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Biomedical subjects

E Papiernik

Publications and source records attributed to E Papiernik.

At least 19 recordsLinked to original sources
PubMed2003

Bacterial vaginosis: prevalence and predictive value for premature delivery and neonatal infection in women with preterm labour and intact membranes.

OBJECTIVES: Assess the predictive values of bacterial vaginosis (BV) for preterm delivery (PD) and neonatal infection and compare them with standard markers of infection among women with preterm labour (PL). STUDY DESIGN: Prospective blinded study in a tertiary referral centre in Paris. Women hospitalised for PL with intact membranes at a term between 24 and 34 weeks were included. Vaginal fluid, collected at inclusion was Gram-stained, scored, and interpreted according to Nugent's criteria. RESULTS: Out of 354 women tested, 254 had normal flora (72.3%), 76 intermediate (21.7%) and 24 BV (6.8%). A history of spontaneous miscarriage after 14 weeks was the only risk factor significantly associated with BV. BV was not significantly associated with PD<35 weeks or neonatal infection. Very preterm delivery (before 33 weeks) was significantly associated with the flora grade (P=0.02): women with normal, intermediate and abnormal flora, respectively had 27 (10.6%), 14 (18.4%) and 6 (25.0%) births before 33 weeks. Of the markers tested, the highest risk of very preterm delivery was associated with BV (odds ratio 2.95, 95% CI (1.1-0.8.1)) and CRP>20mg/dl (4.23 95% CI (1.8-9.7)). Predictive value of BV for preterm birth before 33 weeks were: sensitivity 12.8%, specificity 95.0%, positive predictive value 35.3%, and negative predictive value 84.3%. CONCLUSIONS: The frequency of BV and its association with PD are probably very variable and must be interpreted differently from one population to another. While we found an association between BV results and delivery before 33 weeks, the predictive value of BV was disappointing. Although these findings reinforce the importance of a useful marker of subclinical infection, the usefulness of testing for BV in women with PL has not been demonstrated.

Abortion, Spontaneous↗
PubMed2003

Preterm birth in a French population: the importance of births by medical decision.

This analysis describes the prevalence of preterm birth by medical decision among 50,307 live births from the district of Seine-Saint-Denis in France, using a classification that distinguishes between medically decided preterm births associated with premature rupture of membranes and those for other reasons. Thirty-seven percent of singleton and 28% of twin preterm births result from labour induction or a caesarean section in the absence of labour. One-quarter of singleton indicated preterm births are associated with premature rupture of membranes. Between 28 and 31 weeks of gestation, 40% of all singleton preterm births result from a medical decision not associated with premature rupture of membranes. The high levels of indicated preterm birth must be taken into account in evaluations of preterm birth rates and trends in developed countries.

Cohort Studies↗
PubMed2003

[When the pregnant woman risks iodine deficiency].

There may be situations in France were women do not have sufficient iodine intake during pregnancy. The nutritional needs for iodine are increased during pregnancy, mostly during the first trimester, for the use of the mother and the embryo and fetus. In France, a deficiency in available iodine has been demonstrated in the general population and in a population of pregnant women. Iodine deficiency may affect the mother (goiter, high TSH, low thyroxin levels) and new information points to a risk of retarded development in children born to women with low thyroxin levels during the first and second trimesters of pregnancy. Iodine deficiency can also induce transient high TSH levels in the newborn. The question raised by these new established facts is whether iodine supplementation should be proposed for all pregnant women, and this before the second trimester of pregnancy. Systematic screening for thyroid deficiency might also be useful at the end of the first trimester of pregnancy.

Female↗
PubMed2002

[Audits and confidential enquiry: thoughts on the technique used by the French National Committee for the reduction of maternal deaths].

This study demonstrates the need for a confidential approach to medial information when the objective is to improve medical practices, as was the goal of the French National Committee for the reduction of maternal deaths. This approach is the exact opposite of a litigation where the goal is to determine "guilt". Confidential analysis of maternal deaths is not designed to find a guilty person, but rather to identify the mechanisms leading to a maternal death in order to correct the organizational or medical practice leading to failure. We review here similar actions taken to reduce other types of medical accidents such as anesthesia deaths. The confidential approach has been found to be pertinent in the perinatal audit conducted in the Seine-Saint-Denis region, including all fetal and neonatal deaths, that has shown measurable reduction in the number of fetal deaths.

