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F Goffinet

Publications and source records attributed to F Goffinet.

At least 37 records · Page 2Linked to original sources
PubMed2004

[External cephalic version: experience about 237 versions at Port-Royal maternity].

OBJECTIVES: To evaluate the effectiveness of external cephalic version for reducing the rate of cesarean section by preserving fetal safety. MATERIALS AND METHODS: A retrospective review of 237 external cephalic versions between January 1, 1998 and December 31, 2000 was conducted at Port Royal maternity. RESULTS: The success rate of external cephalic version was 50.6%. When version failed vaginal birth could be allowed after strict evaluation. The rate of cesarean section was 12.5% in the success group and 53% in the unsuccessful group, two thirds were planned. The overall rate of vaginal birth among breech presentations was 67%. After version there were 3.4% abnormal fetal heart rate tracings and 2.9% positive Kleihauer tests. No major complications occurred. Successful external cephalic version was associated with statistically significant higher multiparity, complete breech out of the pelvis and normal amniotic fluid Volume. CONCLUSION: External cephalic version reduces the cesarean section rate by about 20.5% among breech presentations and so, lowers maternal morbidity. External cephalic version could be proposed to the patients when safety criteria are respected and close fetal monitoring is maintained.

Breech Presentation↗
PubMed2004

[Magnesium sulfate in obstetrics: current data].

OBJECTIVE: To review the available evidence regarding history, pharmacology, physiology, maternal/fetal side effects, and efficacy of magnesium sulfate in pregnant women. DATA SOURCES: The literature in Medline was searched from 1966 through April 2003 using the terms "magnesium sulfate," "tocolytic," "preeclampsia," "eclampsia," and "pregnancy." Reviews of bibliographies of retrieved articles provided additional references. RESULTS: Magnesium sulfate (MgSO4) has long been used for prophylaxis of preterm delivery (tocolytic affect) and eclampsia prophylaxis (neuroprotective effect). Randomized controlled trials and systematic reviews have demonstrated the efficacy of magnesium sulfate in preventing eclampsia in patients with preeclampsia or in patients with eclampsia. Whether magnesium sulfate should be administered to patients with severe preeclampsia or to mild preeclampsia is discussed in the manuscript. Inversely, it appears that magnesium sulfate is ineffective in delaying birth or preventing preterm birth when it is used as a tocolytic. Furthermore, there is evidence that high cumulative doses of magnesium sulfate may be associated with increased infant mortality. CONCLUSION: The evidence to date confirms the efficacy of magnesium sulfate therapy for women with eclampsia and preeclampsia. However, magnesium sulfate should not be used in order to treat preterm labor.

Adult↗
PubMed2004

[Mode of delivery and term breech presentation in the PREMODA cohort].

OBJECTIVES: The purpose of this work was to report labor and birth management practices for term breech presentation in France and Belgium in 2001-2002 and to describe indications for cesarean sections (before labor, emergency situations) in breech presentations. MATERIAL AND METHODS: The PREMODA cohort is a survey population which included 19408 deliveries, 8108 of which were term breech presentations. RESULTS: Infants were delivered by cesarean section before labor (59.1%), emergency cesarean section during labor (18.4%) or vaginally (22.5%). The decision for cesarean section before labor was empirical (breech presentation) in 44.3% of the cases. Half of the cesarean sections performed during labor (n=704, 49.3%) were planned C-sections. Overall, 67.8% of the breech presentations were delivered during planned cesarean sections (before or during labor). When vaginal delivery was attempted, the rate of vaginal birth was 70%. CONCLUSION: These early results reveal a high rate of cesarean section as well as differences in inter-regional practices. Considering all cesarean sections performed before labor, the most frequent indication was an empirical decision because of the breech presentation. An increased rate of planned cesarean section does not reduce the rate of vaginal delivery when attempted.

Adult↗
PubMed2004

[Prenatal risk evaluation, parent information and mode of delivery].

