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Biomedical subjects

J Nizard

Publications and source records attributed to J Nizard.

At least 19 recordsLinked to original sources
PubMed2006

[What should you tell a patient with a history of cervical incompetence in the first trimester?].

Data is now more than ever available to inform couples at risk of second trimester miscarriage or preterm delivery. We are able to give customized information according to the obstetrical history and to the evolution of the cervix during the second trimester although the level of scientific evidence is limited or poor. Elective cerclage can be proposed to patients with a history of at least 3 second trimester miscarriages or preterm deliveries. There is no clear consensus on which patients could benefit from therapeutic cerclage. Indications would have to be motivated by a short cervix on ultrasound measurements and the cerclage performed before 24 weeks of gestation.

Bed Rest↗
PubMed2006

Maternal hemodynamic changes following treatment by laser coagulation of placental vascular anastomoses and amnioreduction in twin-to-twin transfusion syndrome.

OBJECTIVES: To investigate maternal hemodynamic changes following laser therapy and amnioreduction in twin-to-twin transfusion syndrome (TTTS). METHODS: Thirty-nine cases with severe TTTS were treated at 16-26 weeks of gestation. Maternal hemodynamic evaluation was performed, including heart rate (HR), arterial pressure and echocardiography with calculation of shortening fraction (SF), left atrial dimensions, stroke volume (SV), cardiac output (CO) and total vascular resistance (TVR), before and 6 h and 24 h after placental surgery. Hemoglobin (Hb), hematocrit (Ht) and protein levels were also measured. Cases were retrospectively divided into groups according to treatment: Group A had laser therapy followed by amnioreduction >1000 mL (n = 25); Group B had laser therapy followed by amnioreduction <1000 mL (n = 14). RESULTS: The mean gestational age at inclusion was 21 (range, 16-26) weeks. The mean amniotic fluid withdrawal was 1700 (range, 1000-3000) and 300 (range, 150-800) mL in Groups A and B, respectively. Cases in Group A showed a decrease in mean arterial blood pressure (P = 0.011) and in TVR (P < 0.0001) and an increase in CO (P = 0.008) and SV (P = 0.022). There was no difference in HR. Significant hemodilution developed as early as 6 h after the procedure, with a reduction in Ht (P < 0.0001), plasma protein (P < 0.0001) and Hb levels of 1.2 g/dL on average (P < 0.0001). There were no changes in any parameters in Group B. CONCLUSIONS: Amnioreduction of severe polyhydramnios in TTTS induces maternal hemodynamic changes within the first 6 h that persist at least 24 h after treatment. These adaptative changes are compatible with hemodilution.

Adult↗
PubMed2005

First-trimester screening for fetal triploidy at 11 to 14 weeks: a role for fetal biometry.

OBJECTIVE: Intrauterine growth restriction in triploidy has been reported as early as in the first trimester. This study was undertaken to evaluate the ability of first-trimester crown rump length (CRL)-based charts to detect triploid fetuses. MATERIAL AND METHODS: Analysis of fetal biometry in cases of triploidy diagnosed in the first trimester over the last three years. Biometry for abdominal circumference (AC), head circumference (HC) and biparietal diameter (BPD) was analyzed in relation to both gestational age (GA)-based charts and to CRL-based charts. RESULTS: Five cases of fetal triploidy were diagnosed at 11 to 14 weeks. Screening based on nuchal translucency (NT) and maternal age showed a risk > 1/300 in only one of the 5 cases of triploid fetus. In all of these five cases, CRL-based biometry was grossly abnormal, although it was abnormal in only two of these five cases in relation to GA-based charts. CONCLUSION: First-trimester CRL-based biometry charts seem to reflect early asymmetrical growth delay in triploidy more accurately than GA-based charts. CRL-based biometry is likely to improve the early detection of triploid pregnancies without leading to dating error.

Abdomen↗
PubMed2005

[French medical demography in Obstetrics and Gynecology in 2003: the trainees].

