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Biomedical subjects

E Papiernik

Publications and source records attributed to E Papiernik.

At least 73 records · Page 4Linked to original sources
PubMed1996

Management and outcomes of 65 quadruplet pregnancies: sixteen years' experience in France.

OBJECTIVE: Data on the prognosis and management of multifetal pregnancies are of vital importance, particularly when the option of selective termination is considered. The present study details the obstetric management, neonatal outcome, and follow-up data of 65 quadruplet pregnancies in France. METHODS: To conduct the study, a questionnaire was sent to families registered with the National Association Helping Parents of Multiple Births (Association National d'Entraide des Parents de Naissance Multiples, A.N.E.P.N.M.). RESULTS: Of 116 questionnaires sent to families of quadruplets born between 1972 and 1988, 65 were received. Of these pregnancies, 58 were obtained with ovulation induction agents, 2 with IVF (in vitro fertilization) and GIFT (gamete intrafallopian transfer) and 5 were spontaneous. Diagnosis was made prior to 13 weeks gestation in 87.2% of cases. Most mothers were hospitalized prior to delivery--mean duration of 47 days. The mean gestational age at delivery was 31.2 +/- 3 weeks with a prematurity rate of 97%. Cesarean sections were performed in 51 cases and vaginal deliveries in 14. Neonatal and perinatal mortality rates were 68 and 104 per 1000, respectively. Birthweights of quadruplets ranged from 760 to 2455 g with a mean of 1615 g. CONCLUSION: Management of quadruplet pregnancies in France consists of early diagnosis, echographical and clinical monitoring, early reduction of maternal activity and cesarean deliveries. Our management of such pregnancies is of high quality as reflected by our obstetrical results. Lack of adequate management, as perceived by families of quadruplets, exists at two levels; a psychological (lack of psychological support) and a financial (lack of specific help).

Birth Weight↗
PubMed1996

Maternal-fetal hemorrhage: a reappraisal.

PURPOSE: To determine the frequency of maternal-fetal hemorrhage at or above 1 microliter of maternal whole blood. METHODS: Seventy-three mothers whose red blood cells bore an Rh antigen (Rh D, Rh c, Rh E) that was absent on red blood cells of their newborns were identified and a new cytological method, the Kleihauerimmunogold-silver-staining technique, was applied on the blood of their neonates to detect and quantify maternal red blood cells. Stringent precautions were taken to avoid contaminations of neonatal blood samples by adult red blood cells. RESULTS: Maternal red blood cells were present in 3 newborns, a frequency of 4% (95% Cl: 1-11%), and the estimated volumes of hemorrhage were 0.8, 1.5, and 101 microliters of maternal whole blood. No obstetric factor was clearly associated in this limited study with the occurrence of maternal-fetal hemorrhage. CONCLUSIONS: Mother-to-fetus microtransfusion greater than 1 microliter is infrequent at or near delivery, and it may be observed after an uncomplicated pregnancy and vaginal delivery.

Adult↗
PubMed1996

[Epidemiology of fetal deaths in the Seine-Saint-Denis perinatal survey].

OBJECTIVE: To analyse the epidemiological characteristics of antepartum stillbirths. DESIGN: A population based cases-cohort study in a limited geographical area, the department of Seine-Saint-Denis, France. Prospective collection of cases and controls between the 1989-10-01 and 1992-09-30, and retrospective collection of data. SUBJECTS: All antepartum stillbirths of 28 weeks gestation of greater, except lethal malformations and multiple pregnancies. RESULTS: 273 antepartum stillbirths were collected during the 3-year study period (52, 2% of the perinatal deaths). The causes were mainly, abruptio placenta and cordonal causes; however, unexplained antepartum stillbirth was the most important group (38, 8%). Hypotrophy was present for 49.5% of cases versus 10.1% of controls (p < 0.001). It was associated with death whatever cause or gestational age, particularly in unexplained antepartum death (54.7%). In univariate analysis, the usual risk factors including obstetrical history, socio-economic characteristics, obstetric care and country of birth were associated with death. But, in multivariate analysis, only "no pregnancy déclaration", "deficient obstetric care", "history of stillbirth", "born in Black Africa" and "born in DOM-TOM" were significantly associated with death. CONCLUSION: More than one half of perinatal deaths concern antepartum stillbirth; the causes have remained unchanged for twenty years and unexplained antepartum stillbirth remains the most important group. The principal risk factor is fetal hypotrophy. The other significant risk factors after multivariate analysis are deficient obstetric care and birth in Black Africa or in the DOM-TOM. To propose prevention actions, progress is necessary in in utero diagnostic of hypotrophy and in the understanding in the risk associated with country of origin.