Perinatal networks, antenatal administration of glucosteroids, postnatal administration of surfactant, and new techniques for mechanical ventilation, have considerably improved the prognosis of extremely preterm infants. Such recent progress in perinatology had enabled neonatologists to provide intensive care for infants born after 24 and 28 weeks of gestation. This practice raises serious medical and ethical issues. The optimal mode of delivery of such newborns is not well established mainly because available studies are retrospective and subjected to biases. Moreover, perinatologists are implicated in the continuing discussion on ethical issues that modify clinical practices.

Birth Weight↗
PubMed2004

Anthracyclines during pregnancy: embryo-fetal outcome in 160 patients.

BACKGROUND: Anthracyclines are essential for the treatment of malignancies observed in pregnant patients. Knowledge of the potential side-effects of chemotherapy on the developing fetus is essential for patient counseling. PATIENTS AND METHODS: We collected information concerning patients treated with anthracyclines during pregnancy from a review of literature between 1976 and 2001 and our experience. The events analyzed were malformations, fetal death and spontaneous abortion. A chi(2) test with a Yates correction was used to compare the distribution of severe events. RESULTS: A total of 160 patient pregnancies were analyzed. The fetal outcome was frequently normal (73%). Abnormalities included malformations (3%), fetal death (9%), spontaneous abortion (3%), fetal complications (8%) and prematurity (6%). Fetal death was often directly consecutive to maternal death (40%). Unfavorable fetal outcome was significantly more frequent in leukemia patients (P = 0.001). In patients with solid tumors, the first trimester was significantly associated with more complications (P = 0.029). The risk of severe fetal toxicity was increased 30-fold when the dose of doxorubicin per cycle exceeded 70 mg/m(2) (P = 0.037). CONCLUSIONS: Anthracyclines may induce embryo-fetal toxicity. Nevertheless the risk seems low, especially after the first trimester and using doses of doxorubicin below 70 mg/m(2).

Abnormalities, Drug-Induced↗
PubMed2003

Bacterial vaginosis: prevalence and predictive value for premature delivery and neonatal infection in women with preterm labour and intact membranes.

OBJECTIVES: Assess the predictive values of bacterial vaginosis (BV) for preterm delivery (PD) and neonatal infection and compare them with standard markers of infection among women with preterm labour (PL). STUDY DESIGN: Prospective blinded study in a tertiary referral centre in Paris. Women hospitalised for PL with intact membranes at a term between 24 and 34 weeks were included. Vaginal fluid, collected at inclusion was Gram-stained, scored, and interpreted according to Nugent's criteria. RESULTS: Out of 354 women tested, 254 had normal flora (72.3%), 76 intermediate (21.7%) and 24 BV (6.8%). A history of spontaneous miscarriage after 14 weeks was the only risk factor significantly associated with BV. BV was not significantly associated with PD<35 weeks or neonatal infection. Very preterm delivery (before 33 weeks) was significantly associated with the flora grade (P=0.02): women with normal, intermediate and abnormal flora, respectively had 27 (10.6%), 14 (18.4%) and 6 (25.0%) births before 33 weeks. Of the markers tested, the highest risk of very preterm delivery was associated with BV (odds ratio 2.95, 95% CI (1.1-0.8.1)) and CRP>20mg/dl (4.23 95% CI (1.8-9.7)). Predictive value of BV for preterm birth before 33 weeks were: sensitivity 12.8%, specificity 95.0%, positive predictive value 35.3%, and negative predictive value 84.3%. CONCLUSIONS: The frequency of BV and its association with PD are probably very variable and must be interpreted differently from one population to another. While we found an association between BV results and delivery before 33 weeks, the predictive value of BV was disappointing. Although these findings reinforce the importance of a useful marker of subclinical infection, the usefulness of testing for BV in women with PL has not been demonstrated.

