-928. doi: 10.1016/j.jgyn.2015.12.007. Epub 2016 Feb 10.
https://pubmed.ncbi.nlm.nih.gov/26874667/
Abstract:
Objectives: Determine the frequency at which palpation of two fontanelles is possible, in order to describe a new clinical diagnosis approach: “the two fontanelles sign”.
Materials and methods: Descriptive study established in the obstetric and gynecology department at Lyon-Sud university hospital between March and November 2013. We followed-up one thousand successive singleton deliveries in cephalic presentation after 30 weeks of gestation. Before starting expulsive efforts, the number of fontanelles perceived (1, 2 or any) was documented. If the number of fontanelles were not noted, the patient was excluded.
Results: Nine hundred and seventy-eight patients were included. In 39.3% of cases (n=384), 2 fontanelles were found, in 57.5% (n=563) only one and in 3.2% (n=31), none.
Conclusion: Both fontanelles palpation is frequently possible and enables quality control of fetal head presentation variety without ultrasound assessment. In order to prove the reliability of clinical examination, study comparing presentation ultrasonography and digital examination finding 2 fontanelles is needed.
Dupuis O, Silveira R, Zentner A, Dittmar A, Gaucherand P, Cucherat M, Redarce T, Rudigoz RC.Am J Obstet Gynecol. 2005 Mar;192(3):868-74. doi: 10.1016/j.ajog.2004.09.028.PMID: 15746684 Clinical Trial.
https://pubmed.ncbi.nlm.nih.gov/15746684/
Abstract:
Objective: This study was undertaken to investigate the reliability of transvaginal assessment of fetal head station by using a newly designed birth simulator.
Study design: This prospective study involved 32 residents and 25 attending physicians. Each operator was given all 11 possible fetal stations in random order. A fetal head mannequin was placed in 1 of the 11 American College of Obstetricians and Gynecologists (ACOG) stations (-5 to +5) in a birth simulator equipped with real-time miniaturized sensor. The operator then determined head position clinically using the ACOG classification. Head position was described as: (1) “engaged” or “nonengaged” (engagement code); (2) “high,” “mid,” “low,” or “outlet” (group code); and (3) according to the 11 ACOG ischial spine stations (numerical code). Errors were defined as differences between the stations given by the sensor and by the operator. We determined the error rates for the 3 codes.
Results: “Numerical” errors occurred in 50% to 88% of cases for residents and in 36% to 80% of cases for attending physicians, depending on the position. The mean “group” error was 30% (95% CI 25%-35%) for residents and 34% (95% CI 27%-41%) for attending physicians. In most cases (87.5% for residents and 66.8% for attending physicians) of misdiagnosis of “high” station, the “mid” station was retained. Residents and attending physicians made an average of 12% of “engagement” errors, equally distributed between false diagnosis of engagement and nonengagement.
Conclusion: Our results show that transvaginal assessment of fetal head station is poorly reliable, meaning clinical training should be promoted. The choice not to perform vaginal delivery when the fetus is in the “mid” position strongly decreases the risk of applying instruments on an undiagnosed “high” station. Conversely, obstetricians who perform only “low” operative vaginal deliveries also deliver unrecognized “mid” station fetuses. Therefore, residency programs should offer training in “mid” pelvic operative vaginal deliveries. Birth simulators could be used in training programs.
Dupuis O, Dupont C, Gaucherand P, Rudigoz RC, Fernandez MP, Peigne E, Labaune JM.Eur J Obstet Gynecol Reprod Biol. 2007 Sep;134(1):29-36. doi: 10.1016/j.ejogrb.2006.09.008. Epub 2006 Oct 17.PMID: 17049711
https://pubmed.ncbi.nlm.nih.gov/17049711/
Abstract:
Objective: To determine the frequency of avoidable neonatal neurological damage.
Study design: We carried out a retrospective study from January 1st to December 31st 2003, including all children transferred from a level I or II maternity unit for suspected neurological damage (SND). Only cases confirmed by a persistent abnormality on clinical examination, EEG, transfontanelle ultrasound scan, CT scan or cerebral MRI were retained. Each case was studied in detail by an expert committee and classified as “avoidable”, “unavoidable” or “of indeterminate avoidability.” The management of “avoidable” cases was analysed to identify potentially avoidable factors (PAFs): not taking into account a major risk factor (PAF1), diagnostic errors (PAF2), suboptimal decision to delivery interval (PAF3) and mechanical complications (PAF4).
Results: In total, 77 children were transferred for SND; two cases were excluded (inaccessible medical files). Forty of the 75 cases of SND included were confirmed: 29 were “avoidable”, 8 were “unavoidable” and 3 were “of indeterminate avoidability”. Analysis of the 29 avoidable cases identified 39 PAFs: 18 PAF1, 5 PAF2, 10 PAF3 and 6 PAF4. Five had no classifiable PAF (0 death), 11 children had one type of PAF (one death), 11 children had two types of PAF (3 deaths), 2 had three types of PAF (2 deaths).
Conclusion: Three quarters of the confirmed cases of neurological damage occurring in levels I and II maternity units of the Aurore network in 2003 were avoidable. Five out of six cases resulting in early death involved several potentially avoidable factors.
(Article in French)
Dupuis O, Simon A.J Gynecol Obstet Biol Reprod (Paris). 2008 Feb;37 Suppl 1:S93-100. doi: 10.1016/j.jgyn.2007.11.015.PMID: 18206318. Review.
https://pubmed.ncbi.nlm.nih.gov/18206318/
Abstract:
Objectives: To determine the best way of fetal monitoring during the active second stage of labor.
Methods: Articles were searched using PubMed and Cochrane library.
Results: Active phase of labor begins with the onset of maternal pushing. It is characterised by frequent and prolonged uterine contractions as well as maternal bearing down efforts. Altogether those mechanical forces lead to an intrauterine pressure increase up to 250 mm Hg and to a marked reduction in placental perfusion. A prolonged period of expulsion will lead to an impairment of fetal oxygenation as well as a rise in carbon dioxide level. Melchior’s FHR classification is specific of the active second stage of labor and described five fetal heart rate patterns: from type 0 to type 4. A reduction in pH and a rise in lactate and P(CO2) values occurred as one progresses from type 0 to type 4 (NP4). During the active phase of labor every method has a significant rate of signal loss. Loss of sensor contact occurred in up to 64% of time with oximetry, 35 to 48% of recordings obtained via external Doppler sensors have more than 20% of signal loss. Even 8 to 11% of recordings obtained via scalp sensors have more than 20% of signal loss. Fetal scalp blood sampling does not allow a continuous recording of fetal well-being and is difficult to perform during this stage. No method has a 100% sensitivity to detect metabolic acidosis. Normal FHR of 1.3% are coupled with an acidosis. Even ST analysis exhibited a small but real false negative rate (NP4).
Conclusion: Active second phase of labor is at high risk of fetal acidosis, and required a close follow-up of the FHR. The length of maternal bearing down efforts should be matched to the fetal heart rhythm Melchior’s classification pattern. Optimal length of bearing down efforts could be 30 min for type 0, 20 min for type 1 and 10 min for type 2, 3 or 4 (NP4).
