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Biomedical subjects

B Carbonne

Publications and source records attributed to B Carbonne.

At least 19 recordsLinked to original sources
PubMed2006

[Economic analysis of the prevention of anti-D immunization].

Any prevention policy has a cost. For anti-D immunization, the main questions concern the cost of a change in the prevention policy by the health insurance fund and more globally by the society in general. Furthermore, the analysis must also examine the cost effectiveness of systematic prevention extended to all Rhesus negative women in comparison with targeted prevention or no prevention. Studies published in Great Britain, Canada, and The United States have generally concluded that the raw cost of systematic prevention is high compared with targeted prevention. On the other hand, the cost-effectiveness would favor the systematic approach. These data are difficult to apply to the French situation because health care costs are different and because of the lack of perfectly reliable epidemiological data on the frequency and consequences of severe forms of allo-immunization. Technological advances, particularly concerning genotyping of fetal Rhesus from maternal blood samples, could have an important impact on the cost factor if a systematic approach is adopted.

Cost-Benefit Analysis↗
PubMed2005

[Prevention of recurrent preterm birth: a comeback for progesterone?].

Progesterone has been prescribed for many years in women with preterm labor despite the lack of benefit for the fetus or neonate. The description of increased risk of intrahepatic cholestasis of pregnancy led to discontinuation of this prescription. Recently, several double-blind randomized trials have focused on the usefulness of progesterone for the prevention of recurrent preterm birth. In this review, we re-examine the pathophysiological rationale for the use of progesterone and discuss the biases and limitations of older studies, detailing two recent randomized trials which suggest use of progesterone should be revisited. Data from these trials appear to provide convincing evidence that preventive use of 17 alpha-hydroxyprogesterone administered by injections early in the course of pregnancy is effective only for women with a history of preterm delivery. This prescription could be part of a more global preventive strategy together with cervical cerclage and preventive treatment of bacterial vaginitis. During treatment, it is advisable to search for secondary hepatic effects. Conversely, there are still no data favoring the use of progesterone for preterm labor. Most preterm deliveries occurring in women without a history of preterm birth preventive use of progesterone should remain a rare indication.

17-alpha-Hydroxyprogesterone↗
PubMed2005

[Operative termination of pregnancy between 12 and 14 weeks' gestation: influence of the operator's experience].

OBJECTIVE: To assess the feasibility of operative termination of pregnancy between 12 and 14 weeks of gestation and the role of the operator's experience in physicians previously unfamiliar to this technique. MATERIALS AND METHODS: A prospective study of 251 operative terminations of pregnancy, from July 1st, 2001 to January 31st, 2002, and from May 1st, 2002 to October 31st, 2002, in order to assess the role of operator's experience. 104 terminations between 12 and 14 weeks were compared to 147 terminations at earlier gestational ages. All patients received cervical ripening with 400 mcg oral misoprostol 3-4 hours before operation performed under general anesthesia. Evaluation criteria were: duration of operation, need for use of forceps, and complications: uterine perforation, cervical laceration, bleeding > 500 ml and need for blood transfusion. RESULTS: There was no difference in the rate of operative complications between terminations before and after 12 weeks. The duration of operation was slightly longer after 12 weeks than before (12.9 +/- 6.7 min versus 11.1 +/- 2.8 min.; p < 0.05). Forceps use was 0.7% before 12 weeks, 20% between 12 and 13 weeks, and 59% between 13 and 14 weeks (p < 0.01). There was no difference in the complication rate or in the need for forceps according to the operator's experience. The perceived difficulty in cervical dilatation was higher in early experience than in experimented operators (19.6% versus 5.2%; p < 0.05). CONCLUSION: Operative termination of pregnancy is technically feasible beyond 12 weeks without dramatic increase in operative complications. Technical skill can be acquired in a short time interval.

Abortifacient Agents, Nonsteroidal↗
PubMed2005

[Acute pulmonary edema during preterm labor: role of nicardipine tocolysis (three cases)].

