Louise Ghesquiere

and 7 more

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.

Yasmine Hamoud

and 6 more

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.

Melissa Gilbert

and 6 more

Louise Ghesquiere

and 5 more

Objective: Define the prevalence of OSA in a population of obese pregnant women. Secondary objectives were to assess its obstetric consequences and define its risk factors in this population. Design – Setting – Population – Methods: This single-center prospective study took place at the Lille University Hospital from 2010 to 2016 and included pregnant women with a body mass index (BMI) > 35 kg/m2. They underwent polysomnography (type 1 sleep testing) between 24 and 32 weeks of gestation to diagnose OSA. Clinical, obstetric, and fetal data were collected monthly and at delivery. We compared the groups with and without OSA and calculated its prevalence. Main outcome measures - Results: This study included 67 women with a mean BMI of 42.4 ± 6.2 kg/m2. Among them, 29 had OSA, for a prevalence of 43.3% (95% confidence interval, 31.4–55.2); it was mild or moderate in 25 women and severe in 4. Comparison of the two groups showed that women in the OSA group were older (31.9 ± 4.7 years vs 29.5 ± 4.8 years, P=.045), had chronic hypertension more frequently (37.9% vs 7.9%, P=.0027), and had a higher mean BMI (43.8 ± 6.2 kg/m2 vs 41.2 ± 6 kg/m2, P=.045). During pregnancy, they developed gestational diabetes more often (48.3% vs 23.7%, P=.04). No significant differences were observed for any of the other criteria studied. Conclusions: The prevalence of OSA was high in our study, and women with it developed gestational diabetes during pregnancy more often. No other obstetric complications were obser

Harmonie Dupuis

and 5 more

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