PubMed Health⌕ Search

Biomedical subjects

F Goffinet

Publications and source records attributed to F Goffinet.

At least 91 records · Page 5Linked to original sources
PubMed1998

[Anatomical study of Cooper's ligament. Value in the surgical cure of urinary incontinence in women].

The objective of the study was to measure Cooper's ligament thickness in the middle and at 1, 2, 3, 4 cm and to find the best place to fix the stitches of colposuspension. This study was performed on fresh cadavers. Sixteen Cooper's ligaments were studied (8 women, mean age 78 +/- 6 years). The length, the width and thickness of Cooper's ligament at 0, 1, 2, 3, 4 cm from the middle were measured. The limits of Cooper's ligament are indefinite. This ligament is significantly thicker (p < 0.01) in the middle and at 4 cm from the middle (2.2 +/- 0.4 mm) than 1 cm (1.4 +/- 0.5), 2 cm (1.4 +/- 0.5 mm) and at 3 cm (1.9 +/- 0.3 mm) from the middle. Cooper's ligament is used to fix the stitches for colposuspension derived from Burch colposuspension (non-incision percutaneous colposuspension to Cooper's ligament, laparoscopic colposuspension...) and sometime help to fix meshes in frondes procedures and the vagina in the Bologna procedure. This study showed the best point to fix the stitches (by its thickness) for colposuspension on this ligament at 4 cm from the middle (the fixation at the origin exposing to periostitis).

Aged↗
PubMed1997

Multicenter study on the clinical value of fetal pulse oximetry. I. Methodologic evaluation. The French Study Group on Fetal Pulse Oximetry.

OBJECTIVE: Our purpose was to evaluate the feasibility of intrapartum fetal pulse oximetry, the distribution of fetal oxygen saturation values, and the relationship with the neonatal outcome in a population with an abnormal fetal heart rate. STUDY DESIGN: A prospective multicenter observational study was performed from June 1994 to November 1995. Fetal oxygen saturation was continuously recorded with use of a Nellcor N-400 fetal pulse oximeter in case of an abnormal fetal heart rate during labor. Simultaneous readings of fetal oxygen saturation and fetal blood analysis were obtained at inclusion and before birth. Feasibility, adverse effects, distribution of fetal oxygen saturation values, and relationship with neonatal outcome were assessed. RESULTS: One hundred seventy-four patients were included. From 172 attempted sensor placements, the procedure was impossible in three cases and fetal oxygen saturation values were obtained in 164 cases (95.3%). Physicians considered sensor placement an easier task than an attempt at fetal blood analysis (easy in 87.5% vs 78.9% for fetal blood analysis, p = 0.03). The mean reliable signal time (+/- SD) was 64.7% +/- 32% during the first stage. There were no serious adverse effects in the study population. The mean fetal oxygen saturation during the first stage of labor was 42.2% +/- 8.0% (10th to 90th percentile range 30% to 53%). Fetal oxygen saturation was significantly correlated with scalp pH (r = 0.29, p = 0.01) but not with neonatal umbilical artery pH or gas values. There was a significant association between low fetal oxygen saturation (< 30%) and poor neonatal condition. CONCLUSION: The feasibility of fetal pulse oximetry is satisfactory in clinical practice. It is easy to use and provides a fair rate of recorded values, even in a population with suspicion of fetal distress. A low fetal oxygen saturation is significantly associated with an abnormal neonatal outcome.

Adult↗
PubMed1997

Multicenter study on the clinical value of fetal pulse oximetry. II. Compared predictive values of pulse oximetry and fetal blood analysis. The French Study Group on Fetal Pulse Oximetry.

