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N Job-Spira

Publications and source records attributed to N Job-Spira.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Predicting the risk of extra-uterine pregnancy. Construction and validation of a French risk scale].

This paper reports the construction and validation of a composite measurement scale to predict the risk of ectopic pregnancy in France. The data from three case-control studies of ectopic pregnancy conducted in France were used. Fourteen potential factors were found to be associated to ectopic pregnancy, which were grouped by multiple correspondence analysis in four dimensions: infection, pelvic surgery, smoking and induced conception. Logistic regression was further used to model the relationship between candidate risk factors (single or grouped as suggested by multiple correspondence analysis) and ectopic pregnancy. The regression coefficients of the final model were scaled and rounded to integers so as to make the scoring system simpler to use. The resulting composite measurement scale was finally validated on two independent samples. It allows simple determination (with a nomogram) of the absolute risk of developing ectopic pregnancy, for a given level of risk factors. This indicator for the risk of ectopic pregnancy could be used by clinicians to predict occurrence and provide an indication as to which type of early pregnancy follow-up and information should be given to women planning a pregnancy. It could also be used to provide earlier diagnostic screening in case of mild symptoms.

Case-Control Studies↗
PubMed1997

Construction of composite scales for risk assessment in epidemiology: an application to ectopic pregnancy.

Composite scoring systems that combine information contained in a number of risk factors are being used increasingly in clinical practice, planning, and health risk appraisal. The authors propose a methodological framework for the construction and validation of a composite measurement scale to assess the risk, considered as a continuous phenomenon, of developing a particular disease or outcome. This framework integrates several statistical methods, especially those concerning model fitting, coefficient rounding, and validation strategy. It also uses psychometric methods, addressing important measurement properties such as measurement level, content and construct validity, and reliability of the constructed scale. The proposed framework is illustrated by application to the construction of a composite scale for measurement of the risk of ectopic pregnancy.

Adolescent↗
PubMed1997

[Ectopic pregnancy recurrence: role of gynecologic, obstetric, contraceptive and smoking history].

The purpose of this study, based on data from the register of ectopic pregnancy in Auvergne (centre of France), is to identify risk factors of recurrence of ectopic pregnancy (EP). The social characteristics, gynaecological, surgical and reproductive history and conditions of the conception of 96 women with a previous EP were compared to those for 566 women without previous EP. Risk factors associated with the management of the first EP could not be analysed with the data available. Several factors increased the risk of recurrence: previous proved or suspected salpingitis (OR = 3.6), maternal smoking (OR = 1.7 to 2.0 according to the consumption level), maternal age greater than 30 (OR = 2.0), and previous recurrent spontaneous abortions (SA) among childless women (OR = 3.4 to 11.9 according to the number of SA). The last of these factors may reflect another unknown risk factors common to recurrent SA and recurrent EP (for example hormonal or karyotype factors). Previous use of intra uterine device is associated with a decrease in the risk of recurrence of EP (OR = 0.27), but this contraceptive method should be considered as an indicator of good fertility rather than as a protective factor for EP recurrence.

Abortion, Spontaneous↗
PubMed1996

Fertility after ectopic pregnancy: first results of a population-based cohort study in france.

The purpose of this paper was to evaluate the reproductive outcome after ectopic pregnancy (EP) from a population-based register in the centre of France. Since 1992, all the women aged 15-44 years, who permanently reside in the target area and who were treated either by surgical or medical procedures for an ectopic pregnancy in one of the area centres, have been registered and prospectively followed until 45 years of age. The analysis presented was based on the 155 women registered between January 1992 and March 1994 who were followed up for at least 6 months, and who were seeking a new pregnancy. The mean follow-up period was 16 months. A total of 102 women (66%) obtained a pregnancy. The first conception was intrauterine for 92 women, and 10 had a recurrence of ectopic pregnancy. Risk factors of recurrence were prior spontaneous abortion and prior tubal damage. For those women who conceived, the mean time to obtain pregnancy ('time to pregnancy') was 4.8 months. The 1 year cumulative intrauterine pregnancy rate (i.e. the probability of obtaining an intrauterine pregnancy within 1 year of seeking pregnancy) was 70%. After multivariate analysis by a Cox regression, the factors associated with higher fertility were age < 30 years, high educational level and no prior tubal damage.

Adolescent↗
PubMed1996

[Epidemiology of ectopic pregnancy: incidence and risk factors].

