Search PubMed⌕ Search

Biomedical subjects

E Papiernik

Publications and source records attributed to E Papiernik.

At least 55 records · Page 3Linked to original sources
PubMed1998

Risk factors for maternal condition at admission to an intensive care unit: does health care organisation play a role? Study Group of the Maternal Morbidity.

The objective of this study was to analyse the relation between severity of maternal condition at the time of intensive care unit (ICU) admission and various individual and institutional factors. This study analysed data from a retrospective population-based study in three French regions during 1991. The population study included 355 patients who were admitted to an ICU during pregnancy, delivery or within 42 days after delivery, for an obstetrical cause. The main outcome measure was the severity of maternal condition at ICU admission estimated from the level of consciousness and from the Simplified Acute Physiology Score (SAPS). The most severe maternal condition was associated with a change in hospital category (from the initially chosen hospital to the hospital referring for ICU) (OR 3.8, 95% CI 1.5-9.6) and with treatment in a private hospital at ICU referral (OR 3.3, 95% CI 1.3-8.3). Foreign nationality was the only individual factor related to very severe maternal condition. These results suggest that health care organisation during pregnancy affects the prognosis of severe maternal condition. The factors involved appear to include the management of unpredictable disorders, the conditions of maternal transfers before ICU admission, and antenatal care of foreigners.

Adult↗
PubMed1998

Should multifetal pregnancy reduction be used for prevention of preterm deliveries in triplet or higher order multiple pregnancies?

This article reviews the arguments for the use of multifetal pregnancy reduction (MFPR) for the prevention of preterm deliveries in triplet and higher order multiple pregnancies and evaluates its effectiveness based on data from published studies. The arguments in favour of pregnancy reduction are based on the substantial mortality and morbidity associated with these pregnancies. Triplets and higher order multiples have increased rates of preterm delivery and intrauterine growth retardation, both of which are independent risk factors for death and handicap. Even controlling for gestational age, rates of mortality and handicap are higher for multiples than for singletons. Moreover, the family's risk of losing a child or having a handicapped child is greater because there are more infants at risk. MFPR effectively lowers these risk by reducing the frequency of preterm delivery. However, its effectiveness may be limited. In some studies, the proportion of preterm deliveries in reduced pregnancies remains above levels found in spontaneous twin or singleton pregnancies and MFPR does not appear to reduce the prevalence of low birth weight. Furthermore, the procedure itself has unwanted side effects: it increases the risk of miscarriage, premature rupture of the membranes and causes adverse psychological effects such as grief or depression for many patients. The authors note that a majority of the higher order multiple pregnancies result from a medical intervention in the first place, either through IVF techniques or the use of ovulation stimulation drugs. Although MFPR is an effective measure for reducing the substantial morbidity and mortality associated with higher order multiple pregnancies, preventive methods, such as limiting to 2 the number of embryos transferred for IVF and better control of the use of ovulation induction drugs, remain more effective and less intrusive.

Female↗
PubMed1998

[Prevention of prematurity in 842 consecutive twin pregnancies].

OBJECTIVE: To evaluate the effects of a specific management in prevention of prematurity in twin pregnancies. METHOD: The parameters involved in obstetrical follow-up of twin pregnancies were evaluated in a retrospective study of 842 twin pregnancies between 1979-1992. RESULTS: Five-hundred-and-fifteen pregnancies were spontaneous. Two-hundred followed treatment with ovulation induction agents and 127 were due to in vitro fertilization. Early diagnosis of twin pregnancies allowed preventive measures against prematurity. Management of twin pregnancies included rest at home and regular clinical examination of the cervix. Monthly consultations and monthly ultrasounds were performed at hospital. Weekly consultations were made by midwives at home. Hospitalization was not systematic, but was necessary in cases of maternal complications. The diagnosis of twin pregnancy was made before 16 weeks in 82.4% of the cases. The mean gestational age at delivery was 36.2 weeks. The prematurity rate was 45.96%. The mean weight of the neonates was 2,376 +/- 533 g for the first twin and 2,297 +/- 547 g for the second twin. The mean Apgar score at 5 minutes was 9.7 and 9.3, respectively for the first and the second twin. The perinatal mortality was 39.3 per 1,000. The main neonatal complications resulted from prematurity. Twins were hospitalized in the intensive care unit in 20.7 cases. CONCLUSION: The present study supports early diagnosis of multiple pregnancies with systematic ultrasound at 11-13 weeks for each pregnancy, information of the patients, rest at home and regular clinical examination of the cervix.

Bed Rest↗
PubMed1998

Socio-demographic risk factors for perinatal mortality. A study of perinatal mortality in the French district of Seine-Saint-Denis.