Confidentiality↗
PubMed2001

Are risk factors the same for small for gestational age versus other preterm births?

OBJECTIVES: This article explores whether the impact of social and demographic risk factors for preterm birth differs for small for gestational age preterm births versus other preterm births. STUDY DESIGN: This was a European case control study of the determinants of preterm birth (4700 cases and 6460 controls). Small for gestational age and non-small for gestational age preterm births were compared with a control group of term births; relationships were explored further by stratifying preterm births into subgroups by mode of onset, the presence of hypertension, and gestational age. RESULTS: Of the social and demographic risk factors for preterm birth identified in this sample, high maternal age, smoking, and low and high maternal body mass index have a stronger effect on small for gestational age preterm births. In contrast, obstetric history, maternal education, and marital status have similar effects regardless of birth weight. Hypertension during pregnancy is strongly associated with small for gestational age preterm birth and contributes to an explanation of observed differences. CONCLUSIONS: These results underline the importance of considering fetal growth restriction in the analysis of risk factors for preterm birth.

Adult↗
PubMed2001

Screening with a uterine Doppler in low risk pregnant women followed by low dose aspirin in women with abnormal results: a multicenter randomised controlled trial.

OBJECTIVES: To assess whether systematic screening with an uterine artery Doppler in low risk pregnant women followed by the prescription of low dose aspirin in cases with abnormal results reduced the incidence of intrauterine growth restriction and pre-eclampsia. DESIGN: A multicentre randomised trial. POPULATION: 3,317 low risk pregnant women. In the Doppler group, the uterine artery Doppler was performed between 20 and 24 weeks. Women with abnormal results received 100 mg of aspirin daily until the 35th week. MAIN OUTCOME MEASURES: Intrauterine growth restriction was defined as birthweight below the tenth and the third centile according to gestational age. Pre-eclampsia was defined as hypertension associated with proteinuria > 0.5g/L. RESULTS: Intrauterine growth restriction, whether defined by the third or tenth centile, did not differ significantly between the two groups (RR = 1.22 [0.73 - 2.04] and 1.18 [0.93 - 1.51] respectively). Screening with uterine artery Doppler did not affect birthweight or any of the criteria of perinatal morbidity. There was no effect on the incidence of pre-eclampsia (RR = 1.99 [0.97 - 4.09]) or hypertensive disorders. These results were the same for nulliparae and multiparae. CONCLUSIONS: There is no justification for screening with uterine artery Doppler in a low risk population, even if abnormal results are followed by aspirin treatment and increased prenatal surveillance. Future studies must assess predictive tests that can be performed early in pregnancy and can identify populations at very high risk of pre-eclampsia and intrauterine growth restriction. Only when all of these conditions are fulfilled, aspirin or other treatments may prove its efficacy.

Adult↗
PubMed2001

Induction of labour and scheduled cesarean deliveries in twin pregnancies at the Port-Royal Maternity Hospital in Paris France.

The study is a critical analysis of the decisions to induce labour or schedule cesareans in the practice of a third level referral centre, with as outcome criterion the reduction of fetal death. 783 women pregnant with twins were included from 1.1.1993 to 31.12.1998, in three groups: originally booked, referred for care during pregnancy, or transferred from another institution. The results show that an important proportion of preterm deliveries result from a medical decision to induce labour or from a scheduled cesarean in the originally booked group with even higher proportions in groups of referred and transferred women. These results are discussed in relation to fetal death rates and causes. Deaths related to fetal growth restriction were not observed in women originally booked for care. The hospital bias has been discussed. The conclusion is that decisions to minimize fetal deaths in twin pregnancies increased preterm deliveries by medical decision.

Cesarean Section↗
PubMed2001

The rate of preterm twin births (22-27 weeks) as a criterion for measuring the quality of prenatal care.