During the past two decades, the incidence of ectopic pregnancy (EP) has doubled or tripled in many parts of the world. In France, EP currently constitutes 2 % of livebirths and 1.6 % of all reported pregnancies. These rates seem presently stable. The main identified risk factors include pelvic inflammatory disease (PID)--in particular that due to Chlamydial infection, previous ectopic pregnancy and cigarette smoking. More than 50 % of EP cases are attributable to infectious factors and cigarette smoking, suggesting dramatic effects on EP rates of appropriate prevention programs. A third risk which could be prevented is induced conception cycles, especially by Clomiphene. Other risk factors are pelvic surgery, previous EP and maternal age (especially over 35 years). Further epidemiologic research is needed to identify new risk factors, to monitor incidence rates and to evaluate the effects of public health policies on EP occurrence. French EP registers will certainly contribute to this research.

Female↗
PubMed1996

[Ectopic pregnancy: factors related to ovum anomalies?].

Identified risk factors for ectopic pregnancy (prior pelvic inflammatory disease, smoking at the time of conception, intrauterine device, obstetrical and surgical history) explain from 60 to 65% of the cases. Egg anomalies may also be a risk factor as it is likely that the transport of an abnormal egg along the uterine tube is less efficient than a normal one. We tested this hypothesis with data from two case-control studies with the same design covering a total of 1955 women. The risk of ectopic pregnancy increased specifically with age, which is compatible with our hypothesis. We also studied the associations with spontaneous abortion, considered to be a marker of the risk of pregnancies involving chromosomal malformations. We observed an association between ectopic pregnancy and spontaneous abortions (especially recurrent abortions), not explained by other known risk factors. Although our data do not supply a single definitive demonstration, our results converge to suggest that egg chromosomal anomalies may play a part in ectopic pregnancy aetiology.

Abortion, Spontaneous↗
PubMed1996

[Fertility after ectopic pregnancy. Results of the first three years of the Auvergne Registry].

The reproductive outcome after ectopic pregnancy is evaluated from a population-based register in the center of France. Since 1992, all the women aged 15-44 years, who permanently reside in the target area and who were treated either by surgical or medical procedures for an ectopic pregnancy in one of the area centers, are registered and prospectively followed until 45 years of age. The analysis presented was based on the 221 women registered between January 1992 and December 1994 who were followed up for at least 6 months, and who were seeking a new pregnancy. The mean follow-up period was 19.8 months. 155 women (70%) obtained a pregnancy. The first conception was intrauterine for 136 women, and 19 had a recurrence of ectopic pregnancy. Risk factors of recurrence were prior spontaneous abortion and prior tubal damage. For those women who conceived, the mean time to obtain pregnancy ("time to pregnancy") was 7.6 months. The one year cumulative intrauterine pregnancy rate (i.e. the probability of obtaining an intrauterine pregnancy within 1 year of seeking pregnancy) was 64%. After multivariate analysis by a Cox regression, the factors associated with lower fertility were aged over 30 years, low educational level, history of infertility and prior tubal damage.

Adolescent↗
PubMed1995

[Incidence of extra-uterine pregnancy and characteristics of treated patients. First results of the Auvergne registry].

OBJECTIVES: To evaluate the course and frequency of ectopic pregnancy in a single population for a prolonged period in order to study the simultaneous changes in distribution of risk factors, identify new risk factors and evaluate the effect of new diagnostic and therapeutic methods on subsequent fertility and the effectiveness of preventive measures. METHODS: All women residing in the Registry zone and treated surgically or medically for ectopic pregnancy were included in the study and followed to the age of 45 years. RESULTS: In 1992, the incidence of ectopic pregnancy was 20.2 per 1,000 live births (n = 160). At least one currently recognized risk factor was found in 80% of the women. A past history of salpingitis was noted in 13% and nearly one half smoked or had smoked at the time of conception. Nineteen percent had a past history of pelvic surgery and 19% had a history of infertility. The ectopic pregnancy recorded was the second one in 9%. Nearly one-third of the ectopic pregnancies recorded (31%) were diagnosed in patients with a intrauterine device. None of these latter patients had other risk factors. Vaginal echography was used for diagnosis in 75% of the cases. Surgery was used as first intention treatment in 94% and medical treatment (methotrexate) was used in 6%.

Adult↗
PubMed1994

Sexually transmitted diseases as major causes of ectopic pregnancy: results from a large case-control study in France.

