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Biomedical subjects

E Papiernik

Publications and source records attributed to E Papiernik.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1999

Neurological and physical maturation in normal growth singletons from 37 to 41 weeks' gestation.

An evaluator blinded to gestational age (GA) assessed a cohort of 397 singletons born at between 37 and 41 week's gestation, by looking at 11 criteria exploring neurological maturity and 12 criteria exploring physical maturity. The analysis of correlation coefficients shows various degrees of association between GA and each of the criteria examined. A highly significant correlation (p < 0.001) was found for 4 neurological criteria defining passive tone in limbs and sucking reflex. The activity of flexor muscles of the neck and crossed extension reflex were also associated with maturity but weakly (p < 0.01). A highly significant correlation (p < 0.001) was found for 8 of the physical criteria, skin colour and texture, lanugo, ear firmness, genitalia, breast size, nipple formation and plantar skin creases. Oedema, skull firmness and ear form were also associated but weakly. With multivariate analysis combining the neurological and physical criteria, predictive values ranked in the following order: 1) plantar skin, 2) breast size, 3) sucking reflex, 4) scarf sign, 5) skin colour, 6) genitalia, 7) popliteal angle, 8) return to flexion of forearms, 9) dorsiflexion angle. In conclusion, a score based on physical and neurological criteria is associated with duration of pregnancy (r2 = 0.32) between 37 and 41 weeks' gestation. Such an instrument allows us to study fetal maturity as a variable independent of GA, and therefore makes it possible to identify various influences that may modify maturational rate during the last weeks of pregnancy.

Cohort Studies↗
PubMed1999

Fetal growth retardation: a limit for the further reduction of preterm births.

Fetal growth retardation is at present the major obstacle for further reduction in preterm births. After 25 years of continuous decline in the preterm birth rate in France from 6.9% in 1972 to 4.4% in 1981 and 3.8% in 1989, there has been an increase to 4.5% in 1995. The major new fact is the progressive increase of medically induced preterm births, mostly related to fetal growth retardation. Spontaneous preterm births have continued to decrease throughout all these years.

Birth Weight↗
PubMed1999

Very and moderate preterm births: are the risk factors different?

OBJECTIVE: To describe the risk factors for very preterm births and to compare the strengths of the associations between these risk factors and very and moderate preterm births. DESIGN: A case-control study. SETTING: Fifteen European countries. METHODS: Between 1994 and 1997, 1675 very preterm births, 3652 moderate preterm births and an unmatched control group of 7965 births at term were included. Odds ratios for very and moderate preterm births (related to socioeconomic status, behavioural factors, maternal age, body mass index and obstetric history) were estimated and compared using polytomous logistic regression. RESULTS: Underprivileged social situation, older maternal age and adverse previous pregnancy outcomes were significantly related to very and moderate preterm births. However, these factors were more strongly associated with very preterm births than with moderate preterm births, for both spontaneous and induced deliveries. Smoking during pregnancy, young maternal age and low body mass index were significantly related to very and moderate spontaneous preterm births, but no significant difference in odds ratios was observed between the two outcomes. CONCLUSION: These results suggest that risk factors for very and moderate preterm births are similar, but the strength of the associations differ, especially for social factors and obstetric history.

Adult↗
PubMed1999

Prenatal screening with evaluated high risk scores.

This paper reviews data that support the effectiveness of the French approach of using risk scoring for evaluating the risk of preterm delivery. This approach, which was developed in 1969 and spread to obstetricians and midwives throughout France in the early 1970s, includes systematic information about the recognition of uterine contractions, advice about reduction of physical exercise, and the prescription of work-leave for women with heavy or physically demanding work loads. The effectiveness of this prevention strategy is assessed using three different data sets: an evaluation of a preterm prevention program in the Alsace Region of France, five successive French national sample surveys which collected data on pregnant women, and a study of the effectiveness of a prevention program for twins in the district of Haut de Seine near Paris. The authors show that the rate of preterm birth in France declined substantially, but that the decline was concentrated among singleton spontaneous births. Since the 1970s induced preterm births have increased, and, interventions have not reduced the high rates of preterm birth among twins.

Female↗
PubMed1998

Higher endothelin concentrations in the fetoplacental unit of pregnant women of African ancestry.

Immunoreactive endothelin was assayed in maternal and fetal biologic fluids of women of African and European ancestry with normal singleton pregnancies undergoing cesarean section at term for obstetric reasons. Endothelin concentration was found to be higher in the umbilical vein and artery blood of women of African origin. Higher production of endothelins in the fetoplacental unit may place these women at a greater risk of preeclampsia.

