Éditeur(s) : HAL CCSD
Résumé : International audience
GYNECOLOGIE OBSTETRIQUE FERTILITE & SENOLOGIE

hal-01653280
https://hal.archives-ouvertes.fr/hal-01653280
DOI : 10.1016/j.gofs.2016.12.017
PUBMED : 28238320

Éditeur(s) : HAL CCSD
Résumé : National audience
Objectives To define the different stages of spontaneous labour. To determine the indications, modalities of use and the effects of administering synthetic oxytocin. And to describe undesirable maternal and perinatal outcomes associated with the use of synthetic oxytocin. Method A systematic review was carried out by searching Medline database and websites of obstetrics learned societies until March 2016. Results The 1st stage of labor is divided in a latence phase and an active phase, which switch at 5 cm of cervical dilatation. Rate of cervical dilatation is considered as abnormal below 1 cm per 4 hour during the first part of the active phase, and blow 1 cm per 2 hours above 7 cm of dilatation. During the latent phase of the first stage of labor, i.e. before 5 cm of cervical dilatation, it is recommended that an amniotomy not be performed routinely and not to use oxytocin systematically. It is not recommended to expect the active phase of labor to start the epidural analgesia if patient requires it. If early epidural analgesia was performed, the administration of oxytocin must not be systematic. If dystocia during the active phase, an amniotomy is recommended in first-line treatment. In the absence of an improvement within an hour, oxytocin should be administrating. However, in the case of an extension of the second stage beyond 2 hours, it is recommended to administer oxytocin to correct a lack of progress of the presentation. If dynamic dystocia, it is recommended to start initial doses of oxytocin at 2 mUI/min, to respect at least 30 min intervals between increases in oxytocin doses delivered, and to increase oxytocin doses by 2 mUI/min intervals without surpassing a maximum IV flow rate of 20 mUI/min. The reported maternal adverse effects concern uterine hyper-stimulation, uterine rupture and postpartum haemorrhage, and those of neonatal adverse effects concern foetal heart rate anomalies associated with uterine hyper-stimulation, neonatal morbidity and mortality, neonatal jaundice, weak suck/poor breastfeeding latch and autism. Conclusion The widespread use of oxytocin during spontaneous labour must not be considered as simply another inoffensive prescription without any possible deleterious consequences for mother or foetus. Conditions for administering the oxytocin must therefore respect medical protocols. Indications and patient consent have to be report in the medical file. © 2016 Elsevier Masson SAS
Revue Sage - Femme

hal-01467543
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01467543
DOI : 10.1016/j.sagf.2016.11.006

Éditeur(s) : HAL CCSD
Résumé : International audience
Introduction Adverse effect of environmental exposures on the pregnancy is now clearly stated in the literature. Chemical, biological, or physical agents are susceptible to influence the onset of the pregnancy, as well as the fetal development. This paper aims to summarize basic knowledge on the topic. Methods A literature review was conducted based on a targeted search on the Medline database. Results Literature data suggested increased risk of congenital malformation, fetal growth, or impaired neurodevelopment. Adverse environmental effects can be observed during the pregnancy, at birth, during the childhood, during the adulthood, and possibly on the next generation. Discussion Prevention tools can be used to limit several domestic, occupational or lifestyle exposures. While emphasizing the importance of the prevention, it is necessary to remind to pregnant women that frequency of adverse pregnancy outcomes remain uncommon, considering the systematic exposures to a large panel of reprotoxicants. © 2017 Elsevier Masson SAS
ISSN: 16374088

hal-01647157
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01647157
DOI : 10.1016/j.sagf.2017.06.004

Éditeur(s) : HAL CCSD
Résumé : International audience
[No abstract available]
Journal of Gynecology Obstetrics and Human Reproduction

hal-01580501
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01580501
DOI : 10.1016/j.jogoh.2017.04.011
PUBMED : 28483643

Éditeur(s) : HAL CCSD
Résumé : National audience
Since the 1950s, Friedman's curves served as reference to guide obstetrical practice around the world. However, recent studies have suggested guidelines based on Freidman's results were too stringent and induce inappropriate and excessive interventionism. The committee aimed to redefine the structure and the normal duration of the labor, as well as the criterion to be fulfilled to consider a labor as abnormal. Several recommendations have been produced based on a systematic literature review. Labor dystocia should not be diagnosed during the latency phase. The beginning of the active phase of the 1st stage of labor has been established between 5 and 6 cm of cervical dilatation, which is later than previously suggested. Rate of cervical dilatation is considered as abnormal below 1 cm per 4 hour during the first part of the active phase, and blow 1 cm per 2 hour above 7 cm of dilatation. A maximum duration for the 2nd stage of labor cannot be defined in the French context, based on the literature. However, exceeding 3 hours, the risk-benefit balance becomes less beneficial. These new guidelines would help to reduce the use of oxytocin and caesarian delivery for labor dystocia. © 2016 Elsevier Masson SAS
Revue Sage - Femme

hal-01467546
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01467546
PUBMED : 28483643
DOI : 10.1016/j.sagf.2016.10.006