Abruptio Placentae↗
PubMed1996

[Morbidity and mortality of premature infants of less than 33 weeks].

The present study in a case-control study in a population based collection of data of all births from 22 to 32 weeks in all maternities of the Seine-Saint-Denis district for three years, 999 on 67819 total births. The study describes the site of births by level of perinatal care (level 3 maternity associated with a neonatal intensive care unit, level 2 with a neonatal pediatric ward without intensive care, and level 1 without any of these pediatric services. The proportion of births at a level 3 maternity is 6.3% for all births, and 12.9% for live birth of less than 33 weeks. The study describes the transfers of the live babies to a neonatal intensive care by external transfers from level 1 and level 2 units or internal transfers in level 2 and 3 units. All babies are transferred. The study describes the per partum and neonatal deaths up to 28 days by week of gestation duration and site of birth. The study uses the comparison between the deaths during delivery (from 28 to 32 weeks) and in the first 28 days compared to controls, using a regression analysis method. The risk of per partum and neonatal death is: OR = 8.08 [1.03-76.40] when site of birth 2 is compared to 3 and OR = 11.78 [1.33-103.77] when site of birth 1 is compared to 3. The study shows that the french obstetricians and pediatricians have not accepted the international consensus proposing that births of less than 33 weeks should take place in level 3 perinatal units, goal which is reached for 80% of those births, with less neonatal deaths and developmental handicaps.

Case-Control Studies↗
PubMed1996

[20 years of perinatal epidemiology. The clinician's viewpoint].

Three periods are described. The first is the period of perinatality from 1971 to 1981 during which the precise objective was to reduce perinatal mortality and morbidity based on actions proposed after cost-effectiveness analysis and early surveys in France to evaluate the effect of these actions. This plan allowed a new policy including prevention of prematurity and improvement in delivery conditions. National surveys have shown a reduction in prematurity rates and perinatal mortality. The second period was a wait-and-see period with the abandon of national actions, but also a transfer of responsibility for perinatal health to the different departments. Certain departments developed perinatal actions:actions in Martinique and Guadeloupe are described together with the early audit on perinatal care in Seine-Saint-Denis. The third period, the current period, began in 1994 when the government proposed a new perinatality plan based on a new perception of maternal mortality risk and a come back of the idea of a collective approach to safe birth.

Delivery, Obstetric↗
PubMed1995

[Maternal transfer and neonatal transfer].

Regionalisation of perinatal health care has not been organised in France. This concept has proposed to reduce mortality and morbidity of newborns of less than 33 weeks or less than 1,500 g at birth by a transfer of the mother before birth to a perinatal center with a neonatal intensive care unit. The available information in France shows that only 14% of those infants will be born in a level 3 centres. In Seine-Saint-Denis district available information shows that the adds ratio for per partum and neonatal death for newborns of 28-36 gestation duration is of 5.27 when a level 1 maternity is compared to a level 3.

Female↗
PubMed1995

The association between occupational factors and preterm birth: a United States nurses' study. Research Committee of the Association of Women's Health, Obstetric, and Neonatal Nurses.

OBJECTIVE: Our purpose was to evaluate factors associated with preterm birth among a national sample of U.S. nurses. STUDY DESIGN: We conducted a case-control study of 210 nurses whose infants were delivered prematurely (< 37 weeks) (cases) and 1260 nurses whose infants were delivered at term (> or = 37 weeks) (controls). An occupational fatigue score was constructed from four sources and varied from 0 to 4. The relation between occupational activity (including hours working and fatigue score) and preterm birth was analyzed with the use of Pearson chi 2 tests, estimates of odds ratios with 95% confidence intervals, and multivariate logistic regression; we controlled for confounding factors. RESULTS: Factors significantly associated with preterm birth included hours worked per week (p < 0.002), per shift (p < 0.001), and while standing (p < 0.001); noise (p = 0.005); physical exertion (p = 0.01); and occupational fatigue score (p < 0.002). The adjusted odds ratios were 1.6 (p = 0.006) for hours worked per week (< or = 36 vs > 36) and 1.4 (p = 0.02) for fatigue score < 3 vs > or = 3. CONCLUSIONS: Preterm birth among working women may be related to hours worked per day or week and to adverse working conditions.