INTRODUCTION: The increase in the number of trainees in Obstetrics and Gynecology (OBGYN) in France since 1999 seems to be a problem for the quality of training and availability of post-training positions. There are no data available on the number and geographical distribution of trainees in OBGYN in France despite the recent and ongoing increase in their number. We performed a survey on the demographical characteristics of trainees in OBGYN in France, their distribution, and the eventual problems related to this increase in 2003. MATERIAL AND METHOD: We used available data from university, governmental institutions, and local trainee contacts. We compared these data to obtain a complete list of French trainees in OBGYN, with their demographical characteristics. RESULTS: In 2003, there were 710 trainees participating in the 5-year OBGYN program in France, 59.5% were women. The proportion of female trainees was not homogeneous throughout France. The number of post-training positions was not proportional to the number of trainees for each region and these numbers will rapidly be insufficient. DISCUSSION: Halfway through the increase in the number of trainees in OBGYN, training capacities of the French system will soon be saturated if not reorganised. There is going to be a major shortage in post-training positions for future newly trained specialists in OBGYN in France.

Demography↗
PubMed2005

[What are the epidemiological data on maternal and paternal smoking?].

A review of the literature published over the last fifteen years shows that active smoking (1.54 [95% CI 1.19-2.01]) and passive smoking (1.17 [95% CI1.02-1.37]) are the cause of a decline in female fertility in the general population. This lower fertility is particularly evident for in vitro fecundation where the relative risk of infertility measured in one study was 2.41 (95% CI 1.07-5.45) and even 4.27 (95% CI 1.53-11.97) if the couple has smoked for five years. Paternal smoking at the time of IVF decreases the number of ovocytes by 46% due to maternal passive smoking. The risk of not having a live infant is high: 3.76 (95% CI 1.40-10.03, p < 0.01). In the general population, active smoking increases the risk of spontaneous abortion by 60-100%, depending on the intensity of smoking. The latest report published in France shows that 37% of women declare they smoked before pregnancy. This rate decreased to 17% during the first trimester, 15% during the second and 14% during the third then rose again to 20.5% two years after delivery. About half of the women who stopped smoking during pregnancy start again after delivery. The desire to breastfeed is lower among smokers, and fewer start breastfeeding which is continued for a shorter time. The effect of paternal smoking has not been described for this factor in France.

Breast Feeding↗
PubMed2004

High-intensity focused ultrasound in the treatment of postpartum hemorrhage: an animal model.

OBJECTIVE: To investigate the use of high-intensity focused ultrasound (HIFUS) to reduce uterine artery blood flow in ewes in the postpartum period. METHODS: HIFUS was applied to the uterine arteries of seven ewes in the postpartum period. Arterial flow velocities were measured before and after the procedure at the site of HIFUS application (target), as well as 3 cm upstream and 3 cm downstream from the target. The uterine arteries were then removed for macroscopic and histological examination. RESULTS: Maximum flow velocities in the target area increased after the procedure by 350% and those upstream from the target decreased by 65%. Macroscopically, the vessel diameter was shown to have reduced at the site of HIFUS application. Microscopically, both the endothelium and media showed thermal lesions. Tissues surrounding the arteries were macroscopically and microscopically normal. CONCLUSION: Exposure of uterine arteries to HIFUS reduces the vessel diameter and thus induces a dramatic increase in the maximum flow velocities within the target area. HIFUS may have a role in the treatment of postpartum hemorrhage.

Animals↗
PubMed2004

[Victims of sexual assault: a routine protocol for better management].

Caring for victims of sexual assault is a difficult situation where the physician has to simultaneously evaluate the psychological impact and conduct a complete and precise physical examination. To make sure every step of the examination is completed and all samplings are done in the correct order by all physicians, it is useful to have a written routine protocol. We describe step-by-step management procedures for victims of sexual assault, taking into consideration the psychological aspect, the physical examination, the different samplings, and the different emergency treatments. Free download of the entire protocol, with the booklet containing examples of prescriptions, is available at http://www.agof.net/constatviol/.