OBJECTIVE: To evaluate the current impact of sexually transmitted diseases (STDs) and their consequences on the occurrence of ectopic pregnancy (EP). DESIGN: Case-control study. SETTING: Fifteen maternity hospitals in the Rhône-Alpes region, France. SUBJECTS: Six hundred twenty-four women with EP diagnosed from October 1988 to December 1991 and 1,247 controls who delivered liveborn children during the same period. MAIN OUTCOME MEASURES: Information on risk factors included behavioral, clinical, and serological indicators of STDs and other known risk factors of EP. RESULTS: Logistic regression identified several indicators of STDs as strong and independent risk factors for EP: previously treated STD without history of salpingitis; history of probably pelvic inflammatory disease (PID) and, especially, history of confirmed PID; previous STDs of the sexual partner; and Chlamydia trachomatis seropositivity. The adjusted attributable fractions of EP for previous symptomatic STDs, symptomatic STDs of the sexual partner, and C. trachomatis seropositivity were 20%, 3.5%, and 25.2%, respectively, giving a total of 43% of EP cases attributable to infectious factors. CONCLUSIONS: Our findings and previous epidemiological and biological evidence suggest that STD is a major cause of EP. The evidence is particularly strong in the case of C. trachomatis infection. An effective way of dramatically reducing the EP rate would be to prevent STD through education programs sensitizing young women to the complications of STD and public health measures promoting the use of protective methods such as condoms.

Adolescent↗
PubMed1994

Incidence of ectopic pregnancy. First results of a population-based register in France.

A population-based register of ectopic pregnancy was established in 1992 for two French departments, with the primary aim of monitoring the trend in ectopic pregnancy over a prolonged period. In this paper, data collected during the first year of registration (1992) are analysed. The rate of ectopic pregnancy was 20.2 per 1000 live births, 15.8 per 1000 reported pregnancies and 9.5 per 10,000 women aged 15-44 years. The ectopic pregnancy rate per 1000 live births increased steeply after the age of 30 years and especially after the age of 35 years, whereas rates per 10,000 women of reproductive age steadily increased until the age of 35 years and decreased thereafter. The rates of ectopic pregnancy were lower in spring and summer than autumn and winter. These results are discussed and comparisons with similar studies conducted in the USA and Scandinavia are attempted.

Adolescent↗
PubMed1993

Ectopic pregnancy and occupational exposure to antineoplastic drugs.

The incidence of ectopic pregnancy has risen substantially during the past two decades, but the aetiology of a third of cases remains unknown. We have used data from a survey of nurses in Paris, France, to examine the relation between ectopic pregnancy and various occupational exposures. We studied two groups of women--operating-theatre staff and nurses from other departments. The women were asked about outcomes of all pregnancies and occupational exposure to anaesthetic gases, formol, ionising radiation, and antineoplastic drugs during the first trimester of pregnancy. Of 734 pregnancies reported, 15 (2%) had been ectopic. In chi-square analysis, there were significant associations (p < 0.02) between ectopic pregnancy and exposure to antineoplastic drugs, the woman's age, and the number of previous pregnancies. Other occupational exposures and working in an operating theatre did not show significant associations. In logistic regression analysis with adjustment for gravidity, the odds ratio (by the exact method) for ectopic pregnancy associated with occupational exposure to antineoplastic drugs was 10.0 (95% CI 2.1-56.2). Because we had only small numbers of ectopic pregnancies, the odds ratios we estimated have wide confidence intervals. Our findings should be confirmed by a larger study specifically designed to investigate the relation between antineoplastic exposure and ectopic pregnancy.

Adult↗
PubMed1993

[Risk factors for ectopic pregnancy. Results of a case control study in the Rhone-Alpes region].

A case-control study was conducted in 14 Rhône-Alpes area (France) maternity hospitals to evaluate the role of several risk factors, particularly infectious factors, in ectopic pregnancy. A total of 624 cases and 1,247 controls were compared for sociodemographic characteristics, cigarette smoking, sexual reproductive and surgical histories, and condition of conception. Different risk factors were found to be associated with an increased risk of ectopic pregnancy: pelvic inflammatory disease confirmed by celioscopy (OR = 3.8, 95%, CI = 2.1-6.9), Chlamydia trachomatis seropositivity (OR = 4.6, 95%, CI = 3.4-6.3), cigarette smoking at the time of conception with a dose-related effect (OR = 1.6 to 2.6), prior tubal surgery (OR = 1.8, 95%, CI = 1.0-3.1), prior uterus, surgery (OR = 3.2, 95%, CI = 1.4-7.1), prior ectopic pregnancy (OR = 6.4, 95%, CI = 3.6-11.3), induced conception cycle by clomiphene citrate (OR = 4.5, 95%, CI = 1.7-12.0), endometriosis (OR = 6.7, 95%, CI = 2.6-17.4) and maternal age, with a strong relation after the age of 35. These findings confirm the major role of pelvic inflammatory disease which could explain fifty percent of the cases and the one of cigarette smoking at the time of conception which could explain twenty percent of the cases.

