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Biomedical subjects

J Berthet

Publications and source records attributed to J Berthet.

At least 19 recordsLinked to original sources
PubMed1999

[Instrumental and manual maneuvers during delivery].

Delivery through the maternal genital tract can be assisted or performed using specific instruments. In France, these techniques are used in 15% of deliveries. The three instruments used are the forceps, the vacuum extractor and the spatula. Manual manoeuvres are essentially used in breech presentation. These are mainly partial and total breech extractions with their many variations. The version consisting of external manoeuvering precedes delivery. In cephalic presentations, the only possible manual manoeuvre is manual rotation of the foetal head.

Extraction, Obstetrical↗
PubMed1998

Urethral cytology and diagnosis of the pregnancy term. About some observations on the use of this method in an hospital setting.

A retrospective study of routine urethrocytograms performed over a 10-year period in 3,478 pregnant women for the diagnosis of pregnancy term was carried out to determine the reliability of urethral cytology when two, three, or four successive urethral smears were performed at 2- or 3-day intervals, and to investigate the correlations between the cytological results and the neurological ages of newborns. Microscopical examination of the 3,478 routine smears demonstrated the existence of a before-term aspect, a near-term aspect, or an at-term aspect in 7.4%, 66.7%, and 22.1% of cases, respectively. The diagnosis of post-term was noted only in 1 smear. Repeated urethrocytograms (1, 2, or 3 smears after the firstone) in women with a previously diagnosed before-term aspect or a near-term aspect revealed the occurence of the at-term aspect over time. Concordant correlations between cytological results and the neurological ages of the newborns were noted in 98.1% of cases. Three developmental stages (beginning, middle, end) of the near-term aspect and three stages of the at-term aspect were described. Due to its interest, the urethral-smear method should be worth generalizing as the other laboratory examinations that are routinely used to determine the term of pregnancy.

Female↗
PubMed1995

[Reflections on compliance in menopause hormone replacement therapy].

Compliance with hormone replacement therapy (HRT) in postmenopausal women is discussed. Although accurate quantitative evaluation is difficult, estimates in French women are provided. Thirty percent of postmenopausal women are under HRT, but data are lacking on the age groups in which HRT is most prevalent. Given the benefits of HRT in terms of public health, physicians should make every effort to educate their patients, in particular regarding differences between oral contraception and HRT. Other targets for HRT education include general practitioners, health insurance agencies, and the media. Better information provided by physicians and drug companies would allow to increase the use of HRT.

Estrogen Replacement Therapy↗
PubMed1994

[Complications of delivery].

Complications of delivery are dominated by the problem of obstetric hemorrhages. Minor complications are common, concerning about 20% of all labors, while serious complications are rare: of the order of 0.1%. Their peculiarity lies in their association with blood coagulation disturbances of multifactorial origin. Treatment requires close cooperation between the anesthesiologist/intensive care specialist and the obstetrician when management decisions are made. Trials of medical and obstetric measures should not lead to any delay when deciding that laparatomy is required to ensure hemostasis. Hesitation most often compromises the chances of success of conservative surgical treatment by selective ligations and forces hysterectomy.

Cesarean Section↗
PubMed1993

[Complete and complicated tears of the perineum in spite of preventive incision. A study of the risk factors and the short-term consequences].

A retrospective study of case controls was carried out by postal enquiry to find out the risk factors for complete complicated tears (DCC) of the perineum occurring after prophylactic episiotomy. There were 33 such cases of DCC out of 8,039 vaginal deliveries which means 0.41% in the University Centre in Grenoble in the years 1985-1986-1987. A control group of 66 cases was paired according to parity and episiotomy. The risk factors were identified as large fetal weight, instrumental deliveries, mid-line episiotomy or perineotomy. The questionnaires could be analysed for faults after delivery in 26 cases and 52 controls (response rate of 90%). The sole significant problem of the cases was perineal and rectal pain lasting more than a month longer than in the control cases. There was no greater dyspareunia, stress incontinence with urine, nor anal incontinence which contradicts previous reports in the literature. The authors conclude there are no serious complications of DCC following perineotomy providing repair is carried out very carefully. The patients in this group show that is was acceptable because no more in this group than in the controls were frightened of a repeat pregnancy.