Counseling↗
PubMed2003

Fertility and pregnancy outcomes following hypogastric artery ligation for severe post-partum haemorrhage.

BACKGROUND: Hypogastric artery ligation is a therapeutic option for severe post-partum haemorrhage. Little is known about the outcomes of subsequent fertility and pregnancy. We studied these parameters in women who required hypogastric artery ligation for severe post-partum haemorrhage in our institution over a 13-year period. METHODS: All patients who required hypogastric artery ligation for severe intractable post-partum haemorrhage from January, 1989 to April, 2001 were included. Data were retrieved from medical files and telephone interviews. RESULTS: A total of 68 patients required hypogastric artery ligation during the study period. Seventeen patients had 21 pregnancies with 13 term deliveries, two ectopic pregnancies, three miscarriages, and three abortions. Twenty-eight patients did not want a new pregnancy and one patient refused the interview. Twenty-three (34%) patients were lost to follow up. None of the patients suffered subsequent infertility and pregnancy was achieved in <12 months once planned. Pregnancy outcomes were normal. Fifty-four percent had vaginal deliveries. Three patients suffered a threatened post-partum haemorrhage that was easily treated medically. CONCLUSIONS: This is the largest reported series of pregnancies following hypogastric artery ligation. Hypogastric artery ligation for post-partum bleeding >1 l appears to be a safe procedure that does not impair subsequent fertility and pregnancy outcomes.

Adult↗
PubMed2002

Teaching ultrasound-guided invasive procedures in fetal medicine: learning curves with and without an electronic guidance system.

OBJECTIVE: To compare the learning curves of inexperienced junior obstetrics/gynecology registrars for ultrasound-guided invasive procedures on a training model, with and without an electronic guidance system. STUDY DESIGN: Four junior registrars performed their first 100 procedures on a training model with a new electronic guidance system, and four other junior registrars performed their first 100 procedures on the same training model without using the guidance system. All procedures were performed using a free-hand technique. We evaluated the quality of the procedure, which we defined as the time spent with the entire needle clearly visualized on the screen over the total duration of the procedure. We constructed learning curves for the eight junior registrars for comparative analysis. RESULTS: Quality of the procedure increased over time for all trainees. The learning curves were significantly steeper for trainees using the electronic guidance system. Trainees using the electronic guidance system performed better in the middle of their learning curve (procedures 25-75). All trainees reached the same level of quality by the end of their 100 procedures. CONCLUSIONS: The automated electronic guidance system helps faster learning but, after 100 procedures on a training model, both groups reached the same level of quality.

Amniocentesis↗
PubMed2002

[Contribution of Doppler exploration of ductus venosus flow].

Among the different means currently available to assess fetal hypoxia and determine the optimal time for fetal extraction in case of intra-uterine growth retardation (IUGR), Doppler measurement of blood flow in the ductus venosus (DV) is one of the most promising. The DV is one of the three fetal circulation shunts observed in utero. Approximately 55% of the oxygenated blood flowing from the umbilical vein to the foramen ovale and the left cavities short circuits the hepatic circulation via the DV. This oxygenated blood is preferentially directed to the myocardium and the brain. Measurement errors (suprahepatic veins, umbilical veins) can lead to erroneous diagnosis of defective DV. Inversely, there is a normal physiological reverse flow in the suprahepatic veins and the inferior vena cava not present in the DV. In case of fetal hypoxia, the proportion of oxygenated blood increases due to increased flow from the umbilical vein into the DV, increasing the proportion of oxygenated blood delivered to the heart and brain instead of the liver. This corresponds to fetal adaptation to hypoxia and the spectrum of the DV thus normally includes a positive wave. When the fetus is unable to adapt to hypoxia, there is an alteration of the right heart function observable in the DV spectrum with diminished diastolic flow or even zero or reverse flow. Anomalous CV flow is a sign of major deterioration of the fetal status before development of severe anomalies. For many, the short-term variability implies immediate extraction of the fetus. Certain well trained teams combine DV flow with other information such as the biophysical examination of the fetus, the quality of the amniotic fluid, visual and automated growth retardation measurements, and other Doppler measurements for decision making. Doppler measurements of the DV, disclosing IUGR or made during surveillance of IUGR, are theoretically made only if other Doppler findings such as arterial redistribution are abnormal. Doppler assessment of DV flow is not a first intention procedure and only concerns a small high-risk fetal population. Experience and good knowledge of fetal anatomy and the Doppler technique are required (it is easy to confuse the physiological spectrum of the suprahepatic veins with a negative wave corresponding to pathological DV flow).

