Gynecologie Obstetrique Fertilite & Senologie最新文献

Objective: The management of patients with endometriosis remains marked by a long, fragmented, and poorly coordinated care pathway, leading to significant diagnostic delay. In this context, the regional EndOccitanie network is being developed to improve the organization and quality of care. The aim of this study was to identify the expectations of patients regarding this network.

Methods: We conducted a descriptive epidemiological study using an online questionnaire administered through the LimeSurvey platform and distributed via the patient associations EndoFrance, Endomind, and the EndOccitanie network. Participants, all diagnosed with endometriosis, evaluated various aspects of their care pathway using a Likert scale.

Results: The results highlight several priority expectations: access to clear and reliable information, the implementation of a coordinated and accessible care pathway, and a comprehensive approach to the disease, including pain management, sexuality, and fertility.

Conclusion: These findings underscore the need to further strengthen the structuring of the EndOccitanie network in order to improve the accessibility, continuity, and quality of care. A future reassessment will help measure the impact of the actions implemented.

Objectives: Management of pregnancies of unknown location (PUL) relies on close monitoring with serial human chorionic gonadotropin (hCG) measurements and repeated ultrasound examinations to exclude ectopic pregnancy (EP). Although safe, this strategy leads to multiple consultations and significant organizational and economic burden. This paper aims to develop and preliminarily validate a simplified clinical algorithm to stratify the risk of EP in women presenting with PUL, in order to adapt follow-up frequency.

Methods: The prospective monocentric OPTIGLI study was conducted at Nantes University Hospital between May and September 2023. All women presenting with PUL were included after informed non-opposition. Fifteen clinical, biological, and ultrasound variables were analyzed using univariate and multivariate logistic regression. A composite predictive score was constructed from significant variables, and its positive predictive value (PPV) and negative predictive value (NPV) were calculated. Economic evaluation and patient satisfaction assessment were also performed.

Results: A total of 162 patients were included; the EP rate was 19.8%. Pregnancy occurring with a copper intrauterine device (IUD) was significantly associated with EP (p = 0.0089). The presence of a lateral uterine mass was associated with earlier EP diagnosis (p = 0.0169). The algorithm showed an NPV of 99.0% and a PPV of 22.0%, allowing reduced follow-up intensity in two-thirds of patients, with an estimated cost reduction of nearly euro10,000 over four months.

Conclusion: The OPTIGLI algorithm is a simple and safe tool for rationalizing PUL management. Multicenter validation is required to confirm its robustness and potential integration into national clinical protocols.

Apart from calcium supplementation, which is beneficial in women with inadequate intake, low-dose aspirin is the only drug with established efficacy for the primary prevention of preeclampsia. Its mechanism - restoration of the thromboxane A2 / prostacyclin balance through platelet cyclo-oxygenase-1 inhibition - accounts for its efficacy in placental vascular disease, and its benefit depends on a dose of 100 to 160 mg, evening intake and, above all, initiation before 16 weeks. The question is no longer whether it works, but in whom, and whether this can be known early enough. Three early identification strategies have been evaluated in turn. Clinical risk factors, used by the historical trials and then by Anglo-Saxon guidelines, are either too restrictive - a history of preeclampsia by construction excludes nulliparous women - or so broad that up to 85% of women would become eligible. First-trimester uterine artery Doppler, a direct reflection of trophoblastic invasion, offered an attractive pathophysiological rationale; the double-blind randomised trials nevertheless proved negative, including the French PERASTUN trial conducted in 1,104 nulliparous women selected on this criterion alone and treated with 160 mg before 16 weeks (16.0% vs 14.4%), Doppler alone lacking specificity and selecting a population with low absolute risk whose preeclampsia is mostly late - precisely where aspirin has no effect. Combined algorithms, associating maternal factors, mean arterial pressure, Doppler and PlGF, perform better: the ASPRE trial reduced preeclampsia before 37 weeks of gestation by 62%, though part of the benefit arose from women already identifiable by their history; the ongoing French RANSPRE trial randomises the screening strategy itself for the first time. This uncertainty about the target population explains the marked heterogeneity of international guidelines and bears directly on safety: while the fetal profile remains reassuring at antiplatelet doses, recent maternal data, including a French nationwide cohort of 5.8 million pregnancies, show an excess of haemorrhagic complications. Defining whom to treat is the condition for preserving a favourable benefit-risk balance.

Objective: The aim of this study is to evaluate the impact of outpatient management on the transfusion rate of blood products for post-mastectomy hematoma since the implementation of the Nursing Support and Post Ambulatory Follow-up Device at Home (DIASPAD).

Method: This is a retrospective monocentric observational study carried out January 1, 2011 and December 31, 2022, at the Henri Becquerel Center. It covers all adult women undergoing total mastectomy with or without associated axillary surgery, without breast reconstruction, who developed a hematoma requiring drainage within 30 days of the initial surgery. The study assesses the use of blood products during hematoma management and compares their use according to two distinct hospitalization modes: conventional hospitalization versus outpatient hospitalization.

