Objective - Determine what is the best initial clinical score to evaluate and propose adequate management to pregnant women with suspicion of COVID-19 infection. Design – setting – population: Retrospective study in one center (Lille, France) from 15 March 2020 to 15 April 2020. Were included all pregnant consulting in our emergency center for a suspicion of COVID-19 infection. Methods – main outcome measures: Women had a clinical, radiologic and biologic first evaluation to adapt management at home or in hospitalization. The National Early Warning Score (NEWS) and the NEWS-PREG, which is an adaptation including trimester of pregnancy, were calculated in posteriori for each patient. Sensitivity, specificity, predictive positive and negative value of these scores to propose adequate management were calculated. Results: 63 women were included. Seventeen were hospitalized (27%) among 4 in intensive care (6,5%). Sensitivity, specificity, predictive positive value and predictive negative value to predict hospitalization of the NEWS were respectively 52.9%, 100%, 100% and 85.2%. There were respectively 82.4%, 93.5%, 82.4% and 93.4% for the NEWS-PREG. Areas under the curve to predict hospitalization of the two scores were 0.77 for the NEWS and 0.88 for the NEWS-PREG. No woman was readmitted or had to be transferred from conventionel hospitalization to intensive care within 48 hours of her initial assessment and orientation. Conclusion: The NEWS-PREG is an interesting initial clinical score which can be used in case of suspicion of COVID-19 infection to propose adequate management. It will be interesting to evaluate in a prospective study.

Objective: Assess efficacy and safety of labour induction in women with one or more previous caesarean deliveries during second and third trimester pregnancy termination or intrauterine fetal death. Design: Retrospective single-centre study between 2007 and 2018. Setting: Lille, France Population: 136 women with history of previous caesarean deliveries (CD) (study group) and 272 controls undergoing labour induction for pregnancy termination or intrauterine fetal death. Methods: Before 32 weeks, misoprostol 400 μg was given orally every 3 hours up to a maximum of five doses in 24 hours. Study group received half doses. After 32 weeks, oxytocin infusion, misoprostol (PGE1) or PGE2 (dinoprostone) were used according to the Bishop score. Main outcome measures: Vaginal delivery within the 24 hours after induction without uterine rupture or severe post-partum haemorrhage defined as blood loss > 1 litre (PPH). Results: Vaginal delivery within the 24 hours after induction without uterine rupture or PPH was 83.5% in the study group versus 92.6% in the control group (p=0.005). 5 (3.7%) uterine ruptures occurred in the study group, 1.7% in case of one previous CD and 15.8% in case of 2 or more previous CD. There were more severe PPH in the study group (6.7% versus 2.2% p=0.03), but no difference was found between women with one or more previous CD. Conclusions: Women with 2 or more prior CD should be informed that they are at higher risk of complications such as uterine rupture and severe post-partum haemorrhage.

Objective - To compare the Fetal Scalp Stimulation (FSS) to Fetal Blood Sampling (FBS) as an adjunctive test of fetal wellbeing in labor in order to reduce Fetal Blood Sampling. Design – A retrospective study from February to December 2019 Setting – Monocentric study, CHRU Lille Population - Singleton pregnancy with gestational age of more than 36 weeks, cephalic fetal presentation Methods –191 FBS procedures performed for non-reassuring fetal heart rate during labor were included. A gentle digital scalp stimulation was performed for 15 seconds, two minutes before each FBS. It was considered as positive when accelerations and/or normal variability were elicited. The FBS was classified as normal when pH was < 7.25. Results - Of the 191 FBS procedures, 163 (85.3%) found a normal pH result, 122 (63.9%) and 154 (80.6%) had an acceleration and a normal variability post-FSS, respectively. When accelerations were observed after FSS, FBS pH result was normal in 91.6% cases (95%CI, 85-95). When normal variability was observed after FSS, FBS pH result was normal in 87.4% cases (95% CI, 81-92). Conclusion - This study suggests that FSS could be an interesting alternative adjunctive test to FBS as it seems to be reliable, non-invasive and easy to perform. Thus, FSS could be performed in the first instance when non-reassuring fetal heart rate is observed in order to limit FBS only to absence of acceleration after FSS.

