Journal de gynécologie, obstétrique et biologie de la reproduction
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J Gynecol Obstet Biol Reprod (Paris) · Jan 2015
[Epidemiology of maternal mortality by infectious cause in France, 2007-2009, using data from confidential maternal mortality report].
Although deaths caused by infection during pregnancy and the postpartum period are rare in France, mortality rates have increased in several countries of the European community. In France, the rate of maternal mortality by infectious cause has decreased over the last 12 years. Infectious causes are currently in fifth place of maternal deaths. ⋯ These cases of puerperal septicemia show that when sepsis is clinically manifest, infection is already well established and widespread deterioration is therefore often irreversible. Maternal mortality is preventable in most cases if several points are observed: early diagnosis, probabilistic antibiotics targeting most frequently involved bacteria including Escherichia coli and Streptococcus A, early transfer to ICU, control septic portal entry, simple preventive measures, influenza vaccination. A "microbiological clinical diagnosis" approach must be initiated at the first clinical signs.
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J Gynecol Obstet Biol Reprod (Paris) · Jan 2015
[Prevalence of burnout among obstetrics and gynecology residents].
Prevalence assessment of burnout among obstetrics and gynecology residents and predisposing factors. ⋯ There is a strong personal accomplishment among obstetrics and gynecology residents; however, burnout and emotional exhaustion remains a reality during obstetrics and gynecology residency.
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Produce recommendations for the management of placenta previa and placenta accrete. ⋯ Placental insertion abnormalities require anesthetic and obstetric coordination. Delivery must be planned in a suitable structure.
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J Gynecol Obstet Biol Reprod (Paris) · Dec 2014
Review[Clinical and pharmacological procedures for the prevention of postpartum haemorrhage in the third stage of labor.]
To describe the clinical and pharmacological procedures for the prevention of Postpartum Haemorrhage (PPH). ⋯ Vaginal birth: only the use of uterotonics reduces the incidence of PPH. Oxytocin is the treatment of choice if it is readily available (grade A). Oxytocin can be used either after the shoulders expulsion or rapidly after the placental delivery (grade B). A dose of 5 or 10IU must be administrated IV over at least 1minute or directly by an intramuscular injection (professional agreement) except in women with documented cardiovascular disease in which the duration of the IV perfusion should be over at least 5minutes (professional agreement). Mechanical procedures have no significant impact on PPH. The decision to use a collector bag is left to the medical team (professional agreement). A systematic complementary oxytocin perfusion is not recommended (professional agreement). Caesarean delivery: There is no evidence to recommend a particular type of caesarean technique to prevent PPH (professional agreement) but a lower uterine section is recommended (grade B). All types of incision expansion may be used (professional agreement). A controlled cord traction is associated with lower blood losses than manual removal of the placenta (grade B). A dose of 5 or 10IU can be injected (IV) over 1minute, and over 5minutes in women with cardiovascular disease (professional agreement). Carbetocin reduces the incidence of PPH but there is presently no inferiority study comparing oxytocin and carbetocin so that oxytocin remains the gold standard therapy to prevent PPH in C-section (professional agreement).