Results: During the study period, 80 patients required revision surgery for post-mastectomy hematoma. Twenty-eight of them received a transfusion, i.e. 35%; with no significant difference between the two hospitalization groups: 37.1% in the outpatient group and 33.3% in the conventional group (P=0.72).

Conclusion: Performing mastectomies on an outpatient basis does not appear to have an impact on the utilization rate of blood products when complicated by hematoma.

Maternal mobilisation and upright positions during labour are recommended by both the World Health Organization (WHO, 2018) and the French National Authority for Health (HAS, 2017) for low-risk women, and more recently by the 2025 SFAR-CARO-HAS guidelines on neuraxial analgesia. Physiologically, upright positions and postural changes optimise uterine dynamics through gravity, improve utero-placental perfusion by preventing aorto-caval compression, and take advantage of pelvic mobility which modifies the diameters of the pelvic inlet and outlet by several millimetres. Cochrane systematic reviews suggest that during the first stage of labour, upright positions and ambulation shorten labour duration and reduce the use of epidural analgesia, with moderate-quality evidence limited by methodological heterogeneity and risk of bias. During the second stage, upright positions shorten expulsion in women without epidural; the BUMPES trial and recent meta-analyses by Verastegui-Martín and Pan do not show a major clinical benefit of upright positions under low-dose epidural, although no detrimental effects are identified. According to the 2021 French Perinatal Survey, 82.7% of women received epidural analgesia and 74.2% used PCEA. Despite consistent guidelines, mobilisation remains underused. Barriers are organisational, technical (including the lack of one-to-one midwifery care), cultural and related to maternal preferences. Promoting a culture of mobility requires interprofessional training, suitable equipment and early antenatal information.

Objective: Historically used for screening gestational diabetes, testing for glycosuria during pregnancy is now controversial. Despite the low diagnostic performance of this test, the "Haute Autorité de Santé" (HAS) recommends performing it at each prenatal visit. However, this practice represents an estimated annual cost of 2 million euros in France. The aim of this study was to evaluate French practices regarding glycosuria prescription and the management adopted by practitioners in case of a positive result.

Materials and methods: An observational study was conducted using a questionnaire distributed to healthcare professionals in France between August 31, 2024, and April 1, 2025. A univariate comparative analysis was performed according to whether glycosuria was prescribed or not, and according to the management implemented in cases of positive glycosuria.

Results: A total of 1132 responses were collected. Glycosuria was prescribed by 62% of respondents during pregnancy follow-up. In the event of a positive result, 45% of practitioners took no action, 45% prescribed screening for gestational diabetes using fasting blood glucose or an oral glucose tolerance test (OGTT), and 10% reinforced dietary and lifestyle advice during the consultation. Glycosuria prescription was significantly more frequent among midwives (P=0.04), practitioners working in private practice (P=0.01), in private healthcare facilities (P=0.04), and in type 1 maternity units (P=0.01).

Conclusion: Glycosuria continues to be prescribed by the majority of practitioners, but with highly heterogeneous practices across France and without evaluation of its effectiveness. Glycosuria testing is costly, and its performance in screening for gestational diabetes has not been demonstrated. Reassessment of its role in prenatal care in France appears necessary.

Objective: Since the LACC trial, the ESGO has favoured laparotomy over laparoscopy for radical hysterectomy in early-stage cervical cancer. The aim of our study was to compare recurrence-free survival (RFS) and morbidity between laparoscopy and laparotomy.

Materials and methods: A single-centre, retrospective observational study (2005-2024) of patients treated with type C radical hysterectomy for stage IA2-IIA1 cervical cancer. The use of an intrauterine manipulator without creating a vaginal collar was routine in laparoscopic surgery.

Results: One hundred and two female patients were included, 65 of whom underwent laparoscopic surgery and 37 laparotomy. With a mean follow-up of 6.2 years, no significant difference was observed in terms of disease-free survival (81.6% for laparoscopy vs 74.2% for laparotomy; P=0.24). After adjusting for stage and conisation, the hazard ratio for recurrence following laparotomy was 1.74 (95% CI: [0.67-4.51]). Long-term overall survival showed no difference between the surgical approaches. Laparoscopy offered significant advantages in terms of blood loss (140.6±264ml vs 228±229ml; P<0.05) and length of hospital stay (4.3±2.6 days vs 7.0±2.8 days; P<0.05). Major complications (Clavien-Dindo III-IV) were similar (7.7% with laparoscopy vs 5.4% with laparotomy; P=0.65).

Conclusion: When performed by surgeons trained to deal with tumours of a medium size (<2cm), laparoscopy did not compromise overall survival compared with laparotomy, whilst significantly reducing perioperative morbidity.