Reply to the article of C. Le Ray and F. Audibert. Schaal JP, Dreyfus M, Bretelle F, Carbonne B, Dupuis O, Foulhy C, Goffinet F, Houfflin-Debarge V, Langer B, Martin A, Mercier C, Mignon A, Poulain P, Simon A, Teurnier F, Verspyck E, Riethmuller D, Hoffmann P, Pierre F.J Gynecol Obstet Biol Reprod (Paris). 2008 Nov;37(7):715-23. doi: 10.1016/j.jgyn.2008.08.001. Epub 2008 Sep 20.PMID: 18805653
https://pubmed.ncbi.nlm.nih.gov/18805653/
Abstract:
The aim of this work is to answer constructively to C. Le Ray and F. Audibert who were surprised that the French guidelines recommended an assisted delivery after 30 min pushing, even if the fetal heart rate is reassuring. We first resumed the definition of “second stage of labor”, this word including the first phase with no pushing efforts and the second phase with active pushing of the mother. With that definition, the length of the second stage is around 60 min for the primipara and 20 min for the multipara, this length being modified by the use of peridural. We then specified the physiological mechanisms influencing the acidobasic equilibrium during the pushing time. Those mechanisms are difficult to consider because foetal heart rate monitoring is often “lost” during that phase. Altogether, these factors bring incertitude about progressive foetal acidosis and incapacity to diagnose it. Finally, the literature analysis teaches us that increasing the second stage of labor (inactive plus active phases) during the normal pregnancy seems to be at low risk for the foetus within the primiparas, but display a risk for the mother and so might be limited. Comparing the delayed pushing with the immediate pushing only lead us to conclude that delayed pushing is dangerous, as is prolonged second stage. In conclusion, we think that prolonging the second stage of labor is possible but must be by increasing the inactive first phase of the second stage, especially as long as we will not get a noninvasive and reliable method allowing assessing the well-being of the foetus.
Dupuis O, Sayegh I, Decullier E, Dupont C, Clément HJ, Berland M, Rudigoz RC.Eur J Obstet Gynecol Reprod Biol. 2008 Oct;140(2):206-11. doi: 10.1016/j.ejogrb.2008.04.003. Epub 2008 May 20.PMID: 18495322
https://pubmed.ncbi.nlm.nih.gov/18495322/
Abstract:
Objective: To evaluate the effect of a novel communication tool, related to the degree of urgency for Caesarean sections (CSs), on the decision-to-delivery interval for emergency CS.
Study design: Red CS are very urgent cases corresponding to life-threatening maternal or foetal situations, orange CS are urgent cases and green CS are non-urgent intrapartum CS. We carried out this cohort study in a French maternity hospital. The study included all emergency Caesarean sections during two 6-month periods, before and after introduction of the code. We compared the decision-to-delivery interval of the two study periods.
Results: Our study included 174 emergency CS. The mean decision-to-delivery interval after introduction of the code was 31.7 min, significantly shorter (p=0.02) than the 39.6 min interval before introduction of the colour code. Except for the preparation time, each time interval decreased. This included transporting the patient into the operating theatre, and the incision-to-delivery time interval.
Conclusion: This study suggests that the use of the three-colour code could significantly shorten the decision-to-delivery interval in emergency CS. Further prospective studies are needed to confirm this result.
(Article in French)
Huissoud C, du Mesnildot P, Sayegh I, Dupuis O, Clément HJ, Thévenet S, Dubernard G, Rudigoz RC.J Gynecol Obstet Biol Reprod (Paris). 2009 Feb;38(1):51-9. doi: 10.1016/j.jgyn.2008.09.011. Epub 2008 Nov 11.PMID: 19004575
https://pubmed.ncbi.nlm.nih.gov/19004575/
Abstract:
Objectives: To assess the efficiency of a new tool designed to shorten the decision-to-delivery interval (DDI) for emergency C-sections (CS).
Materials and methods: DDI comparisons during three 6-month periods in a third level maternity. In stage A we evaluated the spontaneous DDI, in stage B the DDI was measured after the introduction of a color-code communication tool related to the degree of urgency for CS (amber code indicated urgent CS with an ideal DDI of 30 min and red code for very urgent CS with an ideal DDI of 15 min). In stage C we assessed the impact of the color-codes related protocols implementation.
Results: Two hundred and fifty-three C-sections were included (211 urgent CS and 42 very urgent CS). Mean DDI decreased significantly from 42 min to 24 min between period A and period C for amber codes (corresponding to 43.2% and 82.1% of the objectives respectively) and from 24.9 min to 10.7 min for red codes (20% et 83.3% of the objectives).
Conclusion: This study suggests that color-codes and their related application protocols significantly shorten the DDI during the evaluation periods.
(Article in French)
Bloc F, Dupuis O, Massardier J, Gaucherand P, Doret M.J Gynecol Obstet Biol Reprod (Paris). 2010 Apr;39(2):133-8. doi: 10.1016/j.jgyn.2009.12.006. Epub 2010 Jan 8.PMID: 20060654
https://pubmed.ncbi.nlm.nih.gov/20060654/
Abstract:
Objectives: “Colour code” was implemented in our labour and delivery room to facilitate communication between the different actors of emergency c-sections and, more specifically, to reduce the decision to delivery interval in crash c-sections called “red code”. This study aims at evaluating “red colour” c-sections rate, emergency level and decision to delivery interval.
Patients and methods: Over a six-months-period, all “red code” c-sections have been independently reviewed by four experimented obstetricians, including two external from the department. For each c-section, they had to confirm or reject the indication for “red code” c-section. Decision to delivery interval was also collected.
Results: Thirty-eight “red code” c-sections were performed representing 2.3 % of all deliveries and 9.1 % of all c-sections. “Red code” c-section indications have been confirmed in 12 cases and rejected in 13 cases. Opinions were discordant in the 13 others cases. Mean decision to delivery interval was 10.8 minutes.
Conclusion: In our department, defining emergency level by “colour code” is associated with a short decision to delivery interval in crash c-sections but also with a trivialization of this high-risk procedure. Indications should be restricted to avoid unjustified maternal and foetal complications.
Sayegh I, Dupuis O, Clement HJ, Rudigoz RC.Eur J Obstet Gynecologie Reprod Biol. 2004 Sep 10;116(1):28-33. doi: 10.1016/j.ejogrb.2004.01.032.PMID: 15294363
https://pubmed.ncbi.nlm.nih.gov/15294363/
Abstract:
Objective: To assess the interval between the decision to carry out an emergency caesarean section and delivery, and to determine whether this interval can be shortened. Study design: A retrospective study was performed in a French maternity hospital over a 6-month period. All caesarean sections performed during labour were included. These caesarean sections were divided into two groups according to Lucas’s classification: (1) emergency and urgent caesarean sections and (2) scheduled caesarean sections. Results: The mean decision-to-delivery interval was 39.5 min in the first group and 55.9 min in the second group. It was mainly influenced by the time taken to get the patient into theatre. The mean decision-to-operating theatre interval accounted for 45.6 and 53.8% of the mean decision-to delivery-interval, respectively. Conclusion: The recommended interval of 30 min is not routinely achieved. Improving communication within the perinatal team could decrease the decision-to-operating theatre interval and should be promoted.
(Article in French)
Dupuis O, Dubuisson J, Moreau R, Sayegh I, Clément HJ, Rudigoz RC.J Gynecol Obstet Biol Reprod (Paris). 2005 Dec;34(8):789-94. doi: 10.1016/s0368-2315(05)82955-2.PMID: 16319770 .
https://pubmed.ncbi.nlm.nih.gov/16319770/
Abstract:
Aim: Comparison of the decision to delivery interval in cases of forceps delivery and in cases of cesarean sections.
Material and method: A retrospective analysis was performed on 137 cases of forceps deliver (n = 63) and cesarean section (n = 74) indicated for abnormal fetal heart rhythm. All cases were observed in a level 3 maternity unit between October 2003 and August 2004.
Results: The mean decision-to-delivery interval was significantly shorter in the forceps group (14.84 min +/- 6.54 versus 29.31 min +/- 11.79 p < 0.0001). Maternal and neonatal morbidity were comparable.
Conclusion: This study suggests that once the fetal head is engaged, forceps delivery can significantly reduced the decision-to-delivery interval.