Anal Canal↗
PubMed1992

[An original model of experimental endometriosis in the rabbit].

An attempt to create experimental endometriosis in the rabbit by the usual technique was tried on eight animals. It was disappointing. A new technique which is easier to carry out implanting endometrium was suggested. The results were evaluated in 57 animals. The technique proved to be easier and more reliable. The technique cannot be used unless the animal has been through puberty.

Animals↗
PubMed1990

[Antibiotic prophylaxis in cesarean sections without high risk of infection. Therapeutic trial of cefotetan versus placebo].

Caesarean sections are performed with an ever increasing frequency, and their morbidity rate due to infection varies between 35 and 40 per cent. The effectiveness of antibiotic prophylaxis has been demonstrated in caesarean sections with a high risk of infection, but few studies have been devoted to caesarean sections without this high risk. The purpose of our study was to evaluate the effectiveness of antibiotic therapy in this second type of caesarean section since its postoperative infection rate is not negligible (about 25 per cent). We therefore set up a two-centre randomized trial comparing two groups of 133 women without any particular risk of infection. At the moment of umbilical cord clamping, one group received cefotetan 1 g intravenously, while the other group received an intravenous injection of a placebo solution. The postoperative infection rate was 12.5 per cent in the treatment group and 26.9 per cent in the control group (P less than 0.05). The relative risk in the placebo-treated women was 2.15 (95 per cent confidence limits, 1.41 to 3.28). Antibiotic prophylaxis prevented 53.5 per cent of postoperative infections (95 per cent confidence limits, 29 to 69.5 per cent). Moreover, in the treatment group infections were less severe, resulting in a significant decrease in hospital stay and a lower overall cost. We conclude that antibiotic prophylaxis with cefotetan is effective in caesarean sections without a high risk of infection, as it significantly reduces the postoperative morbidity due to infection.

Abscess↗
PubMed1989

[Comparative study of Pfannenstiel's incision and transverse abdominal incision in gynecologic and obstetric surgery].

The ease of execution and the post-operative quality of 2 types of incision commonly performed in pelvic surgery were compared in a prospective randomised study: Pfannenstiel's incision was used in 59 patients and Mouchel's low transverse abdominal incision (LTA) in 60 patients. Results were evaluated 8 days and 3 months after the operation. There was no difference in immediate post-operative results between these two groups of patients. At the 3 month examination, hypoaesthesia of the skin was less frequent in patients who had been operated upon through the LTA incision. The authors conclude that the transmuscular incision is innocuous.

Abdominal Muscles↗
PubMed1989

[Forceps at a university hospital. Critical study of the evolution of the procedure].

A retrospective study was carried out using the obstetric summaries in a computer between the years 1981 and 1986. The percentage of instrumental deliveries using forceps or spatula was significantly reduced whereas the caesarean section rate stayed the same: the majority of forceps deliveries during the year 1986 (14.5% of all deliveries) were carried out under epidural analgesia (70% of the deliveries) and the mean of these (75%) were carried out for delay. This is a definite change as compared with 1981 and it appears to be linked mainly to an increase in the number of epidural analgesics (70% for forceps deliveries in 1986) and a new appreciation of fetal distress. The maternal results were better because most episiotomies were lateral (60% of cases) which meant that only 1.5% of cases affected the sphincters. The immediate neonatal results were good, but do not seem to have been improved by the changes that have been observed, although the methodology for assessing the state of the neonate has improved.

Extraction, Obstetrical↗
PubMed1989

[Choriocentesis: comparison of the effectiveness of a new choriocentesis needle and a transcervical biopsy forceps].

71 samples taken by the transabdominal route were compared with 71 samples taken by forceps through the cervix. A fine (1 mm) transabdominal choriocentesis needle with a thin wall (0.1 mm), a short bevel, and a lateral hole was made to bring together simplicity, effectiveness and safety; success was obtained in 95% of the cases (39/41) of our last 41 samples on the first attempt. For comparison with the forceps, the success rate on the first attempt was only 66% (26/41), but it rose to 97.5% if the patient could take 3 attempts at most. The forceps made it possible to collect a mean quantity large enough (19.9 mg) but it was quite variable (16.7 mg being the range) of complete villi, whereas the choriocentesis needle only gathered a smaller volume (12.7 mg) but more reliable (the range being 3.7 mg). The villi were fragmented, however. To work out the study of the DNA and the karyotype, there is a choice between the forceps and the needle. This choice depends principally on the damage the two techniques can do. This has not been worked out yet in our study except indirectly.