OBJECTIVE: Our purpose was to compare the predictive value of intrapartum fetal pulse oximetry with that of fetal blood analysis for an abnormal neonatal outcome in case of an abnormal fetal heart rate. STUDY DESIGN: A prospective multicenter observational study was conducted from June 1994 to November 1995. Fetal oxygen saturation was continuously recorded with a Nellcor N-400 fetal pulse oximeter in case of an abnormal fetal heart rate during labor. Simultaneous readings of fetal oxygen saturation and fetal blood analysis obtained before birth (i.e., either at full dilatation or before cesarean section when indicated) were compared with the neonatal status. The criteria for an abnormal neonatal outcome were (1) an umbilical arterial blood pH < or = 7.15 and (2) a combined variable including 5-minute Apgar score < or = 7, umbilical arterial pH < or = 7.15, secondary respiratory distress, transfer in a neonatal care unit, or neonatal death. RESULTS: At a 7.20 threshold for fetal scalp pH and 30% for fetal oxygen saturation (i.e., the 10th percentile in the study population), the predictive value of fetal pulse oximetry was similar to that of fetal blood analysis for an arterial umbilical pH < or = 7.15 and for an abnormal neonatal outcome (positive predictive value 56% vs 55%, negative predictive value 81% vs 82%, sensitivity 29% vs 35%, and specificity 93% vs 91%, respectively). The receiver-operator characteristic curve showed similar performance of either technique for cutoff values < or = 7.20 for fetal blood pH and < or = 30% for fetal oxygen saturation, whereas fetal pulse oximetry became superior at higher thresholds. CONCLUSION: The predictive value of intrapartum fetal pulse oximetry can be favorably compared with that of fetal blood analysis. Randomized controlled management trials can now be performed to assess potential clinical benefits of this new tool.

Apgar Score↗
PubMed1997

Evaluating the risk of preterm delivery: a comparison of fetal fibronectin and transvaginal ultrasonographic measurement of cervical length.

OBJECTIVE: Our purpose was to compare the predictive values for preterm delivery of fetal fibronectin and cervical length measured by transvaginal ultrasonography and to determine whether performing both tests improves their separate predictive values. STUDY DESIGN: This prospective blinded study performed both tests on 76 patients hospitalized with signs of premature labor between 24 and 34 weeks of gestation. The outcome measure was delivery before 37 weeks' gestation. RESULTS: The rate of preterm bith was 26.3% (20/76). The predictive values of fetal fibronectin and of a cervical length of < or = 26 mm, considered separately, were approximately equal, and the negative predictive value of each was excellent (86.6% and 89.1%, respectively). This value improved slightly when positive fetal fibronectin, a cervical length < or = 26 mm, or both defined abnormality (negative predictive value 94.4%). The positive predictive values, although less helpful, were still useful (45.2% and 50.0%, respectively). Combining both indicators did not noticeably improve the positive predictive value (52.4%). The risk of preterm delivery for a patient with a positive fetal fibronectin level and a short cervix was high (odds ratio 13.9, 95% confidence interval 3.7 to 52.2). CONCLUSION: Fetal fibronectin and cervical length are approximately equivalent in their ability to distinguish between patients at high and low risk for preterm delivery. For physicians equipped to perform transvaginal ultrasonography, however, the additional information about the fibronectin level provides only slight benefits.

Adult↗
PubMed1997

Predictive value of Doppler umbilical artery velocimetry in a low risk population with normal fetal biometry. A prospective study of 2016 women.