OBJECTIVES: To investigate the impact of a set of socio-demographic risk factors commonly associated with perinatal mortality -- age, parity, marital status, educational attainment, occupation, and ethnic origin in the French district of Seine-Saint-Denis. METHODS: The study has a case-control design with prospective identification of cases. It includes all singleton non-malformed perinatal deaths which occurred between October 1, 1989 and September 30, 1992. Logistic regression is used to estimate odds ratios. Base incidence rates are generated by incorporating sampling information for the controls. RESULTS: All socio-demographic variables are significantly related to the risk of perinatal mortality in univariate analyses. Some of the increased risk due to social factors is explained by differential age and parity distributions. In multivariate models, however, only parity and country of origin are significant. Women born in the French overseas departments and territories and Sub-Saharan Africa have the highest odds ratios. CONCLUSIONS: Women born outside of continental France face an elevated risk of experiencing a perinatal death even after controlling for age, parity and socioeconomic factors. Although, this excess risk may reflect residual variation in socioeconomic status, alternative explanations such as standards of prenatal care, medical problems during pregnancy and delivery, and cultural practices should be explored.

Adult↗
PubMed1997

Fetal oxygen saturation measured by pulse oximetry during labour with clear or meconium-stained amniotic fluid.

OBJECTIVE: To compare fetal oxygen saturation, scalp pH and arterial cord blood gases in cases of clear or meconium-stained amniotic fluid with and without meconium aspiration (MAS). STUDY DESIGN: Thirty-eight women in labour at term with abnormal fetal heart rate were included. Fetal oxygen saturation was continuously monitored using a Nellcor N-400 fetal pulse oximeter and FS-14 sensor. Fetal scalp blood samples were taken systematically at full dilatation or immediately before cesarean section. Arterial cord blood gases were analysed at birth. Fetal oxygen saturation, scalp pH and neonatal blood gases were compared between fetuses with clear amniotic fluid, meconium-stained amniotic fluid without MAS and meconium stained amniotic fluid with MAS. RESULTS: Moderate or thick meconium was observed in 13 cases during labour. Three newborns had a meconium aspiration defined as meconium below the vocal cords. No differences were observed in scalp pH, scalp base excess, umbilical arterial blood pH or base excess between groups. On the other hand, fetal oxygen saturation (fSpO2) obtained before birth was significantly lower in cases of MAS when compared to the other groups. This difference appears to be large compared to that which might be attributed to meconium and its direct effect on fetal pulse oximetry readings. Fetal oxygen saturation dropped dramatically in cases with meconium aspiration between the first stage of labour (44.7 +/- 8.0%) and the last measurement before birth (27.0 +/- 8.5%). CONCLUSION: Meconium aspiration is more likely to be associated with fetal hypoxemia than with fetal acidosis.

Adult↗
PubMed1997

[Type of birth center and conditions of transfer of neonates under 1500 g or gestational age under 33 weeks].

BACKGROUND: Perinatal care's organization has been widely discussed in France during this last decade. Until now, transfer of high-risk neonates from their birth maternity to a pediatric unit using mobile vehicles led by specialized teams is encouraged in this country. POPULATION AND METHODS: Retrospective analysis of the type of maternities of birth for a population of 717 newborns, weighing less than 1,500 g and/or of gestational age under 33 weeks, extracted from a sample of 84,279 births in 1991. RESULTS: Only 15.6% of studied births took place in a maternity including a special intensive care pediatric unit (international level 3); 58.7% of those newborns where transferred outborn. There was a significant difference between the immediate access of newborns to a level 3 pediatric unit according to the location-of birth: significantly fewer newborns were directly transferred to a level 3 unit when born in a facility that included a level 2 pediatric unit, compared with those born in facilities that included a level 1 or 3 pediatric unit. CONCLUSION: Strong efforts should be made to identify mothers at high risk of giving birth to extremely prematured babies or babies with a very low birthweight so that births could take place in maternities properly equipped for their care. Perinatal care's organization should be built on a hierarchical network of maternities and pediatric services related to the risk of the population. Accreditation of maternities and pediatric services could help moving towards this kind of organization.

Bias↗
PubMed1997

Sexual differences in anthropometric measurements in French newborns.

Sexual differences in anthropometric measurements have been studied in a sample of 17,787 preterm and full-term infants, born between 1980 and 1990 in the maternity of Clamart Hospital (Hauts-de-Seine, France). Body weight, body length, head and chest circumferences were found significantly larger in male newborns. Conversely, the subscapular and tricipital skinfold thicknesses had higher values in females. Such greater fatness in females could be related to the better outcome in neonates of this sex. The weight-for-height indices, however, did not show this female advantage: the body mass index (BMI) and the body weight/body length index were greater in male neonates, the ponderal index (PI) showed no sexual difference.