(Article in French)
Ernst D, Clerc J, Decullier E, Gavanier G, Dupuis O.Gynecol Obstet Fertil. 2012 Oct;40(10):566-71. doi: 10.1016/j.gyobfe.2012.05.001. Epub 2012 Sep 5.PMID: 22959082.
https://pubmed.ncbi.nlm.nih.gov/22959082/
Abstract:
Objectives: At birth, evaluation of neonatal well-being is crucial. It is though important to perform umbilical cord blood gas analysis, and then to analyze the samples. We wanted to establish the feasibility and reliability of systematic umbilical cord blood sampling in a French labour ward.
Patients and methods: Study of systematic umbilical cord blood gas analysis was realized retrospectively from 1000 consecutive deliveries. We first established the feasibility of the samples. Feasibility was defined by the ratio of complete cord acid-base data on the number of deliveries from alive newborns. Afterwards, we established the reliability on the remaining cord samples. Reliability was the ratio of samples that fulfilled quality criteria defined by Westgate et al. and revised by Kro et al., on the number of complete samples from alive newborns. At last, we looked for factors that would influence these results.
Results: The systematic umbilical cord blood sample feasibility reached 91.6%, and the reliability reached 80.7%. About the delivery mode, 38.6% of emergency caesarians (IC 95% [30.8-46.3]; P<0.0001) led to non-valid samples, when only 11.3% of programmed caesarians (IC 95% [4.3-18.2]; P<0.0001) led to non-valid samples. Umbilical cord blood analysis were significantly less validated during emergency caesarians.
Discussion and conclusion: Realization of systematic cord blood gas analysis was followed by 8.4% of incomplete samples, and by 19.3% that were uninterpretable. Training sessions should be organized to improve the feasibility and reliability, especially during emergency caesarians.
Chauleur C, Gris JC, Laporte S, Chapelle C, Bertoletti L, Equy V, Gaucherand P, Bazan E, Dupuis O, Gallot D, Mismetti P; STRATHEGE Investigators and The STRATHEGE Group.Thromb Haemost. 2018 Sep;118(9):1564-1571. doi: 10.1055/s-0038-1668524. Epub 2018 Aug 13.PMID: 30103244
https://pubmed.ncbi.nlm.nih.gov/30103244/
Free access
(Article in French)
N Hoen 1, G Ziane, C Grange, D Raudrant, O Dupuis. Gynecol Obstet Fertil. 2011 May;39(5):e73-6. doi: 10.1016/j.gyobfe.2011.03.005. Epub 2011 Apr 21.
https://pubmed.ncbi.nlm.nih.gov/21514203/
Abstract:
Unilateral adrenal ischemia by venous thrombosis during pregnancy is an extremely rare event. We report the case of two women, in their third trimester who presented intense abdominal pain located on their right flank. Obstetric and clinical examination are normal, so as are the biological check-up and hepatic and renal imaging. The thoraco-abdominal CAT scan shows the right adrenal necrosis associated with the vein thrombosis. A C-section was decided to allow administration of appropriate treatment: analgesics and anticoagulants. Clinical evolution was rapidly favorable. Protein S deficiency was diagnosed in one of the patients. The follow-up CAT scan shows the vein re-permeabilisation and disappearing of necrosis signs.
(Article in French)
Schmitt C, Debord MP, Grange C, Ben Cheikh A, Krauth JP, Dupuis O, Golfier F, Raudrant D.J Gynecol Obstet Biol Reprod (Paris). 2010 Feb;39(1):68-71. doi: 10.1016/j.jgyn.2009.09.012. Epub 2009 Nov 6.PMID: 19896780 .
https://pubmed.ncbi.nlm.nih.gov/19896780/
Abstract:
Pregnancy represents an inner transitional prothrombotic state; that is why other coagulation abnormalities may be revealed during this time. Factor V Leiden mutation is the most frequent inherited thrombophilia in the general population. We report the case of a patient by whom this mutation has been revealed during pregnancy by an adrenal vein thrombosis. Through this case, we will review the physiopathology of resistance to activated protein C and its consequences.
(Article in French)
Dupuis O, Madelenat P, Rudigoz RC. Gynecol Obstet Fertil. 2004 Jun; 32(6):540-8. doi: 10.1016/j.gyobfe.2004.02.020.PMID: 15217569 Review.
https://pubmed.ncbi.nlm.nih.gov/15217569/
Abstract:
Objective: This study was undertaken to review the available data on urinary and fecal incontinence and their association with maternal as well as fetal per partum characteristics.
Method: A Pubmed (Medline search performed between 1999 and 2003 using “urinary incontinence and delivery” and “fecal incontinence and delivery” identified 501 relevant papers. Most of them are retrospective analyses whereas few are randomized controlled trials (RCT).
Results: Two studies performed with computer-stored databases analyzed the risk factors of incontinence among 2,886,126 deliveries. Primiparity, birthweight over 4000 g and all types of assisted vaginal deliveries significantly increased the risk of anal sphincter damage. Results concerning the effect of episiotomy are conflicting. Controlled randomized trials have shown that pelvic floor muscle training during pregnancy as well as planned cesarean section significantly and moderately decrease the risk of urinary incontinence. The only RCT available has shown that planned cesarean section did not reduce significantly incontinence of flatus. Finally the only trial that compare surgical techniques used to repair the anal sphincter did not show any significant difference.
Conclusion: Risk factors for anal sphincter damage during delivery are well known. RCT focusing on how to prevent and how to cure fecal as well as urinary incontinence are urgently needed.
Dupuis O, Moreau R, Silveira R, Pham MT, Zentner A, Cucherat M, Rudigoz RC, Redarce T.Am J Obstet Gynecol. 2006 Jun;194(6):1524-31. doi: 10.1016/j.ajog.2006.01.013. Epub 2006 Mar 31.PMID: 16579914
https://pubmed.ncbi.nlm.nih.gov/16579914/
Abstract:
Objective: The purpose of this study was to create a new instrument for the training of doctors in the use of forceps and to compare the trajectories of forceps blades between junior and senior obstetricians.
Study design: We equipped a simulator and forceps with spatial location sensors. The head of the fetus was in an occipitoanterior location, at a “+5” station. Forceps blade trajectories were analyzed subjectively with the 3-dimensional spatial graph and objectively based on 3 points of special interest. Each obstetrician performed 4 forceps blades placements. We compared the trajectories of junior and senior obstetricians.
Results: For senior operators, spatial dispersion was “excellent,” “very good,” or “good” in 92% of cases, whereas this was the case for only 38% of junior doctors (92% vs 38%; P < .001).
Conclusion: A new instrument has been designed to demonstrate the trajectory of forceps blades during application in a simulator. The instrument captures the difference in experience between senior and junior clinicians.
(Article in French)
Dupuis O, Moreau R, Silveira R, Dittmar A, Rudigoz RC, Redarce T.Gynecol Obstet Fertil. 2005 Dec;33(12):980-5. doi: 10.1016/j.gyobfe.2005.06.024.PMID: 16321560 Review. French.
https://pubmed.ncbi.nlm.nih.gov/16321560/
Abstract:
Objective: Obstetrical forceps are used worldwide since more than 400 years. In 2003 forceps deliveries accounted for 6.3% of all deliveries of the AURORE Grand-Lyon perinatal network. Although more than 400 different forceps have been described, obstetrics handbooks neither describe experimental forceps nor provide any chapter dedicated to instrumental delivery training. Our aim was to provide junior obstetricians with information that will allow them to select the best instrument and to let them know about experimental as well as pedagogic forceps.
Patients and methods: International literature review using the terms “forceps” and “delivery” and a four-year experimental work involving a close collaboration between obstetricians and biomechanics of the INSA engineering school.
Results: Two instruments are presented as well as a new forceps classification.
Discussion and conclusion: This classification distinguishes between three types of forceps: operational forceps designed to delivers neonates, experimental forceps designed to study biomechanics and training forceps designed for resident training. For the first time the classic blind forceps procedure is transformed in a full screen real time procedure.