Biopsy↗
PubMed1988

[Indications of radio-pelvimetry at a university hospital and a district general hospital].

Studies carried out on the phantom have shown how reliable transverse diameter measurements of the pelvis are when carried out by X-Ray scanning pelvimetry compared with conventional X-Ray pelvimetry. The practice of scanning radiopelvimetry (digital radiography) depends on the availability of the machine and of an induced, secondary circuit. The arrival of this new technique makes it necessary for the sake of economy to limit the indications for the investigation. We have studied the indications for the examination in a population of pregnant women in a University Hospital Service as well as pregnant women in a District General Hospital. Since the conditions under which obstetrics are carried out in general hospitals are more precarious, more radiological examinations are carried out in them. Frequently investigations were carried out on primiparous women who have normal pelves. It appeared difficult to lower the number of indications. Digital X-Rays will therefore cost a lot. In university hospitals the indications for carrying out the investigations were studied critically. It seems to be possible to reduce the numbers to 6% of all patients who are delivered. Rationalizing the indications will make it possible to avoid the extra cost which results from carrying out scanning X-Ray pelvimetries more reliably and delivering a lesser dose of X-Rays than ordinary conventional X-Ray pelvimetries deliver.

Female↗
PubMed1985

[Blood loss and nausea during legal abortion].

The efficiency of oxytocic drugs in therapeutic abortion was studied in 113 women who were randomly assigned to either a control group (n = 44) receiving no oxytocic drugs, a group (n = 36) receiving 0.2 mg ergometrine by slow intravenous injection, or a group (n = 33) given 5 units oxytocin in a intravenous infusion throughout the procedure. The three groups were comparable with regard to the age of patients, the age of pregnancies and parity. The surgical procedure was the same in all three groups and carried out by the same surgeon. General anaesthesia was obtained with an infusion of 500 mg methohexitone and 500 micrograms fentanyl in 500 ml isotonic dextrose solution at a rate of 3 ml X min-1. The anaesthetic requirements were 2.94 +/- 0.80 micrograms X kg-1 fentanyl and 2.94 +/- 0,80 mg X kg-1 methohexitone. The criteria studied were the blood loss as measured by the volume aspired, the presence or absence of nausea and vomiting after the procedure, the age of pregnancy and the total amount of anaesthetic drugs given. No correlation was found between the amount of anaesthetic drugs given and the frequency of nausea and vomiting, and between the amount of blood lost (r = 0.287; ddl = 111; alpha = 17.322). The study did not, therefore, confirm the reputation of oxytocic drugs in reducing the bleeding. It seemed that, in therapeutic abortion, spontaneous uterine contraction was sufficient to control the bleeding. But a significant correlation was found between the amount of blood lost and the age of the pregnancy (r = 0.399; ddl = 111; alpha less than 1%).

Abortion, Legal↗
PubMed1985

[Evaluation of perineal comfort following delivery in primiparae].

The authors followed a population of 204 primiparous women in order to be able to tackle the causes of those frequent sexual problems that occur after delivery. Obstetric perineal lesions were found in 46 cases of left lateral episiotomies, 104 cases of midline episiotomies and 54 cases where the perineum was said to be intact. Following delivery at the Maternity Unit, those patients who had a perineal incision suffered more without any difference whether the episiotomy was a midline or a lateral one. After a mean of 78 days following delivery, at the post-partum examination, sexual troubles were found to be frequent and 41% complained of dyspareunia. These troubles were scattered in all three series. There was no difference whether the mother was breast-feeding or not in relationship to her sexuality after delivery. The authors conclude that there is no proper correlation between the way the perineum was dealth with surgically and the quality of sexual activity experienced early after delivery.

Dyspareunia↗