Anthropometry↗
PubMed1997

Perception of risk, choice of maternity site, and socio economic level of twin mothers.

The objective of this study was to determine if access to high level health facility (level 3 perinatal center) is related to socio-economic level of the mother and to her perception of risk for a twin birth. A retrospective questionnaire was administrated to the mothers of twins during the first post parum days in each of the 27 maternity sites within a defined geographical district near Paris (Hauts de Seine). The survey instrument was designed to precisely characterize the socioeconomic status of the parents, to measure the perceived risk for the twins expressed by the mother, to measure the relationship between the choice of a maternity site (level 1, 2 or 3) by socioeconomic level, and to measure the fetal and neonatal death rates by socioeconomic status. The opinion of mothers of twins about specific risk for her and for her children is very different by socioeconomic levels, as is the choice of level 3. This is discussed with the rates of fetal and neonatal death rates by socioeconomic level. In the absence of a policy of regionalization of perinatal care, the discriminant factor for access to high level care (level 3 maternity site) is the socioeconomic level.

Cohort Studies↗
PubMed1997

Postpartum blues: a clinical syndrome and predictor of postnatal depression?

Although the obstetricians have been aware of puerperal psychiatric events, atypical postnatal depression was only identified during the 1960s. Early screening is therefore required to enable preventive measures to be taken. Our prospective study was intended to uncover early signs of, or a predisposition towards, postnatal depression before postpartum discharge from the hospital. Studying a population of 186 women who had just given birth and using two tools, the self-administered questionnaires designed by Pitt and by Cox, we found a relationship between postpartum blues, evaluated with Pitt's tool on the 3rd day after delivery, and postnatal depression, evaluated 8 months later. We thus show that the postpartum blues, evaluated with Pitt's tool, especially when severe, is predictive of the subsequent development of postnatal depression.

Depression, Postpartum↗
PubMed1997

[Intensive care of pregnant and puerperal women. Characteristics of patients and health management structures].

INTRODUCTION: In order to understand why maternal mortality is higher in France than in other comparable countries, an epidemiological survey was carried out concerning critical illness during pregnancy, delivery and post partum, to ascertain the frequency of critical illnesses, and describe the characteristics of the patients as well as of the obstetrical services caring for them. MATERIAL AND METHOD: The survey was carried out on all obstetric patients treated in intensive care units (ICU), in three French regions for one year. A detailed questionnaire was retrospectively filled out by a specialized investigator, according to the patient's medical file. RESULTS: The frequency of critical illness was estimated at 310 SD 36 per 100,000 live births. Hypertensive diseases (26%) are the most frequent diagnosis that motivated admission to ICU, followed by the hemorrhages (20%), and then the indirect obstetric causes (17%). A large part of these patients was affected by seriously poor conditions before the present pregnancy. Public hospitals were most often implicated in the care of these patients since the beginning of the pregnancy and still more at the moment of the delivery. There was no difference in prenatal care from one type of hospital to another. On the contrary, pathologies and hospitalisation during pregnancy then the causes and the time of admission to ICU as well as the seriousness of maternal conditions were statistically different from one type of hospital to much more frequently in such pregnancies. Letality did not differ according to the various classes of maternity ward but did differ according to the pathologies leading to the treatment in ICU. CONCLUSION: A large proportion of pregnant women experience seriously critical illness; the relationship between critical illness and maternal mortality according to health care must be studied in depth.

Critical Care↗
PubMed1997

[Analysis of delivery facilities and conditions in 1991 in mothers of infants with birth weights below 1500 grams and/or gestational age under 33 weeks].