While the true figures are not well established, outcomes of twin pregnancies are directly dependent on a small number of preterm births between 22 and 27 weeks. Observation of perinatal outcomes in twin pregnancies yields two contradictory results. Firstly, it shows an improvement in perinatal mortality figures. Secondly, it reveals an increase in the rates of preterm deliveries. These findings result from the observation of 783 twin pregnancies followed and delivered in a level 3 perinatal centre in Paris between 1993 and 1998. Women followed since the beginning of pregnancy through the outpatient clinic of the institution are included in this number, as are women who were referred or transferred to the centre at a later date due to complications, This analysis reflects the influence of two contrasting policies. The first, and less recent policy is devoted to the prevention of preterm births, and is reflected by the low number of extremely preterm deliveries at 22-32 weeks. The second is the effect of our new approach to the prevention of foetal deaths in relation to foetal growth retardation in twins which has resulted in increased medical intervention such as the induction of labour or scheduled Caesarean birth. This has resulted in an increase in twin preterm births from 33 to 36 weeks, with the expected result of fewer foetal deaths.

Female↗
PubMed2001

[Regionalization of perinatal care in the Seine-Saint-Denis department of France].

OBJECTIVE: To evaluate a policy designed to regionalize perinatal care in the Seine-Saint-Denis department of France. METHODS: The place of birth of every preterm infant (born before 33 weeks gestation) in 1998-1999 was compared with that for the period of 1989-1992. The 1989-1992 data came from a prenatal mortality study. For the 1998-1999 period, we used data from an area-based birth registry recording an experimental health certificate. RESULTS: In 1989-1992, 40% of live births before 33 weeks gestation took place in level I maternity units, 37.2% in level II maternity units, and 13.0% in level III maternity units. In 1998-1999, 5.4% took place in level I maternity units, 28.9% in level II maternity units and 65.1% in level III maternity units. The number of postnatal transfers of very preterm infants declined markedly. In 1998-1999, 109 pregnant women were transferred to a level III maternity hospital. This constituted 1.2% of the women who gave birth in Seine-Saint-Denis during this period. CONCLUSION: The policy to regionalize perinatal care and increase maternal transfers was well accepted and successfully implemented. The delivery of very preterm infants in maternity hospitals without neonatal units became a rare event.

Female↗
PubMed2000

Trends in twin birth outcomes and prenatal care utilization in the United States, 1981-1997.

CONTEXT: Multiple births account for an increasing percentage of all low-birth-weight infants, preterm births, and infant mortality in the United States. Since 1981, the percentage of women with multiple births who received intensive prenatal care (defined as a high number of visits, exceeding the recommendation of the American College of Obstetricians and Gynecologists by approximately 1 SD beyond the mean number of visits for women initiating care within each trimester) has increased significantly. OBJECTIVES: To explore the hypothesis that more aggressive management of twin-birth pregnancies may be associated with changes in birth outcomes in this population. DESIGN, SETTING, AND SUBJECTS: Cross-sectional and trend analysis of data from the National Center for Health Statistics' birth and infant death records for all twin births occurring in the United States between 1981 and 1997, excluding those with missing or inconsistent data. MAIN OUTCOME MEASURES: Trends in preterm birth, low birth weight, preterm and term small-for-gestational-age (SGA) births, and infant mortality, by level of prenatal care utilization. RESULTS: The preterm birth rate for twins increased from 40.9% in 1981 to 55.0% in 1997. The percentage of low-birth-weight infants increased from 51.0% to 54.0%. The preterm SGA rate also increased from 11.9% to 14.1%, while the term SGA rate decreased from 30.7% to 20.5%. For women with intensive prenatal care utilization, the preterm birth rate increased from 35.1% to 55.8%, compared with an increase from 50.6% to 59.2% among women with only adequate use. Twin preterm deliveries involving either induction or first cesarean delivery also increased from 21.9% to 27.3% between 1989-1991 and 1995-1997. The twin infant mortality rate for women with intensive prenatal care use declined between 1983 and 1996 and remained lower than the overall twin infant mortality rate. CONCLUSIONS: An apparent increase in medical interventions in the management of twins may result in the seeming incongruity of more prenatal care and more preterm births; however, these data suggest that women with intensive prenatal care utilization also have a lower infant mortality rate. JAMA. 2000;283:335-341

Cross-Sectional Studies↗
PubMed2000

A mathematical model of uterine dynamics and its application to human parturition.