OBJECTIVE: To assess the predictive value of Doppler umbilical artery velocimetry in a low-risk population with normal fetal biometry. STUDY DESIGN: Multicenter prospective study in 17 hospitals with prenatal clinics in France. Two thousand sixteen women who, before 28 weeks gestation were defined as at low risk after routine consultation and after ultrasound. Doppler umbilical artery velocimetry was performed between 28 and 34 weeks gestation. Confounding factors were used to perform multivariate regression. RESULTS: 1903 cases were analysed and 192 (10.1%) had an abnormal Doppler Resistance Index (RI). The abnormal Doppler group contained a significantly higher frequency of severe and moderate small for gestational age infants (SGA), both severe and moderate with a sensitivity of 25.5 and 18.8% respectively. There was no difference in hypertensive disorders or criteria of fetal distress. Mean birth weight was very significantly lower in the abnormal group (162 g). Birth weight was very significantly linked to RI after taking into account confounding variables in the multiple linear regression model (continuous relationship). After multiple logistic regression, the odds ratio associated with an abnormal Doppler result, adjusted for all the confounding factors, was 2.3 (95% CI 1.5-3.7) for moderate SGA and 3.5 (95% CI of 1.8-7.1) for severe SGA. CONCLUSION: Low umbilical Doppler RI is predictive with moderate or severe SGA in a low-risk population with normal fetal biometry, even when the information generally available in clinical practice and ultrasound parameters are taken into account. There is a continuous relationship between RI and birthweight. This predictive value cannot, however, lead to an improvement in neonatal health unless effective measures to prevent SGA exist and umbilical Doppler should not be used in low-risk population on a routine basis.

Birth Weight↗
PubMed1997

Fetal pulse oximetry and fetal heart rate monitoring during stage II of labour.

OBJECTIVE: This study was designed to assess the changes in fetal oxygen saturation (FSpO2) using fetal pulse oximetry when the fetal heart rate (FHR) monitoring became abnormal during stage II of labour. STUDY DESIGN: FSpO2 was recorded with the Nellcor N400 Oximeter (FS-14 sensor) and was averaged over the last 10 min of the second stage of labour. Second stage FHR patterns were assessed according to Melchior's classification. RESULTS: In terms of FHR patterns, FSpO2-10" measured 41.4% in type 0 (n = 5), 42.4% in type 1 (n = 19), 43.3% in type 2 (n = 6), 34.0% in type 3 (n = 4) and 27.6% in type 4 (n = 7) (P = 0.03). CONCLUSIONS: FSpO2-10" decreases in cases of severe FHR abnormality during the second stage of labour and could help to decide whether to perform an instrumental extraction.

Female↗
PubMed1997

Umbilical artery Doppler velocimetry in unselected and low risk pregnancies: a review of randomised controlled trials.

OBJECTIVE: Meta-analysis of data from controlled trials performed in populations at high risk have shown that umbilical artery Doppler velocimetry (umbilical Doppler) can reduce perinatal mortality. The individual published trials among unselected or low risk populations have found no beneficial effect. Our objective was to evaluate the effect of routine use of the umbilical Doppler in unselected or low risk pregnancies by reviewing all published and unpublished randomised controlled trials. STUDY DESIGN: Systematically reviewing published and unpublished trials, we selected trials for the overview only if they were completed randomised trials of umbilical Doppler in unselected or low risk pregnancies. Of the seven trials examined, three were not included in the meta-analysis because of methodological problems or because they did not meet the inclusion criteria. We therefore included four trials: two in unselected and two in low risk populations. These four groups were comparable in their degree of maternal and perinatal risk. Using the Mantel-Haenzel statistical method and pooling the data, we considered 11,375 women in the meta-analysis. RESULTS: Systematic use of the Doppler umbilical artery velocimetry had no statistically significant effect on perinatal deaths in unselected populations (odds ratio [OR] 1.28; 95% confidence interval [CI] 0.61-2.67), low risk populations (OR 0.51; 95% CI 0.20-1.29) or overall for the four trials (OR 0.90; 95% CI 0.50-1.60); nor was there any significant effect on stillbirths (global OR 0.94; 95% CI 0.42-1.98). However, the number of participants remain insufficient and further information is required to arrive at a definite conclusion on the absence of effect. The meta-analysis showed no significant difference between the Doppler groups and the control groups for antenatal hospitalisation, obstetric outcome or perinatal morbidity. CONCLUSION: Based on the results of the published trials, routine use of the umbilical Doppler cannot be recommended.

Blood Flow Velocity↗
PubMed1997

Early amniotomy increases the frequency of fetal heart rate abnormalities. Amniotomy Study Group.