Abortion, Spontaneous↗
PubMed2003

[Per-partum anoxia and handicaps: epidemiological aspects].

Although per-partum anoxia accounts for only a small part (less than 10%) of the etiology of cerebral palsy, statistical computations, based on current epidemiological data, show that, when per-partum anoxia is associated with suboptimal care 9 out of 10 cases of cerebral palsy could be attributed to the anoxia.

Asphyxia Neonatorum↗
PubMed2003

[Dating biometry with crown-rump length, precision of a routine practice].

OBJECTIVE: The goal of this study was to determine the accuracy of an everyday practice for assessing gestational age by ultrasound and redefine the correction of gestational age policy. MATERIALS AND METHODS: This study used first trimester measurements taken during a three-year period. We considered all births from pregnancies that began by an in vitro fertilization procedure. We examined 143 consecutive files containing 257 measurements made by 72 different operators. We applied two reference curves to calculate the date the pregnancy began and the centiles of the prediction interval for +/- 7, +/- 5 and +/- 3 days. RESULTS: The prediction intervals for +/-7, +/-5, +/-3 days excluded 2%, 6%, and 25% respectively of the embryos from one of the two reference curves. These intervals were 1%, 5% and 20%, were better for the other curve. CONCLUSION: Correction of gestational age has to take into consideration variations in the embryo length. We correct the gestational age only if the difference with ultrasound assessment is more than one week.

Adult↗
PubMed2003

[Survey of the practice of cervical ripening and labor induction in France].

OBJECTIVES: Labor induction is a widespread medical practice in France. The medical or obstetric indications for induction as well as the protocols used probably vary from one maternity to another. The objective of this national survey was to describe current medical practices and procedures in France, regarding labor induction and cervical ripening, eight years after the national consensus on labor induction management. A second objective was to assess mothers' opinion on the induction of their labor/level of satisfaction on their childbirth experience. MATERIALS AND METHODS: The sample of maternities was randomly extracted from a list published by the French Ministry of Health. Sampling was performed according to maternity size, geography, and private vs public. Medical information was collected on consecutive labor induction cases in each maternity. Mother's opinions were estimated through a score based on the validated Labour Agentry Scale. RESULTS: Within the 38 maternities included, 21 (55.3%) were public, and 17 (44.7%) private. 1192 women were included in this study and 1090 (91.4%) answered the questionnaire on level of satisfaction. Global rate of elective induction (no medical or obstetric indication) was 24.8% (n=295). Prostaglandins are almost as widely used as oxytocin (45.8% and 47.7% of total labor inductions, respectively). Mostly used methods of delivering prostaglandin are intravaginal (27.1%), controlled-release pessaries (10.2%) and intracervical (8.1%). Among the elective inductions, an important rate of unfavorable cervix was found (n=81, 27.5%) as well as a quite high level of use of prostaglandins (n=51, 17.3%). The statistically independent criteria linked to a high satisfaction score are an older age (OR=1.58; CI 95% [1.80-3.33]), an elective induction (OR=2.44; IC 95% [1.80-3.33]) and a favorable cervix (OR=1.47; [1.08-1.98]). CONCLUSION: The use of prostaglandins in labor induction and cervical ripening is now widespread in France. This technique is not always used in accordance with available scientific data. These results should lead health professionals to set up an evaluation process for their practices, when these are not based on clear scientific evidence.

Adult↗
PubMed2002

Mothers' knowledge of screening for trisomy 21 in 1999: a survey in Paris maternity units.

