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R-C Rudigoz

Publications and source records attributed to R-C Rudigoz.

12 recordsLinked to original sources
PubMed2006

Is neonatal neurological damage in the delivery room avoidable? Experience of 33 levels I and II maternity units of a French perinatal network.

OBJECTIVE: To determine the frequency of avoidable neonatal neurological damage. STUDY DESIGN: We carried out a retrospective study from January 1st to December 31st 2003, including all children transferred from a level I or II maternity unit for suspected neurological damage (SND). Only cases confirmed by a persistent abnormality on clinical examination, EEG, transfontanelle ultrasound scan, CT scan or cerebral MRI were retained. Each case was studied in detail by an expert committee and classified as "avoidable", "unavoidable" or "of indeterminate avoidability." The management of "avoidable" cases was analysed to identify potentially avoidable factors (PAFs): not taking into account a major risk factor (PAF1), diagnostic errors (PAF2), suboptimal decision to delivery interval (PAF3) and mechanical complications (PAF4). RESULTS: In total, 77 children were transferred for SND; two cases were excluded (inaccessible medical files). Forty of the 75 cases of SND included were confirmed: 29 were "avoidable", 8 were "unavoidable" and 3 were "of indeterminate avoidability". Analysis of the 29 avoidable cases identified 39 PAFs: 18 PAF1, 5 PAF2, 10 PAF3 and 6 PAF4. Five had no classifiable PAF (0 death), 11 children had one type of PAF (one death), 11 children had two types of PAF (3 deaths), 2 had three types of PAF (2 deaths). CONCLUSION: Three quarters of the confirmed cases of neurological damage occurring in levels I and II maternity units of the Aurore network in 2003 were avoidable. Five out of six cases resulting in early death involved several potentially avoidable factors.

Birth Injuries↗
PubMed2006

[Spontaneous rupture of the uterine pedicle during pregnancy: Three case reports].

We report a retrospective review of three cases presenting with spontaneous uterine artery rupture during pregnancy. Clinical presentations were intra-peritoneal haemorrhage for two of them and in utero fetal death for the last one. Fetal outcome was poor in all three cases. Uterine vessels spontaneous rupture during pregnancy is an exceptional event. Considering our experience and the literature review, we propose a guideline for vascular rupture during pregnancy.

Adult↗
PubMed2006

[Amniotic fluid embolism: a review].

Amniotic fluid embolism occurs rarely but is a leading cause of maternal mortality. It is a difficult and somewhat intangible diagnosis that warrants a high index of suspicion by physicians. AFE is an unpredictable, unpreventable, and, for the most part, an untreatable obstetric emergency. Management of this condition includes prompt recognition of the signs and symptoms, aggressive resuscitation efforts, and supportive therapy. Any delays in diagnosis and treatment can result in increased maternal and/or foetal impairment or death. Whereas once the invariable outcome of AFE was death of the mother, today the prognosis is somewhat brighter thanks to increased awareness of the syndrome and advances in intensive care medicine. No laboratory test is specific to attest the diagnosis and autopsy must to be realised in case of maternal death. Although non-specific, the diagnosis of AFE could be supported by the observation of amniotic fluid in the central venous blood as well as in the bronchoalveolar fluid. This easy and quick test will be helpful in decision-making. Prompt and aggressive supportive treatment is required to lessen an otherwise dismal outcome, which may include death and permanent disability. This article provides an account of the protean clinical features, pathogenesis, and principles involved in treatment.

Amniotic Fluid↗
PubMed2005

[Obstetrical forceps: yesterday, today and tomorrow. Toward a new classification of obstetrical forceps].

OBJECTIVE: Obstetrical forceps are used worldwide since more than 400 years. In 2003 forceps deliveries accounted for 6.3% of all deliveries of the AURORE Grand-Lyon perinatal network. Although more than 400 different forceps have been described, obstetrics handbooks neither describe experimental forceps nor provide any chapter dedicated to instrumental delivery training. Our aim was to provide junior obstetricians with information that will allow them to select the best instrument and to let them know about experimental as well as pedagogic forceps. PATIENTS AND METHODS: International literature review using the terms "forceps" and "delivery" and a four year experimental work involving a close collaboration between obstetricians and biomechanics of the INSA engineering school. RESULTS: Two instruments are presented as well as a new forceps classification. DISCUSSION AND CONCLUSION: This classification distinguishes between three types of forceps: operational forceps designed to delivers neonates, experimental forceps designed to study biomechanics and training forceps designed for resident training. For the first time the classic blind forceps procedure is transformed in a full screen real time procedure.

Equipment Design↗
PubMed2005

[Compliance with a protocol of prevention of neonatal group B streptococcal sepsis in the Aurore perinatal network].