Table 1. Characteristics of population. Table 1. Characteristics of population. Table 1. Characteristics of population. Table 1. Characteristics of population. Table 1. Characteristics of population. Table 1. Characteristics of population. Table 1. Characteristics of population. Table 1. Characteristics of population. Table 1. Characteristics of population. Table 1. Characteristics of population. Table 1. Characteristics of population. Characteristicsa Characteristicsa Characteristicsa ICS with autotransfusion N = 97 ICS with autotransfusion N = 97 ICS with autotransfusion N = 97 ICS without autotransfusion N = 196 ICS without autotransfusion N = 196 P P P Age, years Age, years Age, years 33.1 ± 5.0 33.1 ± 5.0 33.1 ± 5.0 32.5 ± 5.2 32.5 ± 5.2 0.37 0.37 0.37 BMIb, kg/m2 BMIb, kg/m2 BMIb, kg/m2 25.6 (22.3; 29.3) 25.6 (22.3; 29.3) 25.6 (22.3; 29.3) 25.4 (22.6; 29.6) 25.4 (22.6; 29.6) 0.75 0.75 0.75 Pregnancy parity Pregnancy parity Pregnancy parity 2 (1; 3) 2 (1; 3) 2 (1; 3) 2 (1; 4) 2 (1; 4) 0.22 0.22 0.22 Birth date Birth date Birth date 37 (35; 39) 37 (35; 39) 37 (35; 39) 38 (36; 39) 38 (36; 39) 0.06 0.06 0.06 Multiple pregnancy Multiple pregnancy Multiple pregnancy 10 (10.3) 10 (10.3) 10 (10.3) 18 (9.2) 18 (9.2) 0.76 0.76 0.76 History of PPHc History of PPHc History of PPHc 18 (18.6) 18 (18.6) 18 (18.6) 30 (15.31) 30 (15.31) 0.48 0.48 0.48 Obstetric indication for Cesarean Obstetric indication for Cesarean Obstetric indication for Cesarean Uterine scar Uterine scar Uterine scar 13 (13.4) 13 (13.4) 13 (13.4) 54 (27.6) 54 (27.6) 0.007 0.007 0.007 Placenta abnormality Placenta abnormality Placenta abnormality 57 (58.8) 57 (58.8) 57 (58.8) 90 (45.9) 90 (45.9) 0.04 0.04 0.04 Multiple pregnancy Multiple pregnancy Multiple pregnancy 7 (7.2) 7 (7.2) 7 (7.2) 15 (7.7) 15 (7.7) 0.90 0.90 0.90 Fetal Distress Fetal Distress Fetal Distress 6 (6.2) 6 (6.2) 6 (6.2) 18 (9.2) 18 (9.2) 0.38 0.38 0.38 Dystocia of labor Dystocia of labor Dystocia of labor 4 (4.1) 4 (4.1) 4 (4.1) 6 (3.1) 6 (3.1) 0.73 0.73 0.73 Maternal disease Maternal disease Maternal disease 8 (8.3) 8 (8.3) 8 (8.3) 15 (7.7) 15 (7.7) 0.86 0.86 0.86 Uterine abnormality Uterine abnormality Uterine abnormality 11 (11.3) 11 (11.3) 11 (11.3) 16 (8.2) 16 (8.2) 0.38 0.38 0.38 Pregnancy-related vascular disorder Pregnancy-related vascular disorder Pregnancy-related vascular disorder 5 (5.2) 5 (5.2) 5 (5.2) 14 (7.1) 14 (7.1) 0.52 0.52 0.52 Vaginal bleeding Vaginal bleeding Vaginal bleeding 4 (4.1) 4 (4.1) 4 (4.1) 6 (3.1) 6 (3.1) 0.73 0.73 0.73 Breech presentation Breech presentation Breech presentation 3 (3.1) 3 (3.1) 3 (3.1) 10 (5.1) 10 (5.1) 0.55 0.55 0.55 Type of Anesthesia Type of Anesthesia Type of Anesthesia General anesthesia General anesthesia General anesthesia 31 (32.0) 31 (32.0) 31 (32.0) 43 (21.9) 43 (21.9) 0.06 0.06 0.06 Epidural anesthesia Epidural anesthesia Epidural anesthesia 9 (9.3) 9 (9.3) 9 (9.3) 11 (5.6) 11 (5.6) 0.24 0.24 0.24 Spinal anesthesia Spinal anesthesia Spinal anesthesia 32 (33.0) 32 (33.0) 32 (33.0) 68 (34.7) 68 (34.7) 0.77 0.77 0.77 Combined spinal anesthesia Combined spinal anesthesia Combined spinal anesthesia 34 (35.1) 34 (35.1) 34 (35.1) 82 (41.8) 82 (41.8) 0.26 0.26 0.26 Urgency of Cesarean section Urgency of Cesarean section Urgency of Cesarean section Scheduled Scheduled Scheduled 65 (67.0) 65 (67.0) 65 (67.0) 138 (70.4) 138 (70.4) 0.55 0.55 0.55 Green code Green code Green code 15 (15.5) 15 (15.5) 15 (15.5) 26 (13.3) 26 (13.3) 0.61 0.61 0.61 Orange code Orange code Orange code 4 (4.1) 4 (4.1) 4 (4.1) 16 (8.2) 16 (8.2) 0.20 0.20 0.20 Red code Red code Red code 13 (13.4) 13 (13.4) 13 (13.4) 16 (8.2) 16 (8.2) 0.16 0.16 0.16 a: Values are given in terms of average ± standard deviation, in terms of median (1st quartile; 3rd quartile) or in terms of frequency (percentage). b: BMI: Body mass index c: PPH: Post-partum Haemorrhage a: Values are given in terms of average ± standard deviation, in terms of median (1st quartile; 3rd quartile) or in terms of frequency (percentage). b: BMI: Body mass index c: PPH: Post-partum Haemorrhage a: Values are given in terms of average ± standard deviation, in terms of median (1st quartile; 3rd quartile) or in terms of frequency (percentage). b: BMI: Body mass index c: PPH: Post-partum Haemorrhage a: Values are given in terms of average ± standard deviation, in terms of median (1st quartile; 3rd quartile) or in terms of frequency (percentage). b: BMI: Body mass index c: PPH: Post-partum Haemorrhage a: Values are given in terms of average ± standard deviation, in terms of median (1st quartile; 3rd quartile) or in terms of frequency (percentage). b: BMI: Body mass index c: PPH: Post-partum Haemorrhage a: Values are given in terms of average ± standard deviation, in terms of median (1st quartile; 3rd quartile) or in terms of frequency (percentage). b: BMI: Body mass index c: PPH: Post-partum Haemorrhage a: Values are given in terms of average ± standard deviation, in terms of median (1st quartile; 3rd quartile) or in terms of frequency (percentage). b: BMI: Body mass index c: PPH: Post-partum Haemorrhage a: Values are given in terms of average ± standard deviation, in terms of median (1st quartile; 3rd quartile) or in terms of frequency (percentage). b: BMI: Body mass index c: PPH: Post-partum Haemorrhage a: Values are given in terms of average ± standard deviation, in terms of median (1st quartile; 3rd quartile) or in terms of frequency (percentage). b: BMI: Body mass index c: PPH: Post-partum Haemorrhage a: Values are given in terms of average ± standard deviation, in terms of median (1st quartile; 3rd quartile) or in terms of frequency (percentage). b: BMI: Body mass index c: PPH: Post-partum Haemorrhage a: Values are given in terms of average ± standard deviation, in terms of median (1st quartile; 3rd quartile) or in terms of frequency (percentage). b: BMI: Body mass index c: PPH: Post-partum Haemorrhage Table 2. Univariate analysis: autotransfusion according to the indications for Intraoperative cell salvage (ICS). Table 2. Univariate analysis: autotransfusion according to the indications for Intraoperative cell salvage (ICS). Table 2. Univariate analysis: autotransfusion according to the indications for Intraoperative cell salvage (ICS). Table 2. Univariate analysis: autotransfusion according to the indications for Intraoperative cell salvage (ICS). Table 2. Univariate analysis: autotransfusion according to the indications for Intraoperative cell salvage (ICS). Table 2. Univariate analysis: autotransfusion according to the indications for Intraoperative cell salvage (ICS). Table 2. Univariate analysis: autotransfusion according to the indications for Intraoperative cell salvage (ICS). Table 2. Univariate analysis: autotransfusion according to the indications for Intraoperative cell salvage (ICS). Table 2. Univariate analysis: autotransfusion according to the indications for Intraoperative cell salvage (ICS). Table 2. Univariate analysis: autotransfusion according to the indications for Intraoperative cell salvage (ICS). Table 2. Univariate analysis: autotransfusion according to the indications for Intraoperative cell salvage (ICS). Indication of ICS a ; b Indication of ICS a ; b Indication of ICS a ; b ICS with