Adult↗
PubMed1998

Management and outcome of triplet pregnancy.

The parameters involved in obstetrical follow-up of triplet pregnancies were evaluated in a retrospective study between 1975-1993 of the follow-up of 91 triplet pregnancies. During this long interval of time, many changes in management of triplets occurred. Considering these differences, two periods in the present study were compared: 1975-1986, which consists of a previously published retrospective analysis of 21 triplet pregnancies; and 1987-1993, during which the modalities of the 7-year follow-up described previously were applied to 70 triplet pregnancies. No improvement was observed between the two periods. Nineteen pregnancies were spontaneous. Thirty-seven allowed treatment with ovulation induction agents and 35 were due to in vitro Fertilization. Early diagnosis of multiple pregnancies allows installation measures for the prevention of prematurity. Management, initiated upon diagnosis, included home rest and a weekly follow-up at home by a midwife every week. Monthly consultations and ultrasounds were performed at the hospital. Hospitalization was not systematic but was done in cases of maternal complications. The mean term for the diagnosis of triplet pregnancy was 13.9 +/- 5.3 weeks. The mean gestational age was 33.4 weeks; 90% of the deliveries were by cesarean section. The mean weight of the neonates was 1716 g. The mean Apgar score at 1 and 5 m was 7.7 and 9.3, respectively. The perinatal mortality was 80 per 1000. The main neonatal complications resulted from prematurity. Authors compared rates of Hyaline Membrane Disease in infants of patients treated with corticosteroids and of patients who were not. Hyaline Membrane Disease occurred in 13% of the corticotherapy group and in 31% of the untreated group. The present study supports systematic corticotherapy between 28 and 34 weeks for triplet pregnancies.

Adult↗
PubMed1998

-Anesthesia and analgesia practice patterns in French obstetrical patients-.

OBJECTIVE: To assess the rate of epidural analgesia (EA) for parturition and the techniques of anaesthesia for Caesarean section (CS). STUDY DESIGN: Retrospective study. PATIENTS: A series of 84,235 deliveries. METHODS: The series was extracted from a total of 770,054 deliveries carried out in 1991, according to the number of births in each hospital (1/1 if the births were < or = 100 per year, up to 1/25 if they were > or = 2,000 per year). The data analyzed included: anaesthesia technique, whether or not there was an anaesthetist on night duty at the hospital, birth rate in the hospital, type of hospital: university (UH), general (GH) or private (PH). For vaginal deliveries, the mode of labour commencement (spontaneous or induced), the multiplicity of pregnancies and a history of past CS were also noted. RESULTS: Vaginal deliveries: the overall rate of EA was 37.2%. EA were not carried out in 5% of maternity hospitals. In cases of spontaneous labour, the average rate was 32.1%, significantly less than for induced labour (59.6%, P < 0.0001) and in cases of previous CS (39%, P < 0.05). There was no statistical difference in cases of multiple pregnancies (35.7%). The average rate of EA was correlated to the number of annual births (P < 0.001) and was increased when the anaesthetist was present in hospital at night (P < 0.001). It was also significantly lower in GH (P < 0.001) than in UH or PH, which were equivalent. Scheduled CS: general anaesthesia (GA) was carried out at a significantly higher rate than regional anaesthesia (RA) (49.7% vs 48.4%, P < 0.05). In 15.1% of hospitals, RA was not available. The incidence of RA was influenced neither by the rate of annual births nor by the presence of the anaesthetist in the hospital during night. However, RA was significantly less frequent in GH (46.3%, P < 0.001) than in UH (48.6%) and in PH (53.6%) which were equivalent. CS during labour: the incidence of RA was significantly higher than GA (53.2% vs 44.1%, P < 0.001). In 17.1% of hospitals, RA was never carried out. The rate of RA was correlated to the size of the maternity hospital, and significantly higher (P < 0.001) when the anaesthetist was present in hospital during night. The differences between UH, GH and EP were the same than for scheduled CS. CONCLUSION: In France in 1991, the average rate of 37.2% for EA for obstetrics was high when compared to the rate in United Kingdom. It was equivalent to those in United States and Ontario, Canada. The discrepancies between hospitals were mainly related to structural and organizational factors. The influence of the size of the maternity hospital, the 24-hour service of EA was also shown in other studies. However, the difference between GA and UH and PH is a French particularity. The high rate of GA for CS differs largely with those in the UK or the USA. The time saving aspect of GA was probably an important factor for the choice of this technique. This study must be reactualized and enlarged to determine the demand of EA for labour by parturients and obstetricians.

Analgesia, Epidural↗