Animals↗
PubMed2002

[The French and English health systems: compared evolution after the mid-1990s].

In the recent past, the British and French health care systems have both undergone significant reforms, enveloped in a state of Urgency, resulting primarily in France from the increasing rate of growth in health expenditure and in England from malfunctioning procedures such as waiting lists. After describing current features of the National Health Service (NHS), this study extracts and considers the points of convergence and divergence in the respective policies of the two countries: similarities in the choice of priorities, decentralisation of decision-making, negotiation between actors at the local level, development of the quality concept, and the differences in formulating objectives and involving the system's users. The considerations provided here should allow for a better understanding of the developments of these respective health policies and their future evolution.

Delivery of Health Care↗
PubMed2002

[Obstetrics, surgical gynecology, or medical gynecology: what type of practice interests today's interns?].

INTRODUCTION: Two major modifications have recently changed the training program of interns in obstetrics and gynecology in France. The first modification is an important increase in the number of interns in OBGYN, allowing more lower ranked medical students to enter this training. The second modification is the imposed subdivision of the pool of interns in two distinctive branches: obstetrics and gynecological surgery, and medical gynecology with a 2/1 ratio. These modifications were decided without consulting interns on the type of practice they intend to have later. This study tries to determine what type of practice French interns in OBGYN intend to have when they have finished their training. MATERIAL AND METHOD: We distributed surveys to all French interns in OBGYN. The survey included questions on the type of practice they intend to have, and questions on their opinions on how OBGYN show be taught. RESULTS: Two third of interns wanted to have a full practice in OBGYN. This proportion was the same considering only first year interns. Three quarters of interns wanted to have a future practice that includes at least medical gynecology, and only one intern wanted to do solely medical gynecology later. French interns in OBGYN wanted more medical gynecology teaching during their training CONCLUSION: Despite recent modifications in the training program, French interns in OBGYN intend to have a full practice later. This choice is not influenced by the 5 years of training.

Attitude of Health Personnel↗
PubMed2001

Acquired right heart outflow tract anomaly without systemic hypertension in recipient twins in twin-twin transfusion syndrome.

Significant hemodynamic changes are commonly observed in both fetuses in twin-twin transfusion syndrome. In the recipient twin there is cardiac dysfunction with hypertrophy of both ventricles and overall enlargement of the heart. We describe five cases of recipient twins in twin-twin transfusion syndrome with right ventricle hypertrophy, pulmonary stenosis and tricuspid regurgitation acquired in utero. These symptoms developed with no signs of systemic hypertension. Three of the five recipient twins survived and were developing normally at 3-30 months of age. Postnatal outcome is likely to have improved as a result of prenatal diagnosis of right ventricle outflow tract obstruction and timed delivery. These acquired anomalies of the right heart might be related to the particular hemodynamic conditions of the recipient twin. A global heart dilatation is logically expected, but this hypertrophy without dilatation is probably related to the shared plasma of fetuses with opposite hemodynamic conditions. This is what we consider as the hemodynamic-hormonal paradox. These acquired anomalies, though severe, are accessible to neonatal treatment if treated early.

Adult↗