OBJECTIVE: To determine whether early amniotomy, when practised as an isolated intervention, increases the hourly rate of fetal heart rate record abnormalities. DESIGN: This is a secondary analysis of the results of a multicentre randomised trial of early versus late amniotomy in labour. SETTING: Secondary and tertiary level teaching hospitals. INTERVENTION: Early amniotomy versus an attempt to conserve the amniotic membranes. MAIN OUTCOME MEASURES: The hourly rates of early, mild variable, severe variable and late decelerations; caesarean section rates. RESULTS: Severe variable decelerations, when classified as categorical events (> or = 1/h to 2/h, > or = 2/h to < 4/h, > or = 4/h), were more frequent in the amniotomy group (chi2 for trend = 5.7, P = 0.017). The mean hourly rates of severe variable and late fetal heart rate decelerations were increased in the amniotomy group (severe variable: amniotomy group 1.4/h, control 0.7/h, P = 0.021; late: amniotomy group 3.3/h, control 2.3/h, P = 0.011). Although the overall rate of caesarean was similar in the two groups (OR 1.2; 95% CI 0.8-1.8), there was an increase in caesarean section for fetal distress (OR 2.3; 95% CI 1.1-4.5) associated with amniotomy. CONCLUSION: Our data suggest that early amniotomy increases the hourly rate of severe variable fetal heart rate decelerations without evidence of an adverse effect on neonatal outcome. In settings where the diagnosis of fetal compromise is based primarily on electronic monitoring, caesarean section for fetal distress may be increased by early amniotomy.

Adult↗
PubMed1997

[Clinical value of umbilical Doppler. Results of controlled trials in high risk and low risk populations].

OBJECTIVE: In order to assess the clinical utility of the use of arterial umbilical Doppler velocimetry, we performed meta-analysis in high and low-risk pregnancies with randomized controlled trials. We included in the low-risk meta-analysis the data of the french multicentric study submit to publication. STUDY DESIGN: Exhaustive review of published and non published trials was performed; quality of trials was assessed before inclusion in meta-analysis. Mantel-Haenzel statistic method was used. We used odds ratio with 95% confidence interval (CI) to present results. RESULTS: Meta-analysis in the high-risk population performed with 13 trials (n = 9162) shows a 36% significant reduction in perinatal-deaths in the Doppler group. The reduction in deaths was also observed in perinatal deaths after exclusion of lethal malformation (OR = 0.62, CI:[0.45; 0.86]) and in stillbirths (OR = 0.54, CI:[0.29; 0.91]). There is no difference in maternal, obstetrical and other perinatal outcomes. Meta-analysis in the low-risk population performed with 4 trials (n = 11451) does not show any benefit in the Doppler group, in particular in perinatal deaths (OR = 0.90, Cl:[0.50; 1.60]). CONCLUSION: Use of umbilical Doppler velocimetry in high-risk pregnancies involve a one third reduction in perinatal mortality. This proved effect should induce obstetricians to performed systematically an umbilical Doppler in pregnancies "at fetal risk". On the other hand, there is no indication to perform an umbilical Doppler in an unselected or a low-risk population.

Female↗
PubMed1997

[Echographic measurement of the inferior uterine segment for assessing the risk of uterine rupture].