autotransfusion N=97 ICS with autotransfusion N=97 ICS with autotransfusion N=97 ICS without autotransfusion N =196 ICS without autotransfusion N =196 P P P Placenta abnormality Placenta abnormality Placenta abnormality 55 (56.7) 55 (56.7) 55 (56.7) 86 (43.9) 86 (43.9) 0.039 0.039 0.039 Placenta accreta Placenta accreta Placenta accreta 27 (27.8) 27 (27.8) 27 (27.8) 24 (12.2) 24 (12.2) < .001 < .001 < .001 Placenta previa Placenta previa Placenta previa 30 (30.9) 30 (30.9) 30 (30.9) 63 (32.1) 63 (32.1) 0.834 0.834 0.834 Risk factors for uterine atony Risk factors for uterine atony Risk factors for uterine atony 22 (22.7) 22 (22.7) 22 (22.7) 33 (16.8) 33 (16.8) 0.228 0.228 0.228 Uterine fibroids Uterine fibroids Uterine fibroids 13 (13.4) 13 (13.4) 13 (13.4) 10 (5.1) 10 (5.1) 0.013 0.013 0.013 Multiple pregnancy Multiple pregnancy Multiple pregnancy 10 (10.3) 10 (10.3) 10 (10.3) 18 (9.2) 18 (9.2) 0.758 0.758 0.758 Fetal macrosomia Fetal macrosomia Fetal macrosomia 1 (1.0) 1 (1.0) 1 (1.0) 5 (2.6) 5 (2.6) - - - Uterin scar Uterin scar Uterin scar 14 (14.4) 14 (14.4) 14 (14.4) 47 (24.0) 47 (24.0) 0.058 0.058 0.058 Postoperative bleeding Postoperative bleeding Postoperative bleeding 10 (10.3) 10 (10.3) 10 (10.3) 3 (1.5) 3 (1.5) 0.001 0.001 0.001 Maternal heart disease Maternal heart disease Maternal heart disease 3 (3.1) 3 (3.1) 3 (3.1) 5 (2.6) 5 (2.6) 0.723 0.723 0.723 Pregnancy-related vascular disorder Pregnancy-related vascular disorder Pregnancy-related vascular disorder 5 (5.2) 5 (5.2) 5 (5.2) 8 (4.1) 8 (4.1) 0.765 0.765 0.765 Preeclampsia Preeclampsia Preeclampsia 2 (2.1) 2 (2.1) 2 (2.1) 3 (1.5) 3 (1.5) - - - HELLP syndrome HELLP syndrome HELLP syndrome 1 (1.0) 1 (1.0) 1 (1.0) 2 (1.0) 2 (1.0) - - - Retroplacental hematoma Retroplacental hematoma Retroplacental hematoma 2 (2.1) 2 (2.1) 2 (2.1) 3 (1.5) 3 (1.5) - - - Transfusion difficulties Transfusion difficulties Transfusion difficulties 6 (6.2) 6 (6.2) 6 (6.2) 28 (14.3) 28 (14.3) 0.042 0.042 0.042 Rare blood group Rare blood group Rare blood group 0 (0) 0 (0) 0 (0) 24 (12.2) 24 (12.2) 0.001 0.001 0.001 Jehovah’s witness Jehovah’s witness Jehovah’s witness 1 (1.0) 1 (1.0) 1 (1.0) 1 (0.5) 1 (0.5) - - - Sickle cell disease Sickle cell disease Sickle cell disease 5 (5.2) 5 (5.2) 5 (5.2) 3 (1.5) 3 (1.5) 0.121 0.121 0.121 Haemostasis disorder Haemostasis disorder Haemostasis disorder 0 (0) 0 (0) 0 (0) 8 (4.1) 8 (4.1) 0.056 0.056 0.056 Prepartum anemia Prepartum anemia Prepartum anemia 3 (3.1) 3 (3.1) 3 (3.1) 4 (2.0) 4 (2.0) - - - History of severe PPH History of severe PPH History of severe PPH 5 (5.2) 5 (5.2) 5 (5.2) 15 (7.7) 15 (7.7) 0.425 0.425 0.425 Other indication Other indication Other indication 4 (4.1) 4 (4.1) 4 (4.1) 17 (8.7) 17 (8.7) 0.228 0.228 0.228 a Values are given in terms of frequency (percentage). b Patients could have one, two or three indications for ICS. a Values are given in terms of frequency (percentage). b Patients could have one, two or three indications for ICS. a Values are given in terms of frequency (percentage). b Patients could have one, two or three indications for ICS. a Values are given in terms of frequency (percentage). b Patients could have one, two or three indications for ICS. a Values are given in terms of frequency (percentage). b Patients could have one, two or three indications for ICS. a Values are given in terms of frequency (percentage). b Patients could have one, two or three indications for ICS. a Values are given in terms of frequency (percentage). b Patients could have one, two or three indications for ICS. a Values are given in terms of frequency (percentage). b