Moreau R, Pham MT, Silveira R, Redarce T, Brun X, Dupuis O.IEEE Trans Biomed Eng. 2007 Jul;54(7):1280-90. doi: 10.1109/TBME.2006.889777.PMID: 17605359
https://pubmed.ncbi.nlm.nih.gov/17605359/
Abstract:
Today, medical simulators are increasingly gaining appeal in clinical settings. In obstetrics childbirth simulators provide a training and research tool for comparing various techniques that use obstetrical instruments or validating new methods. Especially in the case of difficult deliveries, the use of obstetrical instruments-such as forceps, spatulas, and vacuum extractors-has become essential. However, such instruments increase the risk of injury to both the mother and fetus. Only clinical experience acquired in the delivery room enables health professionals to reduce this risk. In this context, we have developed, in collaboration with researchers and physicians, a new type of instrumented forceps that offers new solutions for training obstetricians in the safe performance of forceps deliveries. This paper focuses on the design of this instrumented forceps, coupled with the BirthSIM simulator. This instrumented forceps allows to study its displacement inside the maternal pelvis. Methods for analyzing the operator repeatability and to compare forceps blade placements to a reference one are developed. The results highlight the need of teaching tools to adequately train novice obstetricians.
Dupuis O, Decullier E, Clerc J, Moreau R, Pham MT, Bin-Dorel S, Brun X, Berland M, Redarce T.Eur J Obstet Gynecol Reprod Biol. 2011 Dec;159(2):305-9. doi: 10.1016/j.ejogrb.2011.09.002. Epub 2011 Oct 2.PMID: 21968031
https://pubmed.ncbi.nlm.nih.gov/21968031/
Abstract:
Objective: The aim of this study was to evaluate whether forceps training on a birth simulator allows obstetricians to improve forceps blade placement.
Study design: Analysis was based on 600 forceps blade placements performed by ten trainees on a simulator. The trajectories used by the trainees were assessed using reference spheres that reflected an optimal bimalar placement. Three definitions of success were used: small-sphere success, medium-sphere success and large-sphere success were respectively defined by the forceps blade tip being within 5, 10 or 15mm of the center of the sphere (the small-sphere being nested within the medium-sphere and the small and medium being nested within the large-sphere). Wilcoxon paired analysis was performed to compare the first (50 trajectories) and final (50 trajectories) sets of five forceps placements. Graphical representation and linear regression were used to visualize the learning process.
Results: 596 trajectories were available for analysis. During the last set of five forceps the success rate was respectively 28%, 72% and 86% for small-sphere, medium-sphere and large-sphere success with the right blade and 8%, 32% and 70% for the left blade. Wilcoxon analysis showed a highly significant improvement for all kinds of success in the right blade and for large-sphere success in the left blade. Linear regression slopes were significant. Using a projection, the theoretical numbers of placements needed to achieve a 100% success rate for small-sphere, medium-sphere and large-sphere were respectively 80, 45 and 35.
Conclusion: These results strongly suggest that performing forceps blade placement on birth simulator allows obstetricians to improve their skills.
Vayssière C, Beucher G, Dupuis O, Frauds O, Simon-Toulza C, Sentilhes L, Meunier E, Parant O, Schmitz T, Riethmuller D, Baud O, Galley-Raulin F, Diemunsch P, Pierre F, Schaal JP, Fournié A, Oury JF; French College of Gynaecologists and Obstetricians.Eur J Obstet Gynecol Reprod Biol. 2011 Nov;159(1):43-8. doi: 10.1016/j.ejogrb.2011.06.043. Epub 2011 Jul 28.PMID: 21802193 Review.
https://pubmed.ncbi.nlm.nih.gov/21802193/
Abstract:
Routine use of a partograph is associated with a reduction in the use of forceps, but is not associated with a reduction in the use of vacuum extraction (Level A). Early artificial rupture of the membranes, associated with oxytocin perfusion, does not reduce the number of operative vaginal deliveries (Level A), but does increase the rate of fetal heart rate abnormalities (Level B). Early correction of lack of progress in dilatation by oxytocin perfusion can reduce the number of operative vaginal deliveries (Level B). The use of low-concentration epidural infusions of bupivacaine potentiated by morphinomimetics reduces the number of operative interventions compared with larger doses (Level A). Placement of an epidural before 3-cm dilatation does not increase the number of operative vaginal deliveries (Level A). Posterior positions of the fetus result in more operative vaginal deliveries (Level B). Manual rotation of the fetus from a posterior position to an anterior position may reduce the number of operative deliveries (Level C). Walking during labour is not associated with a reduction in the number of operative vaginal deliveries (Level A). Continuous support of the parturient by a midwife or partner/family member during labour reduces the number of operative vaginal deliveries (Level A). Under epidural analgesia, delayed pushing (2h after full dilatation) reduces the number of difficult operative vaginal deliveries (Level A). Ultrasound is recommended if there is any clinical doubt about the presentation of the fetus (Level B). The available scientific data are insufficient to contra-indicate attempted midoperative delivery (professional consensus). The duration of the operative intervention is slightly shorter with forceps than with a vacuum extractor (Level C). Nonetheless, the urgency of operative delivery is not a reason to choose one instrument over another (professional consensus). The cup-shaped vacuum extractor seems to be the instrument of choice for operative deliveries of fetuses in a cephalic transverse position, and may also be preferred for fetuses in a posterior position (professional consensus). Vacuum extraction deliveries fail more often than forceps deliveries (Level B). Overall, immediate maternal complications are more common for forceps deliveries than vacuum extraction deliveries (Level B). Compared with forceps, operative vaginal delivery using a vacuum extractor appears to reduce the number of episiotomies (Level B), first- and second-degree perineal lesions, and damage to the anal sphincter (Level B). Among the long-term complications, the rate of urinary incontinence is similar following forceps, vacuum extraction and spontaneous vaginal deliveries (Level B). Anal incontinence is more common following forceps delivery (Level B). Persistent anal incontinence has a similar prevalence regardless of the mode of delivery (caesarean or vaginal, instrumental or non-instrumental), suggesting the involvement of other factors (Level B). Rates of immediate neonatal mortality and morbidity are similar for forceps and vacuum extraction deliveries (Level B). It appears that difficult instrumental delivery may lead to psychological sequelae that may result in a decision not to have more children (Level C). The rates of neonatal convulsions, intracranial haemorrhage and jaundice do not differ between forceps and vacuum extraction deliveries (Levels B and C). Rapid sequence induction with a Sellick manoeuvre (pressure to the cricoid cartilage) and tracheal intubation with a balloon catheter is recommended for any general anaesthesia (Level B). Training must ensure that obstetricians can identify indications and contra-indications, choose the appropriate instrument, use the instruments correctly, and know the principles of quality control applied to operative vaginal delivery. Nowadays, traditional training can be accompanied by simulations. Training should be individualized and extended for some students.
Moreau R, Pham MT, Brun X, Redarce T, Dupuis O. IEEE Trans Inf Technol Biomed. 2011 May;15(3):364-72. doi: 10.1109/TITB.2011.2107746. Epub 2011 Jan 20.PMID: 21257384
https://pubmed.ncbi.nlm.nih.gov/21257384/
Abstract:
This paper presents the control algorithm implanted on the childbirth simulator BirthSIM in order to provide training to novice obstetricians. The forceps extraction is an obstetric manipulation learned by experience. However, nowadays the training is mainly provided during real childbirths. This kind of training could lead to dramatic consequences due to the lack of experience of some operators. This paper explains the approach that has been used to simulate the dynamic process of a childbirth on the BirthSIM simulator. We especially focus on one procedure that reproduces a difficult instrumental delivery. The recorded tractive force to extract the fetus corresponds to the literature results that confirm the realism of the simulator. The novice results emphasize the need of a childbirth simulator in order to gain initial experience without any risks.