Beta adrenergic agonists are still used as first line treatment for preterm labor in many institutions, but their side effects lead to use alternative tocolytic drugs such as calcium channel blockers. We report three cases of pulmonary edema during preterm labor associated with the use of calcium channel blocker, intravenous nicardipine, widely used for tocolysis in France. In this article, potential mechanisms of this severe complication are briefly discussed: pregnancy-induced overload, deleterious hemodynamic effects of calcium channel blockers, concomitant administration of calcium channel blockers and/or beta-agonists and finally concomitant administration of physiological saline and/or glucocorticoids. Based on our experience, we recommend avoiding the association of calcium channel blockers and beta-agonists for preterm labor. Nicardipine, if used, should be administered at an adjusted dose with electric syringe to reduce volume infusion.

Acute Disease↗
PubMed2004

Association of a fetal quadrigeminal cyst with a possibly congenital thalamic astrocytoma.

CASE REPORT: This article reports on the exceptional association of a fetal quadrigeminal malformative cyst with a possibly congenital pilocytic astrocytoma of the pulvinar. Both the cyst and the tumor required treatment due to their postnatal growth. DISCUSSION: Treatment modalities and difficulties are emphasized, as well as the difficulties of prenatal counseling.

Adult↗
PubMed2004

Antiphospholipid syndrome and second- or third-trimester fetal death: follow-up in the next pregnancy.

OBJECTIVE: To evaluate the efficacy of a uniform management protocol in antiphospholipid-antibody-positive obstetric patients with at least one second- or third-trimester intra-uterine fetal death. STUDY DESIGN: A prospective study of 33 successive pregnancies in antiphospholipid-antibody-positive patients, diagnosed after an intra-uterine fetal death. The management included treatment by a combination of aspirin and low-molecular-weight heparin, and a close follow-up with at least clinical examination, ultrasonography, uterine, and umbilical artery Doppler monthly from the first trimester. In the absence of any anomaly, delivery was induced between 37 and 38 weeks' gestation. RESULTS: In this high risk population, seven recurrences of vascular pathology occurred: five cases of mild, isolated fetal growth retardation and one of preeclampsia associated with fetal growth retardation requiring preterm delivery. Eight patients were delivered before 37 weeks. No recurrence of second- or third-trimester fetal death was observed. Uterine artery Doppler was informative as early as the first trimester (12-15 weeks): a bilateral notch was associated with a lower birthweight (2626+/-688 g versus 3178+/-353 g, respectively, p = 0.01), despite similar gestational age. The negative predictive value of uterine Doppler was more than 92% at 12-15 weeks' gestation and remained high throughout pregnancy. CONCLUSION: Although intra-uterine fetal death is considered at high risk of recurrence in case of antiphospholipid syndrome (APS), a uniform management protocol including aspirin and heparin and close obstetrical follow-up led to a favorable outcome in most cases.

Adult↗
PubMed2004

[Surgical site infections after cesarean section: results of a five-year prospective surveillance].

AIMS: To determine the incidence of surgical site infections and to identify risk factors for infections. METHOD: A prospective study of surgical site infections (SSI) after cesarean section was carried out from September 1997 to September 1998 (pilot study) and from January 2000 to August 2003, using the methodology of the American National Nosocomial Infection Surveillance System. Follow up of women was performed by midwives until discharge and during the post-natal visit. Suspected surgical site infections were confirmed by surgeons and infection control practitioners. The microbiological file of each patient was edited 30 days after cesarean section. Risk factors were analyzed using a logistic regression model. RESULTS: During the pilot study, infection rate was estimated at 3.2%. At multivariate analysis, factors independently associated with an increased risk of SSI were ASA score > 1, performance of cesarean section in a room not dedicated to this activity, and use of an open urine drainage system. During the following years (2000-2003), infection rates progressively decreased to reach 1.9% in 2003. Infections included superficial wound infections (involving skin and subcutaneous tissue) (47%), deep wound infections (involving deep and soft tissue (fascia and muscle) (20%) and organ/space infections (i.e. endometritis, pelvic abscess) (33%). Infections occurred after patient discharge in 47.5% of cases and diagnosis was based only on clinical findings in 30% of cases. Infected patients were hospitalized longer (median: 6 days) than non infected patients. CONCLUSION: Prospective surveillance of SSI led to better awareness of infectious problems among health care workers, to identification of risk factors and evaluation of health procedures. Surveillance contributed to a decrease in nosocomial infections.

Adult↗