Patients could have one, two or three indications for ICS. a Values are given in terms of frequency (percentage). b Patients could have one, two or three indications for ICS. a Values are given in terms of frequency (percentage). b Patients could have one, two or three indications for ICS. a Values are given in terms of frequency (percentage). b Patients could have one, two or three indications for ICS. Table 3. Multivariate analysis: autotransfusion according to the indications for Intraoperative cell salvage. Table 3. Multivariate analysis: autotransfusion according to the indications for Intraoperative cell salvage. Table 3. Multivariate analysis: autotransfusion according to the indications for Intraoperative cell salvage. Table 3. Multivariate analysis: autotransfusion according to the indications for Intraoperative cell salvage. Table 3. Multivariate analysis: autotransfusion according to the indications for Intraoperative cell salvage. Table 3. Multivariate analysis: autotransfusion according to the indications for Intraoperative cell salvage. Table 3. Multivariate analysis: autotransfusion according to the indications for Intraoperative cell salvage. Table 3. Multivariate analysis: autotransfusion according to the indications for Intraoperative cell salvage. Table 3. Multivariate analysis: autotransfusion according to the indications for Intraoperative cell salvage. Indication of ICS OR OR OR CI 95% CI 95% CI 95% P P Placenta accreta 3.42 3.42 3.42 [1.8 ; 6.54] [1.8 ; 6.54] [1.8 ; 6.54] < .001 < .001 Uterine fibroids 3.74 3.74 3.74 [1.49 ; 9.38] [1.49 ; 9.38] [1.49 ; 9.38] 0.005 0.005 Postoperative bleeding 10.15 10.15 10.15 [2.67 ; 38.53] [2.67 ; 38.53] [2.67 ; 38.53] < .001 < .001 Transfusion difficulties 0.11 0.11 0.11 [0.015 ; 0.85] [0.015 ; 0.85] [0.015 ; 0.85] 0.034 0.034 Uterine scar 0.80 0.80 0.80 [0.39 ; 1.63] [0.39 ; 1.63] [0.39 ; 1.63] 0.536 0.536 Other 0.70 0.70 0.70 [0.21 ; 2.18] [0.21 ; 2.18] [0.21 ; 2.18] 0.519 0.519

Objective - This study aims to assess fetal physiology training in terms of theoretical knowledge, fetal heart rate interpretation and use of second-line examination. Design - - Single-center prospective study (CHU Lille, France) Setting - The evaluation of fetal well-being during labor is based on fetal heart rate (FHR) analysis and requires knowledge of physiology. Population - Obstetrics and gynecology residents from November 2017 to November 2018 (n=34) Methods – The training was conducted in 3 steps: a session of FHR interpretation and the use of fetal scalp blood sampling (FBS) on clinical cases, then a teaching session on fetal physiology, and finally another session on the same cases presented in the first one. Main Outcome Measures – Theoretical knowledge evaluation (MCQs), number of FBS requested, the reproducibility of responses. Results - Almost 3% estimated their training sufficient on fetal physiology, 11.8% on fetal heart rate analysis and 14.7% on second-line examination. The training allowed a significant improvement of their theoretical knowledge evaluation (mediane [IQR] : 1.5[1.0 to 2.0] vs 4.0[3.0 to 4.5] of MCQs, p <0.001)), a decrease in the number of FBS requested (36.3% vs 29.5%, p =0.002). The Krippendorff’s alpha index assessing the reproducibility of their response was significantly improved, reflecting a better homogenization of practices (alpha [IC95] : 0.60[0.55 to 0.65] vs 0.72[0.67 to 0.76]). Conclusions - The improvement of knowledge in fetal physiology allows a better interpretation of the FHR with better indications of second-line examinations and a homogenization of practices. Funding- None