BACKGROUND: Ultrasonography has been used to examine the scarred uterus in women who have had previous cesarean sections in an attempt to assess the risk of rupture of the scar during subsequent labor. The predictive value of such measurements has not been adequately assessed, however. We aimed to evaluate the usefulness of sonographic measurement of the lower uterine segment before labor in predicting the risk of intrapartum uterine rupture. METHODS: In this prospective observational study, the obstetricians were not told the ultrasonographic findings and did not use them to make decisions about type of delivery. Eligible patients were those with previous cesarean sections booked for delivery at our hospital. 642 patients underwent ultrasound examination at 36-38 weeks' gestation, and were allocated to four groups according to the thickness of the lower uterine segment. Ultrasonographic findings were compared with those of physical examination at delivery. FINDINGS: The overall frequency of defective scars was 4.0% (15 uterine ruptures and 10 dehiscences). The frequency of defects rose as the thickness of the lower uterine segment decreased: there were no defects among 278 women with measurements greater than 4.5 mm, three (2%) among 177 patients with values of 3.6-4.5 mm, 14 (10%) among 136 patients with values of 2.6-3.5 mm, and eight (16%) among 51 women with values of 1.6-2.5 mm. With a cut-off value of 3.5 mm, the sensitivity of ultrasonographic measurement was 88.0%, the specificity 73.2%, positive predictive value 11.8%, and negative predictive value 99.3%. INTERPRETATION: Our results show that the risk of a defective scar is directly correlated to the degree of thinning of the lower uterine segment at around 37 weeks of pregnancy. The high negative predictive value of the method may encourage obstetricians in hospitals where routine repeat elective cesarean is the standard procedure to offer a trial of labor to patients with a thickness value of 3.5 mm or greater.

Adult↗
PubMed1997

[The value of intravaginal ultrasonography of the cervix uteri for evaluation of the risk of premature labor].

OBJECTIVE: To determinate the predictive value of cervical length, measured by transvaginal ultrasound, for preterm delivery among patients with signs of preterm labor. PLACE: Department of Gynecology & Obstetrics, Poissy Hospital Center. MATERIAL AND METHODS: A prospective study that measured cervical length by transvaginal ultrasound was performed among 108 patients with a singleton pregnancy hospitalized with signs of premature labor between 24 and 34 weeks' gestation or within 21 days of inclusion. RESULTS: The rate of preterm birth was 22.2% (24/108). When cervical length was < or = 26 mm, the gestational age at delivery was significantly lower that when it exceeded 26 mm (36.3 +/- 3.0 weeks compared with 38.5 +/- 2.1 weeks; p < 0.0001). 40.4% (19/47) of patients whose cervical length was < or = 26 mm gave birth prematurely, compared with only 8.2% (5/61) of those with a cervix > 26 mm The sensitivity, specificity, positive predictive value, and negative predictive value of transvaginal ultrasonography were, respectively, 79.2, 66.6, 40.4, and 91.8% for delivery before 37 weeks' gestation, and 75.0, 62.0, 25.5, and 93.4% for delivery within 21 days of the ultra-sound measurement. CONCLUSION: Transvaginal ultrasound of the cervix provides an objective method for evaluating the risk of preterm delivery. Its predictive values are impressive and allow better discrimination between women at high risk of preterm delivery and those in false preterm labor.

Adult↗
PubMed1996

Laparoscopic unilateral ovarian transposition prior to irradiation: prospective study of 20 cases.

BACKGROUND: The objective of this study was to evaluate the feasibility, morbidity, and efficacy of unilateral laparoscopic ovarian transposition on the preservation of hormonal function in premenopausal patients requiring pelvic irradiation (external and/or intracavity by brachytherapy). METHODS: This prospective study was based on 20 patients: 17 presenting with cervical cancer, 2 with Hodgkin's disease, and 1 with ependymoma of the cauda equina. The operative technique consisted of releasing the right ovary from its pelvic attachments, and placing it as high and as laterally as possible in the right paracolic gutter, after creating a pedicle on the infundibulopelvic ligament. The follow-up of ovarian function was more than 1 year for 14 patients. RESULTS: The therapeutic protocol was not modified as a result of ovarian transposition. No intraoperative or postoperative complications were observed. The mean dose of irradiation received by the transposed ovary was 1.75 gray (Gy) (range 0.4-3.7). Mean follow-up was 2 years. Two cases of menopause (14.7%), in the only 2 patients older than 40 years, were observed among the 14 patients followed for more than 1 year. The success rate was 100% for patients younger than age 40 years. CONCLUSIONS: Laparoscopic ovarian transposition is a simple and reliable method, which does not complicate subsequent therapeutic protocol. Its short term efficiency is comparable to results obtained by laparotomy, with a lesser morbidity. Although long term evaluation is necessary, laparoscopic surgery should be considered as an alternative to laparotomy for ovarian transposition.