Moreau R, Ochoa V, Pham MT, Boulanger P, Redarce T, Dupuis O.J Biomed Inform. 2008 Dec;41(6):991-1000. doi: 10.1016/j.jbi.2008.03.012. Epub 2008 Apr 8.PMID: 18479975
https://pubmed.ncbi.nlm.nih.gov/18479975/
Open Access
Dupuis O, Moreau R, Pham MT, Redarce T.BJOG. 2009 Jan;116(2):327-32; discussion 332-3. doi: 10.1111/j.1471-0528.2008.02004.x.PMID: 19076965
https://pubmed.ncbi.nlm.nih.gov/19076965/
Abstract:
This paper aims to highlight the benefits of simulator training in obstetric manipulations such as forceps blade placement. The BirthSIM simulator is used to mimic operative vaginal deliveries. To characterise forceps blade placement, we studied the curvature of forceps path. The orientation of the forceps blades are studied in the quaternion unit space to ensure time-independent analysis. The results showed progress for all novices in forceps blade placement. Simulator training helps them to develop their self-confidence and acquire experience before working in the delivery room.
Moreau R, Jardin A, Pham MT, Redarce T, Olaby O, Dupuis O.Conf Proc IEEE Eng Med Biol Soc. 2006;2006:4416-9. doi: 10.1109/IEMBS.2006.260284.PMID: 17946629
https://pubmed.ncbi.nlm.nih.gov/17946629/
Abstract:
This paper presents work resulting from a collaboration between obstetricians and researchers. It shows the benefits from the use of an instrumented childbirth simulator for the training of obstetricians and midwives. This new tool allows to surpass the constraints linked to the traditional training in a childbirth ward. This simulator training is designed to complete the traditional training used in teaching hospitals. Such a training allows residents to acquire a beginning experience before training in a childbirth ward but it also allows instructors to improve the teaching gestures without constraints. A clinical study of the forceps blades placement gesture with several residents who trained on a childbirth simulator is made. The results clearly show the progress in the obstetric gestures of all the residents who have used the simulator.
Moreau R, Pham MT, Brun X, Redarce T, Dupuis O.Int J Med Robot. 2008 Dec;4(4):373-80. doi: 10.1002/rcs.222.PMID: 19006201
https://pubmed.ncbi.nlm.nih.gov/19006201/
Abstract:
Background: In obstetrics, manipulations are mainly learned during real deliveries. To minimize the risks linked to such training, we propose a childbirth simulator as a teaching tool in hospitals. More specifically, we focus on training with forceps during obstetric manipulation.
Methods: The training method can be divided into two steps: the teaching of forceps placement, and the extraction manipulation. In this paper we focus on the extraction manipulation on the simulator and the analysis of the results, taking into account several parameters and using an evaluation function to obtain a global score.
Results: Experimental results reveal novice difficulty while proceeding to the fetus extraction. These results highlight the fact that novices need a personalized training which can be carried out on the BirthSIM simulator.
Conclusion: Results lead to the conclusion that a simulator training offers benefit to novices by providing them with risk-free training to acquire initial experience before proceeding to conventional training in the delivery room.
Moreau R, Ochoa V, Pham MT, Boulanger P, Dupuis O.Annu Int Conf IEEE Eng Med Biol Soc. 2009;2009:5854-7. doi: 10.1109/IEMBS.2009.5334410.PMID: 19964873
https://pubmed.ncbi.nlm.nih.gov/19964873/
Abstract:
This paper presents a method to evaluate medical gestures. The objective is to objectively assess a gesture carried out by novice doctors. The proposed method is based on the study of the curvature of the 3D gesture and provide a global performance index for one manipulation. The study of the number of peaks on the curvature indicates if the gesture is smooth or not. The application is the obstetric gestures linked to the forceps use but the method can be applied to different gestures without loss of generality. Seven residents carried out 30 forceps blade placements. The results clearly show a difference between the gestures carried out. This highlights the difficulty of the gesture according to the fetal head presentation.
Moreau R, Ochoa V, Pham MT, Boulanger P, Redarce T, Dupuis O.Annu Int Conf IEEE Eng Med Biol Soc. 2008;2008:3430-3. doi: 10.1109/IEMBS.2008.4649943.PMID: 19163446
https://pubmed.ncbi.nlm.nih.gov/19163446/
Abstract :
This paper presents a method to evaluate a gesture carried out by a resident obstetrician by comparing it to a gesture carried out by an expert obstetrician. The studied gesture is the forceps blade placement. Resident paths were recorded on a childbirth simulator while placing forceps blades instrumented with six degrees of freedom sensors. The path is characterized by the positions and the orientations. In this paper we particularly focus on the orientations. Forceps orientations are expressed in the quaternion unit space and the curvature of quaternion path is compared by correlation to a reference defined by an expert. Residents have been trained on a simulator and their gestures are evaluated by comparing their orientation path curvatures to reference path curvatures. Quantitative results confirm the qualitative analysis, residents become more similar to the reference while training on simulator.
Dupuis O, Silveira R, Dupont C, Mottolese C, Kahn P, Dittmar A, Rudigoz RC.Am J Obstet Gynecol. 2005 Jan;192(1):165-70. doi: 10.1016/j.ajog.2004.06.035.PMID: 15672020
https://pubmed.ncbi.nlm.nih.gov/15672020/
Abstract:
Objective: A depressed skull fracture is an inward buckling of the calvarial bones and is referred to as a “ping-pong” fracture. This study aimed to look at differences between “spontaneous” and “instrument-associated” depressed skull fractures.
Study design: This retrospective, case-control analysis included every neonate who was admitted with a depressed skull fracture between 1990 and 2000. Cases after a spontaneous vaginal delivery, elective cesarean delivery, or cesarean delivery that was performed during labor without previous instrument use were classified as “spontaneous” (n = 18 cases). Cases after a delivery in which forceps or a vacuum cup had been used either successfully or unsuccessfully were classified as “instrument-associated” (n = 50 cases). Continuous data were analyzed with 2-tailed unpaired t tests; chi 2 analysis was used for nominal data. A probability value of <.05 was considered statistically significant.
Results: Fifty depressed skull fractures were associated with an instrument delivery, and 18 depressed skull fractures were classified as “spontaneous.” The only obstetric parameter that differed significantly between the 2 groups was the length of the active phase. Among the 68 neonates, 15 neonates underwent prolonged second stage, forceps or manual head rotation, or forceps use during elective cesarean delivery. All “instrument-associated” cases were caused by forceps application or sequential instrument use; depressed skull fractures never occurred after isolated vacuum extraction. Every type of forceps was involved. Intracranial lesions were significantly more frequent in the instrument-associated group (30% vs 0%; P = .02). Two infants sustained persistent severe motor disabilities.
Conclusion: Depressed skull fractures occur in the setting of spontaneous and operative deliveries, although the incidence is higher in the latter case. Depressed skull fractures that are associated with instrumental deliveries are significantly more likely to be associated with intracranial lesions. Persistent disabilities are rare.
(Article in French)
Dupuis O, Silveira R, Redarce T, Dittmar A, Rudigoz RC.Gynecol Obstet Fertil. 2003 Nov;31(11):920-6. doi: 10.1016/j.gyobfe.2003.09.007.PMID: 14623555.
https://pubmed.ncbi.nlm.nih.gov/14623555/
Abstract:
Objectives: The purpose of this study was to evaluate the incidence of forceps and vacuum application and the incidence of its related neonatal complications. This study was performed in a network of 37 maternity hospitals.
Patients and method: A postal questionnaire was sent to 156 obstetricians between February and March 2003.