OBJECTIVE: To assess mothers' knowledge of screening tests for trisomy 21. STUDY DESIGN: Interview of all women who had recently delivered a healthy child and were present in 15 Paris maternity units during one of the two non-consecutive days in June 1999 (N = 734). RESULTS: Two-third said that they had access to a nuchal translucency measurement (NTM) and to maternal serum screening (MSS), and 16% to amniocentesis. Thirty-eight percent of the women who had NTMs and 69% of those who had serum screening said that they had been informed of the need for amniocentesis if the results were abnormal. Among the women who had amniocentesis, 20% did not know the risk of miscarriage and 41% had not been informed about the possibility of terminating the pregnancy if trisomy 21 was diagnosed. CONCLUSIONS: Mothers' knowledge about the screening tests for trisomy 21 remains fragmentary. Providing comprehensive information about all these tests should be considered in early pregnancy so that women can make informed choices.

Adult↗
PubMed2002

[Fetal macrosomia: management, obstetrical and neonatal results. Multicenter case-control study in 15 maternity hospitals in Paris and the Ile de France area].

OBJECTIVE: To study the perinatal management of fetal macrosomia (FM) and the obstetrical and neonatal results related to FM in the Ile de France area. MATERIALS AND METHODS: Case-control study from the fifteenth of July to the fifteenth of September 1999 in fifteen maternity in Paris and the Ile de France area. All singletons, without malformation, weighing more than 4,000 grams, born after 37 weeks of pregnancy during the study were included. The control group had the same inclusion and exclusion criteria (except the birth-weight) and was defined by the next delivery of same parity. RESULTS: 384 FM and 384 controls have been included. Usual risk factors of macrosomia have been found. The screening of gestational diabetes was realised in 56.8% and FM was suspected before delivery in 59.3% in the FM group. In cases of FM, the midwife was alone at the time of delivery in 53.4% of spontaneous vaginal delivery. FM was associated with a longer labour and a more frequent use of oxytocin. There was six times more severe perineal tears (1.7 vs 0.3%; p = 0.05) for women with FM whereas the rate of haemorrhage at delivery was the same in both groups. Cesarean section' rate before and during labor was higher in the FM group whereas instrumental extraction was not different. In this study, FM was not associated with an excess of fetal morbidity (injury, Apgar score, pH cord) even if we found ten times more shoulder dystocia. CONCLUSION: Complications related to FM were mainly maternal in this study. Some recommendations accounting fetal macrosomia were not widely adopted as screening of gestational diabetes or necessity to have a whole obstetric team at the time of delivery.

Adult↗
PubMed2002

Laparoscopic surgery is not inherently dangerous for patients presenting with benign gynaecologic pathology. Results of a meta-analysis.

BACKGROUND: Laparoscopic surgery presents a large number of advantages over laparotomy. The goal of this work was to check whether these benefits outweigh any greater risk of complications. METHODS: The study design was a meta-analysis of published data from prospective randomized clinical trials (RCT). For the period 1966 to June 2000 we searched Medline and Cochrane Controlled Trial Registers and asked the investigators for further details. Meta-analysis was carried out with the Cochrane review manager software RevMan 4.1. RESULTS: A total of 27 prospective RCT including 3611 women (1809 treated by operative laparoscopy and 1802 treated by laparotomy) were enrolled in the meta-analysis. The overall risk of complications was significantly lower for patients operated by laparoscopic surgery [relative risk (RR) 0.59; 95% confidence interval (CI) 0.50-0.70]. There was no statistically significant difference concerning the risk of major complications with respect to the approach used (RR 1.0; 95% CI 0.60-1.65). The risk of minor complications was significantly lower for patients operated by laparoscopic surgery (RR 0.55; 95% CI 0.45-0.66). Concerning the risks of readmission, second procedure and blood transfusion, there was no difference between the two groups. Identical results were found when we performed a sensitivity analysis including or excluding studies according to the methodological score. Subgroup analysis according to how serious the surgery was (minor, major, advanced) showed a significant increase in the risk of transfusion for advanced procedures performed by laparotomy. CONCLUSIONS: Laparoscopic surgery is not inherently dangerous for patients presenting benign gynaecological pathologies. The potential risk of complications should no longer be advanced as an argument against using laparoscopic surgery rather than laparotomy for an operation when the indication allows the choice.

Female↗