Adult↗
PubMed1996

Ultrasonographic measurement of lower uterine segment to assess risk of defects of scarred uterus.

BACKGROUND: Ultrasonography has been used to examine the scarred uterus in women who have had previous caesarean sections in an attempt to assess the risk of rupture of the scar during subsequent labour. The predictive value of such measurements has not been adequately assessed, however. We aimed to evaluate the usefulness of sonographic measurement of the lower uterine segment before labour in predicting the risk of intrapartum uterine rupture. METHODS: In this prospective observational study, the obstetricians were not told the ultrasonographic findings and did not use them to make decisions about type of delivery. Eligible patients were those with previous caesarean sections booked for delivery at our hospital. 642 patients underwent ultrasound examination at 36-38 weeks' gestation, and were allocated to four groups according to the thickness of the lower uterine segment. Ultrasonographic findings were compared with those of physical examination at delivery. FINDINGS: The overall frequency of defective scars was 4.0% (15 ruptures, 10 dehiscences). The frequency of defects rose as the thickness of the lower uterine segment decreased: there were no defects among 278 women with measurements greater than 4.5 mm, three (2%) among 177 women with values of 3.6-4.5 mm, 14 (10%) among 136 women with values of 2.6-3.5 mm, and eight (16%) among 51 women with values of 1.6-2.5 mm. With a cut-off value of 3.5 mm, the sensitivity of ultrasonographic measurement was 88.0%, the specificity 73.2%, positive predictive value 11.8%, and negative predictive value 99.3%. INTERPRETATION: Our results show that the risk of a defective scar is directly related to the degree of thinning of the lower uterine segment at around 37 weeks of pregnancy. The high negative predictive value of the method may encourage obstetricians in hospitals where routine repeat elective caesarean is the norm to offer a trial of labour to patients with a thickness value of 3.5 mm or greater.

Adult↗
PubMed1996

[Epidemiology of fetal deaths in the Seine-Saint-Denis perinatal survey].

OBJECTIVE: To analyse the epidemiological characteristics of antepartum stillbirths. DESIGN: A population based cases-cohort study in a limited geographical area, the department of Seine-Saint-Denis, France. Prospective collection of cases and controls between the 1989-10-01 and 1992-09-30, and retrospective collection of data. SUBJECTS: All antepartum stillbirths of 28 weeks gestation of greater, except lethal malformations and multiple pregnancies. RESULTS: 273 antepartum stillbirths were collected during the 3-year study period (52, 2% of the perinatal deaths). The causes were mainly, abruptio placenta and cordonal causes; however, unexplained antepartum stillbirth was the most important group (38, 8%). Hypotrophy was present for 49.5% of cases versus 10.1% of controls (p < 0.001). It was associated with death whatever cause or gestational age, particularly in unexplained antepartum death (54.7%). In univariate analysis, the usual risk factors including obstetrical history, socio-economic characteristics, obstetric care and country of birth were associated with death. But, in multivariate analysis, only "no pregnancy déclaration", "deficient obstetric care", "history of stillbirth", "born in Black Africa" and "born in DOM-TOM" were significantly associated with death. CONCLUSION: More than one half of perinatal deaths concern antepartum stillbirth; the causes have remained unchanged for twenty years and unexplained antepartum stillbirth remains the most important group. The principal risk factor is fetal hypotrophy. The other significant risk factors after multivariate analysis are deficient obstetric care and birth in Black Africa or in the DOM-TOM. To propose prevention actions, progress is necessary in in utero diagnostic of hypotrophy and in the understanding in the risk associated with country of origin.

Abruptio Placentae↗