Results: Response rate was 78%. In 2002 the operative vaginal delivery rate was 11.2% of all live births. Forceps are the primary instruments (6.3%) whereas vacuum delivery rate was 4.9%. One obstetrician never uses forceps while 38 (31%) never use vacuum. Only 29 (24%) report using both instruments frequently. During 2002 no neonatal death related to an operative vaginal delivery was reported while 145 neonatal complications were (3.2%). Major complications were one depressed skull fracture (1/4589) and 14 extensive caput succedaneum (14/4589). Minor complications were cutaneous lesions (124/4589) and facial palsy (6/4589). Vacuum delivery was associated with a significantly higher extensive caput succedaneum rate (P = 0.018) while the only depressed skull fracture observed was related to forceps use. Forceps delivery was associated with a significantly higher cutaneous lesions rate (P < 0.001).
Discussion and conclusions: This study showed that, in 2002, operative vaginal deliveries still represent a significant amount of vaginal deliveries, a majority of obstetricians do not use both instrument and neonatal associated complications are frequent (3.2%) but rarely severe. Therefore, we believe that every method that allows a safe teaching of operative delivery should be promoted.
(Article in French)
Dupuis O.J Gynecol Obstet Biol Reprod (Paris). 2008 Dec;37 Suppl 8:S288-96. doi: 10.1016/S0368-2315(08)74766-5.PMID: 19268205 .
https://pubmed.ncbi.nlm.nih.gov/19268205/
Abstract:
The appropriate use of forceps, vacuums or spatulas facilitates the rapid delivery of foetuses faced with life-threatening situations. It also makes possible the relief of certain cases of prolonged second-stage labor. In France, operative vaginal delivery (OVD) accounts for approximately 10% of all births. OVD training aims to optimize maternal, as well as neonatal safety. It should enable trainees to indicate or contraindicate an OVD safely, as well as to choose the appropriate instrument, use it correctly, and master quality control principles. Traditional OVD training is confronted with both spatial and time-related limitations. Spatial constraints involve both the teacher and trainee who only have limited visual access to the pelvic canal, and the head of the foetus; the time constraint occurs whenever the OVD occurs in an emergency setting. These limitations have been further aggravated by new constraints: decreasing time dedicated to training (European safety rules prohibit work the day after night duty), increasing litigation and constraints imposed by society. Training by means of simulation removes such limitations making it possible to both avoid exposing pregnant women to the hazards of traditional training, and adapt the training to the skills of each trainee. OVD training should include forceps, vacuums and the use of spatulas. The OVD skills of obstetricians should be audited regularly on both a personal and a confidential level. Such audits could be based on a method using a simulator. Prospective studies comparing traditional and simulation-based training should be encouraged.
(Article in French)
Dupuis O, Meysonnier C, Clerc J.J Gynecol Obstet Biol Reprod (Paris). 2016 Apr;45(4):343-52. doi: 10.1016/j.jgyn.2015.04.011. Epub 2015 Jun 19.PMID: 26096348 .
https://pubmed.ncbi.nlm.nih.gov/26096348/
Abstract:
Objectives: The aim of this study is to describe knowledge on forceps delivery in the area of Lyon.
Material and methods: It is a multicentric observational study carried between January 1, 2013 and June 9, 2013. A questionnaire was sent to obstetricians and residents of the area of Lyon. It related prerequisites for operative vaginal delivery, the method used to apply forceps, practices and preferences of operators.
Results: Seventy-five responses were obtained (47 obstetricians, 28 residents). About prerequisites: 6.4% of the obstetricians and 14.3% of the residents never do urinary catheterization. Instrumental delivery is never performed when the fetal head is not engaged. Mid-pelvic operative vaginal delivery is performed by 51.1% of obstetricians. Trans-abdominal ultrasound assessment is conducted in cases of clinical doubts about the fetal head position. For occipital anterior and left anterior positions, the left blade is first applied. A flexion of the fetal head is applied for anterior positions but not in posterior positions. Most of operators do not perform instrumental rotation. Vacuum extractor is the privileged instrument for obstetricians and forceps is often used in second line.
Conclusion: This study shows that most of the recommendations for forceps delivery are followed. In front of the lake of statistical power of this study, it might be interesting to improve a largest study with a comparison between obstetricians and residents’ practices.
Rudy Lapeer, Vilius Audinis, Zelimkhan Gerikhanov, Olivier Dupuis. Med Image Comput Comput Assist Interv. 2014;17(Pt 2):57-64. doi: 10.1007/978-3-319-10470-6_8.
https://pubmed.ncbi.nlm.nih.gov/25485363/
Abstract:
Obstetric forceps are commonly used when the expulsion of the baby during childbirth fails to progress. When the two forceps blades are applied correctly, i.e. symmetrically, the inner surface of each blade maximises the area in contact with the fetal head. On the contrary, when the blades are applied asymmetrically, the contact areas between the inner surface of the blades and the fetal head are minimal and at distinct locations at the left and right sides of the fetal head. It is therefore assumed in the field of obstetrics that asymmetric application is bound to cause intra-cranial damage due to significantly higher shear forces and significant deformation of the fetal cranial bones as compared to symmetric application. In this paper we present the first of a series of studies to analyse the mechanical contact between head and forceps under different conditions using finite element analysis. We used high fidelity mesh models of a fetal skull and obstetric forceps. The fetal cranial material properties are known from previous studies. We observed significantly higher deformations and stresses for the asymmetric application of the blades as compared to symmetric placement.
(Article in French)
Saucedo M, Deneux-Tharaux C, Bouvier-Colle MH; Le Comité national d’experts sur la mortalité maternelle. J Gynecol Obstet Biol Reprod (Paris). 2013 Nov;42(7):613-27. doi: 10.1016/j.jgyn.2013.06.011. Epub 2013 Sep 13.PMID: 24035736.
https://pubmed.ncbi.nlm.nih.gov/24035736/
Summary:
To monitor the maternal mortality which is an indicator of the quality of obstetric and intensive care, France has a specific approach since 1996. Recently linkages have been introduced to improve the inclusion of cases. Here are the results for the 2007 to 2009 period. The identification of the pregnancy associated deaths is lying on different data bases that are medical causes of death, birth register and hospital discharges. To document the cases, confidential enquiries are conducted by two assessors on the field; a committee of medical experts analyses the documents, select the underlying cause and assess the quality of health care. Two hundred and fifty-four obstetric deaths were identified from 2007 to 2009 giving the maternal mortality ratio (MMR) of 10.3 per 100,000 births. The maternal age and nationality, the region of deaths are associated to the MMR. The haemorrhages are the leading cause but their ratio is 1.9 versus 2.5 previously; this decrease results from the postpartum haemorrhage by uterine atony going down. The suboptimal care are still frequent (60%) but slightly less than before. The linkage method should be pursuited. Maternal mortality is rather stable in France. We may reach more reduction as deaths due to atony decreased as suboptimal care did.
(Article in French)
Dupuis O, Gaucherand P, Mellier G; et le Comité de pilotage de la cellule des transferts périnatals (liste des membres en fin d’article).J Gynecol Obstet Biol Reprod (Paris). 2006 Nov;35(7):702-10. doi: 10.1016/s0368-2315(06)76467-5.PMID: 17088772 .
https://pubmed.ncbi.nlm.nih.gov/17088772/
Abstract:
Introduction: This study aims to describe the organization that was implemented at the Rhône-Alpes perinatal hotline, as well as to describe in utero transfer and neonate transport from an epidemiological point of view.
Material and method: A cohort study was performed between January 2003 and December 2004. Every in utero transfer and neonate transport was included. Transfers performed in 2003 were compared to transfers performed in 2004. Three endpoints were defined: the rate of in utero transfer (number of in utero transfers/number of in utero transfers + number of neonatal transfers), the rate of transfer toward level II units (number of transfers from level I to level II/number of transfers from level I to level II + number of transfers from level I to level III) as well as the rate of intra network transfer (number of intra network transfers/number of intra network transfers + number of extra network transfers).