OBJECTIVE: Our purpose was to measure the compliance with the network hospitals protocol for preventing neonatal group B streptococcal sepsis. MATERIALS AND METHOD: All vaginal deliveries during a one-week period in 37 maternities of the perinatal network were reviewed retrospectively. RESULTS: A total of 752 records were reviewed. Compliance with the protocol regarding the time of culture was 91.1%. Overall, prevalence of group B streptococcal carriage was 14.2%. Among patients eligible for intrapartum antibiotics, 46.4% received adequate prophylaxis. Considering the length of labor, one out of two patients could have received intrapartum adequate antibiotics. Regarding newborns, 86.1% received adequate medical surveillance. There was no confirmed case of group B streptococcal sepsis during the week of study. CONCLUSION: All the maternities of network Aurore accepted and adopted evaluation principle. Some elements of protocol could be better applied, in particular delivering adequate intrapartum antibiotic prophylaxis.

Anti-Bacterial Agents↗
PubMed2005

[Decision-to-deliver interval for forceps delivery and cesarean section: 137 extractions for abnormal fetal heart rhythm during labor].

AIM: Comparison of the decision to delivery interval in cases of forceps delivery and in cases of cesarean sections. MATERIAL AND METHOD: A retrospective analysis was performed on 137 cases of forceps deliver (n = 63) and cesarean section (n = 74) indicated for abnormal fetal heart rhythm. All cases were observed in a level 3 maternity unit between October 2003 and August 2004. RESULTS: The mean decision-to-delivery interval was significantly shorter in the forceps group (14.84 min +/- 6.54 versus 29.31 min +/- 11.79 p < 0.0001). Maternal and neonatal morbidity were comparable. CONCLUSION: This study suggest that once the fetal head is engaged, forceps delivery can significantly reduced the decision-to-delivery interval.

Adult↗
PubMed2004

[Fecal and urinary incontinence after delivery: risk factors and prevention].

OBJECTIVE: This study was undertaken to review the available data on urinary and fecal incontinence and their association with maternal as well as fetal per partum characteristics. METHOD: A Pubmed (Medline search performed between 1999 and 2003 using "urinary incontinence and delivery" and "fecal incontinence and delivery" identified 501 relevant papers. Most of them are retrospective analyses whereas few are randomized controlled trials (RCT). RESULTS: Two studies performed with computer-stored databases analyzed the risk factors of incontinence among 2,886,126 deliveries. Primiparity, birthweight over 4000 g and all types of assisted vaginal deliveries significantly increased the risk of anal sphincter damage. Results concerning the effect of episiotomy are conflicting. Controlled randomized trials have shown that pelvic floor muscle training during pregnancy as well as planned cesarean section significantly and moderately decrease the risk of urinary incontinence. The only RCT available has shown that planned cesarean section did not reduce significantly incontinence of flatus. Finally the only trial that compare surgical techniques used to repair the anal sphincter did not show any significant difference. CONCLUSION: Risk factors for anal sphincter damage during delivery are well known. RCT focusing on how to prevent and how to cure fecal as well as urinary incontinence are urgently needed.

Anal Canal↗
PubMed2003

[Instrumental extraction in 2002 in the "AURORE" hospital network: incidence and serious neonatal complications].

OBJECTIVES: The purpose of this study was to evaluate the incidence of forceps and vacuum application and the incidence of its related neonatal complications. This study was performed in a network of 37 maternity hospitals. PATIENTS AND METHOD: A postal questionnaire was sent to 156 obstetricians between February and March 2003. RESULTS: Response rate was 78%. In 2002 the operative vaginal delivery rate was 11.2% of all live births. Forceps are the primary instruments (6.3%) whereas vacuum delivery rate was 4.9%. One obstetrician never uses forceps while 38 (31%) never use vacuum. Only 29 (24%) report using both instruments frequently. During 2002 no neonatal death related to an operative vaginal delivery was reported while 145 neonatal complications were (3.2%). Major complications were one depressed skull fracture (1/4589) and 14 extensive caput succedaneum (14/4589). Minor complications were cutaneous lesions (124/4589) and facial palsy (6/4589). Vacuum delivery was associated with a significantly higher extensive caput succedaneum rate (P = 0.018) while the only depressed skull fracture observed was related to forceps use. Forceps delivery was associated with a significantly higher cutaneous lesions rate (P < 0.001). DISCUSSION AND CONCLUSIONS: This study showed that, in 2002, operative vaginal deliveries still represent a significant amount of vaginal deliveries, a majority of obstetricians do not use both instrument and neonatal associated complications are frequent (3.2%) but rarely severe. Therefore, we believe that every method that allows a safe teaching of operative delivery should be promoted.

Adult↗