We have developed a simple mathematical model with three physiologically significant states to describe the changes in intrauterine pressure associated with a contraction during human parturition. The myometrium is modelled as a set of smooth muscle cells, each of which is in one of three states (quiescent, contracted, refractory) at a given time. These states are occupied according to a cycle governed by three temporal parameters. The solutions of the equations describing the model show an oscillatory behavior for particular values of these parameters, which is very similar to the time dependent development of intrauterine pressure during labor. Due to its non-linear terms, our model could lead to chaotic oscillations (in the mathematical sense), whose clinical counterpart may occur in cases of dystocia. Despite its simplicity, this model appears to be a useful guide to further investigations of the oscillatory behavior of the myometrium, or other smooth muscles, in normal and pathological situations.

Dystocia↗
PubMed2000

Risk factors for 14-21 week abortions: a case-control study in Europe. The Europop Group.

Data from a case-control survey in Europe, carried out between 1994 and 1997, were used to investigate the risk factors for spontaneous abortions at 14-21 weeks (late abortions), according to the vital status of the fetus before the onset of labour. Late abortions included 62 involving a fetus alive before the onset of labour, 216 late abortions of a fetus already dead, together with 4592 control pregnancies at term (>/=37 weeks) from seven countries. Histories of induced abortion, spontaneous abortion and preterm birth were more closely associated with late abortion of a live fetus than with late abortion of a dead fetus. Women aged >/=35 years and women living alone had a much higher risk of late abortions than women aged 20-24 years and married women, regardless of the vital status of the fetus before labour. These results provide evidence that obstetric history and socio-demographic factors are risk factors for late abortions but differences are observed according to the vital status of the fetus before labour.

Abortion, Spontaneous↗
PubMed2000

The relationship between intrauterine growth restriction and preterm delivery: an empirical approach using data from a European case-control study.

OBJECTIVE: To test whether being small for gestational age, defined as having a birthweight less than the 10th centile of intrauterine growth references, is a risk factor for preterm delivery for singleton live births. DESIGN: A case-control study. SETTING: Maternity hospitals in 16 European countries. SAMPLE: Four thousand and seven hundred preterm infants between 22 and 36 completed weeks of gestation and 6,460 control infants between 37 and 40 weeks of gestation. METHODS: Newborn babies are identified as being small for gestational age using customized reference standards derived from models of fetal growth. The impact of being small for gestational age on preterm delivery is estimated using logistic regression. MAIN OUTCOME MEASURE: Spontaneous or induced preterm delivery. RESULTS: Being small for gestational age is significantly associated with preterm birth, although the magnitude of this association differs greatly by type of delivery and gestational age. Over 40% of induced preterm births for reasons other than the premature rupture of membranes are small for gestational age compared with 10.7% of control infants (OR 6.41). For spontaneous or premature rupture of membranes related preterm births, the association is also significant, but weaker (OR 1.51). The relationship between growth restriction and preterm delivery is strongest for preterm births before 34 weeks of gestation. CONCLUSIONS: These findings highlight the phenomenon of abnormal fetal growth in all premature infants and, in particular, infants delivered by medical decision for reasons other than premature rupture of membranes. The observed association between being small for gestational age and preterm delivery among spontaneous preterm births merits further attention because the causal mechanisms are not well understood.

Case-Control Studies↗
PubMed1999

Antenatal glucocorticoid treatment and cystic periventricular leukomalacia in very premature infants.