Results: In 2003, 865 in utero transfers (IUT) and 1297 neonate transports (NT) were performed, in 2004 848 IUT and 1069 NT were performed. The rate of in utero transfer significantly increased from 40 to 44.2% in 2004 (865/2162 versus 848/1917, p = 0.007). The rate of transfer toward level II units increased for the mothers from 31.8% to 36.9% (177/557 versus 174/471, p = 0.09) and significantly increased for the neonates from 43.2 to 51.6% in 2004 (335/775 versus 327/633, p = 0.002). Finally the rate of intra network transfer has not significantly changed: for the IUT it decreased from 87 to 86% (755/865 versus 732/848, p = 0.59) and for the NT from 91% to 90% (1179/1297 versus 963/1069, p = 0.45).
Conclusion: The organization that was implemented allows not only a safe 24 hour on call management of maternal transfers as well as neonate transport, but also a precise knowledge of epidemiologic indications relative to perinatal transfer.
(Article in French)
Dupuis O, Arsalane A, Dupont C, Janvier M, Laurenceau N, Louzas I, Mikala M, Gariod S, Beaumont G, Rudigoz RC, Gaucherand P.Gynecol Obstet Fertil. 2004 Apr;32(4):285-92. doi: 10.1016/j.gyobfe.2004.02.007.PMID: 15123097
https://pubmed.ncbi.nlm.nih.gov/15123097/
Abstract:
Objective: Preterm labor is one of the major causes of concern for level I and II obstetricians. The purpose of this study was to determine the incidence of in utero transfer performed for preterm labor. We also aimed to evaluate the algorithm we used in case of call for preterm labor. This algorithm allowed us to study the rate of endovaginal sonography use prior to in utero transfer, to calculate its predictive value and to evaluate the risk of delivery during transfer.
Patients and method: We conducted an 8-months prospective study of all calls for preterm labor received at a regional call center in France (EU). All obstetrical data were entered in a computerized anonymous database. Three months after the first call midwives collected data from the receiving hospital.
Results: Calls for preterm labor account for 40% of calls for in utero transfer. Two hundred and sixty-five calls have been received for preterm labor; among them 50 cases were associated with a preterm rupture of membrane, a maternal or fetal pathology and 14 cases were lost for follow-up. Those 64 cases were excluded leaving 201 cases for analysis. Twenty-eight had a cervix dilated 4 cm, or more, while 173 had a cervix dilated less than 4 cm. Fifty percent of woman that had a cervical dilatation of 4 cm or more delivered more than 4 h after the call. Among the 173 patients that had a cervix dilated less than 4 cm, 71% had not delivered 7 days after the hotline call and 26% had an endovaginal ultrasonography performed before the transfer. None of the women that had a cervical length longer than 27 mm delivered in the 7 following days. None of the 176 women that were transferred delivered during the transfer.
Discussion and conclusion: In utero transfer for preterm labor is the leading cause of in utero transfer. Endovaginal ultrasonography prior to transfer should be performed in order to avoid unnecessary transfer. Women who have a preterm labor with a cervical dilatation of 4 cm or more are not an absolute contra-indication to in utero transfer. In those cases the transfer indication should be discussed on a case-to-case basis including the actual term and the distance between hospitals.
(Article in French)
Clerc J, Gaucherand P, Berland M, Dupuis O.Gynecol Obstet Fertil. 2009 Mar;37(3):222-8. doi: 10.1016/j.gyobfe.2009.01.007. Epub 2009 Mar 3.PMID: 19261505
https://pubmed.ncbi.nlm.nih.gov/19261505/
Abstract:
Objective: In 2006, the Ministry of Health issued a legal text relating to organization of maternal transports: “By the end of the year 2008, transfers of women and new-born babies will have to be treated in a centralized way”, have to provide a 24 hours service and can take several forms such as a regional transfer center, working for several perinatal network or a simple hotline within the level 3 maternity hospital of the perinatal network and would be managed by efficiently trained professionals. In order to help professionals to choose between various types of organizations, we considered to evaluate their degree of satisfaction with the Rhône-Alpes regional hotline center.
Patients and methods: A postal survey was carried out 15 months after the creation of the regional hotline center to the 146 obstetricians and neonatologists of the perinatal network. Eight questions dealt with the following points: organization of in utero transfers and retransfers for obstetricians on the one hand, and the organization of neonatal transfers and retransfers for pediatricians on the other hand.Moreover, several questions relating to the communication quality and the global transport organization were asked to all of these professionals. Finally, practitioners were asked whether the regional hotline center should carry on its activity or not.
Results: The response rate was 51%. Seventy-two percent of practitioners considered the regional hotline center improved the communication between professionals. 66.7% thought that it improved the organization of transport. Obstetricians get benefits in 91.7% of in utero transfers and in 63.8% of retransfers. Neonatologists get benefits in 92.3% of new born babies’ transfers and in 53,8% of retransfers. Finally, 85.3% of the doctors felt that the regional hotline center was time saving and 96% of them felt that this structure should carry on its activity.
Discussion and conclusion: In the French Rhône-Alpes region, most obstetricians and pediatricians are satisfied by a regional hotline center dedicated to in utero as well as neonate transfer.
(Article in French)
Clerc J, Doret M, Decullier E, Claris O, Picaud JC, Dupuis O.Gynecol Obstet Fertil. 2011 Jul-Aug;39(7-8):412-7. doi: 10.1016/j.gyobfe.2011.02.020. Epub 2011 Jul 13.PMID: 21742533 French.
https://pubmed.ncbi.nlm.nih.gov/21742533/
Abstract:
Objective: The main objective of this study was to calculate the percentage of preterm births before 28 weeks gestational age (weeks GA) outside level-3 maternity wards and determine how many could have been prevented.
Methods: This was an observational, multicenter, retrospective cohort study, which included all the deliveries that occurred between 24 and 27 weeks GA + 6 days in the Greater Lyon perinatal network (France) occurring between first of March 2008 and first of March 2009. In utero transfers (IUTs) and newborn transfers (NBTs) which were carried out outside the network, medical abortions, and foetal deaths in utero were excluded. The duration between patient’s arrival in the level 1 and 2 maternity and birth was compared at the 97(th) percentile of the mother’s transfer time in level-3 maternity. Births that occurred outside of level-3 maternity wards were considered avoidable each time the first duration was more than the second.
Results: During the study period, 113 infants were born alive between 24 and 27 weeks GA+6 days in the network. They were all included in the study. Ninety were born in a level-3 maternity ward and 23 were born in level-1 and 2 maternity wards (20%). There were 35 requests for IUT and 28 were carried out (80%). In 65% of non-level 3 births, no IUT was requested. In 17% of cases, an IUT request could have prevented births in level 1/2 maternity wards. If twin pregnancies had been transferred to a level-3 maternity ward, 26% of non-level 3 births would have been avoided. If all high-risk pregnancies had been transferred to a level-3 maternity ward, 40% of non-level 3 births would have been avoided.
Discussion and conclusion: Any time a pregnant woman is hospitalized in a type 1/2 maternity ward before 28 weeks GA, doctors should consider an in utero transfer to a level-3 maternity ward. It may be possible to lower the birth-rate of non-level 3 births by a targeted increase in in utero transfers and by transferring high-risk pregnancies to a level-3 maternity ward.
(Article in French)
Dupuis O, Clerc J.Rev Prat. 2009 Jun 20;59(6):843-8.PMID: 19642445
(Article in French)
D Gavanier 1, M Orsoni, O Dupuis, P J Valette Gynecol Obstet Fertil. 2012 Nov;40(11):711-4.
doi: 10.1016/j.gyobfe.2012.07.006. Epub 2012 Oct 23.
https://pubmed.ncbi.nlm.nih.gov/23099023/
Abstract:
Spontaneous hemoperitoneum is not frequent. We report here a rare cause of spontaneous hemoperitoneum during the second trimester of pregnancy. A ruptured uterine artery aneurysm was revealed in a patient who came for important abdominal pain. A CT scan showed a large hemoperitoneum and an additional arterial image. The patient underwent rapidly an embolization, which allowed a complete closure of the aneurysm. The patient gave birth to a healthy child. The diagnosis of hemoperitoneum must be discussed without delay. Once imagery realised, a good management of the patient must be done depending on the origin of the hemoperitoneum.