AIMS: To identify maternities (in terms of level of activity and linkage with pediatric services) where, in 1991, mothers gave birth to infants of gestational age less than 33 weeks and/or with birth weight under 1500 g. To analyse factors linked to the probability of choosing a particular maternity as place of delivery for this population and measure the impact of maternal transferts on the rates of deliveries. To estimate the number of neonate transferts which could be avoided with simple recommendations. To propose policies that would allow France to come closer to the results of other reference countries in term of management of obstetrical and neonate care. MATERIAL AND METHOD: We extracted from a retrospective sample of 84,279 births (out of a total of 770,148), 717 infants meeting previously defined criteria and related to the population described above, using univariate and multivariate analysis and logistic regression. RESULTS: The Odds-ratio for a delivery to take place in a maternity with a volume of more than 2000 deliveries a year, compared with those doing less than 300 deliveries, is 4, 12. Only 15.8% of those deliveries took place in maternities linked to a level 3 pediatric unit (i.e where an intensive care neonates unit was located in the same building). 39.5% of births took place in level 1 maternities where no required pediatric service existed. Logistic regression techniques showed that the choice of a maternity for mother referral was more linked to the number of deliveries than to its level of pediatric services. In the studied population, 46% of the difference between the observed number of births in high volume maternities (compared to the expected number) could be explained by a maternal referral. The analysis of deliveries showed that for 34% of mothers who gave birth to a baby in a level 1 or 2 maternity, there was a possibility of being referred easily in a level 3 maternity. CONCLUSION: This study shows that the level of care of mothers at high risk of delivering a very premature and/or hypotrophic infant is far from international standards. Simple actions could double the number of births taking place in adapted maternities. We propose to both obstetricians and pediatrists, a common program to enhance the level of care.

Analysis of Variance↗
PubMed1997

[Cesarean sections in France: impact of organizational factors on different utilization rates].

In this study, we analysed the potential impact of organizational factors to explain the variation of cesarean sections' rates. We used a retrospective sample of 84,372 deliveries and two subsamples of low risk deliveries for cesarean sections. We determined different organisational factors that included: juridical and financial status of maternities, their architecture, the type of on-call for obstetricians, pediatrists and anesthetists, the annual number of deliveries and the level of pediatric staff and equipments of the maternities. We used multiple regression techniques to study the specific effect of each parameter, while controlling effects of age and parity of the mothers. We have found that even on the low risk samples, variation of rates were important. The type of on-call, the level of pediatric services and the architecture of maternities exerted a strong and significant effect on the rate of cesarean sections compared to the absence of impact of the number of deliveries. We discuss the reasons why, explaining the occurrence of those factors and then, stress the need to take into account the relevant factors for organizational audits. It appears that, in the context of the new regulation of the health system, these results should give obstetricians reasons to enhance their efforts to correct inefficient practices and to respect consensual guidelines and joint accreditation of obstetric and pediatric units.

Adult↗
PubMed1996

Obstetric patients treated in intensive care units and maternal mortality. Regional Teams for the Survey.

OBJECTIVE: To ascertain the frequency of serious diseases in pregnant women. STUDY DESIGN: A population based survey was performed in France. The cases were all the women admitted for treatment in intensive care unit (ICU). The severity of the cases was measured with the simplified acute physiology score (SAPS) the lethality and the rate of still birth. RESULTS: 435 obstetric patients were included. The estimated frequency of severe diseases was 310 S.D.36 per 100,000 live births. The most frequent diagnose that motived admission in ICU was hypertensive diseases. The lethality rates differed greatly between specific disorders. The lethality rate was lower when scheduled maternity was located in a teaching hospital. CONCLUSION: Regarding these results it appears that the majority of obstetric patients with severe diseases are referred to suitable care, but a small proportion of women who had to change their type of care registered a significant higher lethality.

Female↗
PubMed1996

Maternal position during labor: effects on fetal oxygen saturation measured by pulse oximetry.

OBJECTIVE: To determine the effects of maternal left lateral, right lateral, and supine positions during labor on fetal oxygen saturation measured by pulse oximetry. METHODS: Fetal oxygen saturation measured by pulse oximetry was obtained in 15 laboring women randomly and successively adopting left lateral, supine, and right lateral positions for 10 minutes each. Repeated measures analysis of variance was used for statistical analysis. RESULTS: Changes in fetal oxygen saturation were observed in different maternal positions. The supine position was associated with a lower fetal oxygen saturation than the left lateral position. One supine hypotensive syndrome occurred and was associated with a drop in fetal oxygen saturation. CONCLUSION: Maternal supine position during labor is associated with a lower fetal oxygen saturation than the left lateral position.

Adult↗
PubMed1996

[Kangaroo method and care].

The kangaroo-mother method was initiated by colombian pediatricians in 1979. The method is based on a permanent skin to skin contact of low birth weight infants with their mother. It has spread out in many developing countries as an alternative cheap method for the care of low birth weight infants with several advantages: temperature regulation, prolonged breast-feeding, promotion of mother-infant interaction, decreased mortality. The kangaroo method has been adapted in European countries as kangaroo care that consists in daily mother-infant skin to skin contact during few hours. Introducing the incubator in the mother's room is an other derivative of the method which allows prolonged early contact of the mother with her infant. A major interest of these methods is that they favour parent-infant interaction; however this requires qualified and devoted staffs.

Body Temperature Regulation↗