Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
In intrauterine pregnancies of uncertain viability with a gestational sac without a yolk sac (with a mean of three orthogonal transvaginal ultrasound measurements <25 mm), the suspected pregnancy loss should only be confirmed after a follow-up scan at least 14 days later shows no embryo with cardiac activity (Grade C). In intrauterine pregnancies of uncertain viability with an embryo <7 mm on transvaginal ultrasound, the suspected pregnancy loss should only be confirmed after a follow-up scan at least 7 days later (Grade C). In pregnancies of unknown location after transvaginal ultrasound (i.e. not visible in the uterus), a threshold of at least 3510 IU/l for the serum human chorionic gonadotrophin assay is recommended; above that level, a viable intrauterine pregnancy can be ruled out (Grade C). Postponing conception after an early miscarriage in women who want a new pregnancy is not recommended (Grade A). A work-up for women with recurrent pregnancy loss should include the following: diabetes (Grade A), antiphospholipid syndrome (Grade A), hypothyroidism with anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies (Grade A), vitamin deficiencies (B9, B12) (Grade C), hyperhomocysteinaemia (Grade C), hyperprolactinaemia (Grade B), diminished ovarian reserve (Grade C), and a uterine malformation or an acquired uterine abnormality amenable to surgical treatment (Grade C). The treatment options recommended for women with a missed early miscarriage are vacuum aspiration (Grade A) or misoprostol (Grade B); and the treatment options recommended for women with an incomplete early miscarriage are vacuum aspiration (Grade A) or expectant management (Grade A). In the absence of both chorioamnionitis and rupture of the membranes, women with a threatened late miscarriage and an open cervix, with or without protrusion of the amniotic sac into the vagina, should receive McDonald cerclage, tocolysis with indomethacin, and antibiotics (Grade C). Among women with a threatened late miscarriage and an isolated undilated shortened cervix (<25 mm on ultrasound), cerclage is only indicated for those with a history of either late miscarriage or preterm delivery (Grade A). Among women with a threatened late miscarriage, an isolated undilated shortened cervix (<25 mm on ultrasound) and no uterine contractions, daily treatment with vaginal progesterone up to 34 weeks of gestation is recommended (Grade A). Hysteroscopic section of the septum is recommended for women with a uterine septum and a history of late miscarriage (Grade C). Correction of acquired abnormalities of the uterine cavity (e.g. polyps, myomas, synechiae) is recommended after three early or late miscarriages (Grade C). Prophylactic cerclage is recommended for women with a history of three late miscarriages or preterm deliveries (Grade B). Low-dose aspirin and low-molecular-weight heparin at a preventive dose are recommended for women with obstetric antiphospholipid syndrome (Grade A). Glycaemic levels should be controlled before conception in women with diabetes (Grade A)
ISSN: 0301-2115

hal-01295639
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01295639
DOI : 10.1016/j.ejogrb.2016.02.015
PUBMED : 27039249

Éditeur(s) : HAL CCSD
Résumé : International audience
Objectives: To assess the adhesion of French obstetricians and gynecologists to the French clinical practice guidelines for pregnancy loss, issued by the French College of Obstetricians and Gynecologists, one year after publication.Methods: An online vignette-based study was emailed to a sample of French obstetricians and gynecologists to compare their management of women with missed early miscarriage and incomplete early miscarriage. A descriptive statistical analysis was performed comparing the rates of appropriate management for these two indications before and after the release of the guidelines.Results: Of the 404 specialists contacted, 143 completed the questionnaire. Forty-three percent stated that they had changed their practices following the release of the guidelines. The rate of adhesion was moderate for the management of missed early miscarriage (53% after publication of the guidelines versus 42% before, P = 0.001) with a trend to avoid watching-and-waiting management. The rate of adhesion was poor for the management of incomplete early miscarriage (43% after the publication of the guidelines versus 27% before, P < 0.001) with a lower use of misoprostol.Conclusion: Adhesion to the French guidelines appears to be moderate for the management of missed early miscarriage and low for the management of incomplete early miscarriage.
ISSN: 24687847

hal-01558814
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01558814
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01558814/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01558814/file/Le%20Gouic%20et%20al.%20-%20Evaluation%20of%20adherence%20to%20French%20clinical%20practic.pdf
DOI : 10.1016/j.jogoh.2017.03.005

Éditeur(s) : HAL CCSD AGU and the Geochemical Society
Résumé : International audience
Continental rifts and passive continental margins show fundamental along-axis segmentation patterns that have been attributed to one or a number of different processes: extensional fault geometry, variable stretching along strike, preexisting lithospheric compositional and structural heterogeneities, oblique rifting, and the presence or absence of eruptive volcanic centers. The length and width scales of the rift stage fault-bounded basin systems change during the late evolution of the new plate boundary, and the role of magmatism may increase as rifting progresses to continental rupture. Along obliquely spreading ridges, first-order mid-ocean ridge geometries originate during the synrift stage, indicating an intimate relationship between magma production and transform fault spacing and location. The Gulf of Aden rift is a young ocean basin in which the earliest synrift to breakup structures are well exposed onshore and covered by thin sediment layers offshore. This obliquely spreading rift is considered magma-poor and has several large-offset transforms that originated during late stage rifting and control the first-order axial segmentation of the spreading ridge. Widely spaced geophysical transects of passive margins that produce only isolated 2-D images of crust and uppermost mantle structure are inadequate for evaluation of competing rift evolution models. Using closely spaced new geophysical and geological observations from the Gulf of Aden we show that rift sectors between transforms have a large internal variability over short distances (∼10 km): the ocean-continent transition (OCT) evolves from a narrow magmatic transition to wider zones where continental mantle is probably exhumed. We suggest that this small-scale variability may be explained (1) by the distribution of volcanism and (2) by the along-strike differences in time-averaged extension rate of the oblique rift system. The volcanism may be associated with (1) the long-offset Alula-Fartak Fracture Zone, which may enhance magma production on its younger side, or (2) channeled flow from the Afar plume material along the newly formed OCT and the spreading ridge. Oblique extension and/or hot spot interactions may thereby have a significant control on the styles of rifting and continental breakup and on the evolution of many magma-poor margins.
ISSN: 1525-2027

hal-00504866
https://hal.archives-ouvertes.fr/hal-00504866
https://hal.archives-ouvertes.fr/hal-00504866/document
https://hal.archives-ouvertes.fr/hal-00504866/file/G3-Leroy_al-2010.pdf
DOI : 10.1029/2009GC002963