(Article in French)
Debord MP, Poirier E, Delgado H, Charlot M, Colin C, Raudrant D, Golfier F, Dupuis O.J Gynecol Obstet Biol Reprod (Paris). 2016 Mar;45(3):307-14. doi: 10.1016/j.jgyn.2015.04.004. Epub 2015 May 11.PMID: 25977141.
https://pubmed.ncbi.nlm.nih.gov/25977141/
Abstract:
Aim: To show the effectiveness of ultrasound-guided puncture in the treatment of lactational breast abscess and identify its risk factors.
Materials and methods: Retrospective descriptive study at the CHU of Lyon-Sud from December 2007 to December 2013, including patients with lactational breast abscess confirmed on ultrasound and treated with antibiotics and analgesics. Realisation of ultrasound-guided needle under local anesthesia by the radiologist and washing the cavity with physiological serum.
Results: Forty patients had lactational abscesses at an average of 10 weeks post-partum. Thirty-four patients were treated by needle aspiration, of which 2 had first surgical drainage. The average size of the abscess was 41.2mm. The success rate of needle aspiration was 91.2%. No cases of recurrence were observed, however, there were 5 fistulisations. In all, 91.2% were treated on an outpatient basis. In 87.8% of cases, breastfeeding was continued on the healthy side and in 48.5% of cases on the affected side. The major risk factor for abscess was mastitis in 91.1% of cases.
Conclusion: Ultrasound guidance of needle aspiration should be gold standard for the treatment of lactational breast abscesses to continue breastfeeding including the affected side.
Dupuis O, Delagrange L, Dupuis-Girod S.Orphanet J Rare Dis. 2020 Jan 7;15(1):5. doi: 10.1186/s13023-019-1286-z.PMID: 31910869 Free PMC article. Review.
https://pubmed.ncbi.nlm.nih.gov/31910869/
Open Access
Delagrange L, Dupuis O, Fargeton AE, Bernard L, Decullier E, Dupuis-Girod S.BJOG. 2023 Feb;130(3):303-311. doi: 10.1111/1471-0528.17303. Epub 2022 Oct 9.PMID: 36156839
https://pubmed.ncbi.nlm.nih.gov/36156839/
Free PMC article
Delagrange L, Dupuis O, Dupuis-Girod S.BJOG. 2023 May;130(6):690-692. doi: 10.1111/1471-0528.17420. Epub 2023 Mar 5.PMID: 36872070
https://pubmed.ncbi.nlm.nih.gov/36872070/
No abstract available
Shovlin CL, Buscarini E, Sabbà C, Mager HJ, Kjeldsen AD, Pagella F, Sure U, Ugolini S, Torring PM, Suppressa P, Rennie C, Post MC, Patel MC, Nielsen TH, Manfredi G, Lenato GM, Lefroy D, Kariholu U, Jones B, Fialla AD, Eker OF, Dupuis O, Droege F, Coote N, Boccardi E, Alsafi A, Alicante S, Dupuis-Girod S.Eur J Med Genet. 2022 Jan;65(1):104370. doi: 10.1016/j.ejmg.2021.104370. Epub 2021 Nov 1.PMID: 34737116
https://pubmed.ncbi.nlm.nih.gov/34737116/
Open Access
Eker OF, Boccardi E, Sure U, Patel MC, Alicante S, Alsafi A, Coote N, Droege F, Dupuis O, Fialla AD, Jones B, Kariholu U, Kjeldsen AD, Lefroy D, Lenato GM, Mager HJ, Manfredi G, Nielsen TH, Pagella F, Post MC, Rennie C, Sabbà C, Suppressa P, Toerring PM, Ugolini S, Buscarini E, Dupuis-Girod S, Shovlin CL.Orphanet J Rare Dis. 2020 Jun 29;15(1):165. doi: 10.1186/s13023-020-01386-9.PMID: 32600364
https://pubmed.ncbi.nlm.nih.gov/32600364/
Open Access
(Article in French)
Dupont C, Touzet S, Cao D, Prunaret-Julien V, Audra P, Putet G, Dupuis O, Rudigoz RC.J Gynecol Obstet Biol Reprod (Paris). 2005 Oct;34(6):589-99. doi: 10.1016/s0368-2315(05)82884-4.PMID: 16208202 .
https://pubmed.ncbi.nlm.nih.gov/16208202/
Abstract:
Objective: Our purpose was to measure the compliance with the network hospitals protocol for preventing neonatal group B streptococcal sepsis.
Materials and method: All vaginal deliveries during a one-week period in 37 maternities of the perinatal network were reviewed retrospectively.
Results: A total of 752 records were reviewed. Compliance with the protocol regarding the time of culture was 91.1%. Overall, prevalence of group B streptococcal carriage was 14.2%. Among patients eligible for intrapartum antibiotics, 46.4% received adequate prophylaxis. Considering the length of labor, one out of two patients could have received intrapartum adequate antibiotics. Regarding newborns, 86.1% received adequate medical surveillance. There was no confirmed case of group B streptococcal sepsis during the week of study.
Conclusion: All the maternities of network Aurore accepted and adopted evaluation principle. Some elements of protocol could be better applied, in particular delivering adequate intrapartum antibiotic prophylaxis.
(Article in French)
C. Schmitt a, F. Cotton b, M.-P. Gonnaud c, M. Berland a, F. Golfier a, D. Raudrant a, O. Dupuis a Gynecol Obstet Fertil. 2009 :70-73.
https://doi.org/10.1016/j.gyobfe.2008.10.007
Abstract:
Early postpartum bleeding remains in France the leading cause of maternal mortality in perinatal period. In association with obstetrical and medical measures to control bleeding, uterine arteries embolization constitutes an efficient non-surgical measure whose potential side effects must be kept in mind. We report the case of a patient that presented a popliteal sciatic paralysis in the hours following the procedure. Through this case, we will review the different types of embolization complications.
Dupont C, Touzet S, Cao D, Prunaret-Julien V, Audra P, Putet G, Dupuis O, Rudigoz RC.J Gynecol Obstet Biol Reprod (Paris). 2005 Oct;34(6):589-99. doi: 10.1016/s0368-2315(05)82884-4.PMID: 16208202 .
https://pubmed.ncbi.nlm.nih.gov/16208202/
Abstract:
Objective: Our purpose was to measure the compliance with the network hospitals protocol for preventing neonatal group B streptococcal sepsis.
Materials and method: All vaginal deliveries during a one-week period in 37 maternities of the perinatal network were reviewed retrospectively.
Results: A total of 752 records were reviewed. Compliance with the protocol regarding the time of culture was 91.1%. Overall, prevalence of group B streptococcal carriage was 14.2%. Among patients eligible for intrapartum antibiotics, 46.4% received adequate prophylaxis. Considering the length of labor, one out of two patients could have received intrapartum adequate antibiotics. Regarding newborns, 86.1% received adequate medical surveillance. There was no confirmed case of group B streptococcal sepsis during the week of study.
Conclusion: All the maternities of network Aurore accepted and adopted evaluation principle. Some elements of protocol could be better applied, in particular delivering adequate intrapartum antibiotic prophylaxis.
(Article in French)
G. Bagou a, B. Cabrita b, P.-F. Ceccaldi c, G. Comte a, M. Corbillon-Soubeiran d, J.-F. Diependaele e, F.-X. Duchateau f, O. Dupuis g, V. Hamel h, A. Launoy i, N. Laurenceau-Nicolle j, E. Menthonnex k, Y. Penverne h, T. Rackelboom l, A. Rozenberg m, C. Telion m
Annales françaises d’Anesthésie et de réanimation 2012 ;31 :652-665
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