Adolescent↗
PubMed1992

[Appendectomy, a risk factor for ectopic pregnancy].

As part of a case-control study of ectopic pregnancy, we evaluated the potential etiological role of appendectomy. Previous appendectomy was associated with an increased risk of ectopic pregnancy (adjusted Odds-ratio: 2.2; 95 percent CI: 1.5-3.2). Ruptured appendix did not appear to be more strongly associated with an increased risk of ectopic pregnancy than unruptured appendix. Such confounding factors as absence of pathological diagnosis of appendicitis and relationship between age of appendectomy and age of first sexual intercourse are discussed. This study provides an additional argument in favor of laparoscopy in childbearing age to diagnose appendicitis and salpingitis.

Adolescent↗
PubMed1991

Risk factors for ectopic pregnancy: a case-control study in France, with special focus on infectious factors.

A case-control study was conducted in 1988 in seven Paris area maternity hospitals to evaluate the role of several risk factors, particularly infectious factors, in ectopic pregnancy. A total of 279 cases and 279 controls were compared for sociodemographic characteristics, cigarette smoking, sexual, reproductive and surgical histories, and conditions of conception. Pelvic inflammatory disease confirmed by celioscopy (odds ratio (OR) = 5.5, 95% confidence interval (CI) 2.1-13.9) and Chlamydia trachomatis seropositivity (OR = 3.9, 95% CI 2.3-6.7) appeared to be important risk factors for ectopic pregnancy. Other risk factors found to be associated with an increased risk of ectopic pregnancy were dose-related cigarette smoking at the time of conception (ORs 1.3 to 2.5), appendectomy (OR = 1.6, 95% CI 1.1-2.5), prior tubal surgery (OR = 5.1, 95% CI 1.7-15.4), induced conception cycle (OR = 3.2, 95% CI 1.1-9.3), and prior ectopic pregnancy (OR = 13.3, 95% CI 4.5-39.2). However, some of the latter risk factors, i.e., prior tubal surgery, prior ectopic pregnancy, and perhaps appendectomy, may be considered to be the results of pelvic inflammatory disease and sexually transmitted diseases. Maternal age, parity, prior induced abortion, and prior spontaneous abortion were not associated with ectopic pregnancy. Use of intrauterine device, progestagen micropill, and also combined estroprogestative pill at the time of conception were associated with a better prevention of intrauterine pregnancy than of ectopic pregnancy. These findings confirm the importance of several previously reported risk factors of ectopic pregnancy: sexually transmitted diseases, cigarette smoking, and prior ectopic pregnancy. They also identified new risk factors, appendectomy and induced conception cycle, and revealed that the combined estroprogestative pill does not prevent ectopic pregnancy as effectively as it does intrauterine pregnancy.

Adolescent↗
PubMed1991

Risk factors for spontaneous abortion: a case-control study in France.

A case-control study was conducted in seven maternity hospitals in the Paris area in 1988 to evaluate the role of several risk factors in spontaneous abortion. A total of 279 cases and 279 controls were compared for socio-demographic characteristics, reproductive history and for conditions of conception. Prior fetal losses [odds ratio (OR) = 2.30 for n greater than or equal to 2; 95% confidence interval (CI) = 1.17-4.61] and maternal age at pregnancy (greater than 30 years) appeared to be major and independent risk factors of spontaneous abortion. Other factors associated with an increased risk of fetal loss were: geographical or ethnic origin (OR = 2.85 for North African women; 95% CI = 1.58-5.10); psychological problems at the time of conception, either related to the outcome of the pregnancy (OR = 3.08; 95% CI = 0.92-10.25) or unrelated to this outcome (OR = 3.35; 95% CI = 1.41-8.00). The following factors were not associated with spontaneous abortion: gravidity, parity, prior induced abortion, prior sexually transmitted diseases and Chlamydia trachomatis serology, menstrual cycle abnormalities, induced conception cycle and in-vitro fertilization, cigarette smoking, current or past use of combined oestrogen/progestagen pill or intrauterine device. These findings confirm the importance of two risk factors for fetal loss: maternal age and number of prior spontaneous abortions. Two risk factors, ethnic origin and psychological problems at the time of conception are also identified, which require further study.

Abortion, Spontaneous↗