BACKGROUND: Antenatal glucocorticoid therapy decreases the incidence of several complications among very premature infants. However, its effect on the occurrence of cystic periventricular leukomalacia, a major cause of cerebral palsy, remains unknown. METHODS: We retrospectively analyzed a cohort of 883 live-born infants, with gestational ages ranging from 24 to 31 weeks, who were born between January 1993 and December 1996 at three perinatal centers in the Paris area. The mothers of 361 infants had received betamethasone before delivery, the mothers of 165 infants had received dexamethasone before delivery, and the mothers of 357 infants did not receive glucocorticoids. We compared the rates of cystic periventricular leukomalacia among the three groups of infants in bivariate and multivariate analyses after adjustment for confounding factors. RESULTS: The rate of cystic periventricular leukomalacia was 4.4 percent among the infants whose mothers had received betamethasone, 11.0 percent among the infants whose mothers had received dexamethasone, and 8.4 percent among the infants whose mothers had not received a glucocorticoid. After adjustment for gestational age, the mode of delivery, and the presence or absence of chorioamnionitis, prolonged interval between the rupture of membranes and delivery (>24 hours), preeclampsia, and the use of tocolytic drugs, antenatal exposure to betamethasone was associated with a lower risk of cystic periventricular leukomalacia than was either the absence of glucocorticoid therapy (adjusted odds ratio, 0.5; 95 percent confidence interval, 0.2 to 0.9) or exposure to dexamethasone (adjusted odds ratio, 0.3; 95 percent confidence interval, 0.1 to 0.7). The adjusted odds ratio for the group of infants whose mothers had received dexamethasone as compared with the group of infants whose mothers had not received a glucocorticoid was 1.5 (95 percent confidence interval, 0.8 to 2.9). CONCLUSIONS: Antenatal exposure to betamethasone but not dexamethasone is associated with a decreased risk of cystic periventricular leukomalacia among very premature infants.

Betamethasone↗
PubMed1999

Social differences of very preterm birth in Europe: interaction with obstetric history. Europop Group.

Social differences of very preterm birth (22-32 completed weeks of amenorrhea) were studied using data from a large case-control survey in Europe between 1994 and 1997; 1,675 very preterm births and 7,965 full-term births were included. The relation between social factors and very preterm birth was studied according to obstetric history and the mode of delivery onset. Very preterm birth was significantly related to low educational level among women with no previous adverse pregnancy outcome (odds ratio (OR) = 2.67, 95 percent confidence interval (CI) 1.66-4.28) and among primigravid women and those with previous first-trimester abortion (OR = 2.01, 95 percent CI 1.56-2.58). In this group, unemployment of all household members was associated with a double risk of very preterm birth. No significant association between very preterm birth and socioeconomic status was observed among women with previous second-trimester abortion or preterm birth. Socioeconomic indicators remained significantly associated with both spontaneous and induced very preterm births among women with no previous late fetal loss or preterm birth. The results are consistent with social factors affecting the risk of very preterm birth, but the relation differs according to obstetric history.

Adolescent↗
PubMed1999

Perinatal mortality in twin pregnancies: a 3-year analysis in Seine Saint-Denis (France).

OBJECTIVES: Our purpose was to evaluate perinatal mortality in twins and to investigate factors associated with this mortality. STUDY DESIGN: A prospective study on the perinatal mortality was performed in the department of Seine-Saint-Denis. Out of all the perinatal deaths, we have retrospectively isolated those arising from twin pregnancies. RESULTS: There were 54 twin pregnancies complicated with perinatal death. The perinatal mortality rate in twin pregnancy was 78.0 per 1000 twin babies delivered. Out of 86 twin deaths, 38 (44.2%) were born before 28 weeks gestation and out of 82 twin perinatal deaths, 37 (45.1%) weighed less than 1000 g. Chorionicity was recorded in 44 twin pairs: 21 (47.7%) were dichorionic and 23 (52.3%) monochorionic. Finally, out of 48 twin sets there were four (8.3%) monoamniotic pregnancies. CONCLUSIONS: The present data show that extreme prematurity represents nearly half of perinatal mortality in twins. This study indicates also a significant proportion of monochorionic placentation among twin pregnancies with poor outcome.

Adult↗