Case-Control Studies↗
PubMed1995

Is prevention of preterm births in twin pregnancies possible? Analysis of the results of a prevention program in France (1989-1991).

OBJECTIVES: A policy aimed at the prevention of early preterm births in twin pregnancies has been evaluated. The prevention program included: early diagnosis of twinning, information of the mothers about the risk of prematurity, attempts to restrain physical activity and early work leave prescription when indicated. STUDY DESIGN: Cohort study of all twin births in a given geographical area (Hauts-de-Seine district); 546 mothers with pregnancy duration of > or = 26 weeks were included; 1088 newborns were followed up to the 28th day of life. RESULTS: The recommended prevention program is largely used (88% of early diagnosis of twinning, 62% of the women informed and 73% of prescription for reduced physical activity). The very preterm (26-28 weeks) and early preterm (< or = 32 weeks) birth rates are low: 1.5 and 8.5%, respectively. The stillbirth rate is 11 per thousand and the neonatal mortality rate (0-27 days) is 10 per thousand live births, with a persistent difference between the first and the second twin. CONCLUSION: The present study demonstrates the open access and acceptability of the prevention policy; in addition, the perinatal outcomes are better than those of comparable published cohorts.

Cohort Studies↗
PubMed1995

The regionalization of perinatal care in France--description of a missing policy.

This paper reviews published data on the organization and evaluation of regionalized perinatal care programs in countries where they exist and describes those elements presently lacking in France. The advantage of maternal compared to neonatal transport is described vis-85-vis its effect on perinatal deaths as well as neonatal and developmental handicaps. Most studies describe a major advantage of maternal transfers, with less perinatal deaths (including stillbirths and neonatal deaths) and lower rates of severe developmental handicaps. In contrast, French publications show that widespread regionalization of perinatal care does not exist in spite of proposals advocating this concept made more than 20 years ago. Thus, many deliveries of less than 33 weeks gestation length or/and less than 1500 g birth weight take place in maternity sites without adequate neonatal care, despite ample evidence that such infants are at much greater risk of perinatal death or severe handicaps at 2 years of age after transfer than if they had been born in a perinatal center. For these reasons, professional organizations in France should choose to implement a policy of maternal transfers as a major effort in the near future.

Birth Weight↗
PubMed1995

Working conditions, maternity legislation, and preterm birth.

The review of the scientific literature on the role of employment-related physical activity suggests that prolonged standing and long working hours may increase the risk of preterm delivery. Although maternity legislation in many European countries has regulated work schedules and working conditions for pregnant women, none of the European countries except for France seems to have experienced a reduction in preterm rates. France has had both a comprehensive maternity legislation and a national program specifically aimed to reduce preterm birth. Despite the lack of reduction in preterm rates, paid maternity leave, guaranteed job protection, and regulation of hazardous working conditions remain a desirable societal goal for any industrialized nation.

Europe↗
PubMed1995

[Practical use of sulprostone in the treatment of hemorrhages during delivery].

OBJECTIVE: To assess intravenous use of sulprostone (Nalador), a prostaglandin E2 analogue, is case of post-partum haemorrhage due to uterine atonia. MATERIALS AND METHODS: A retrospective study on 315 cases of post-partum haemorrhage (PPH) from 1st January 1990 to 31st December 1992 in Baudelocque maternity. In 91 cases of PPH due to uterine atonia, usual oxytocin drugs were not sufficient and intravenous sulprostone was used. Characteristics of the patients, mode of sulprostone administration, side effects and treatment failures are reported. RESULTS: One or two dose of 500 micrograms were sufficient in 71% cases. Mean perfusion rate was 8.3 micrograms/mn. Success of treatment was 89% with few side effects (5.5%). No serious complication due to sulprostone was observed. Risk of treatment failure was 8.3 times greater when the delay between diagnosis of uterine atonia and sulprostone administration was more than 30 mn. CONCLUSION: Prostaglandins treatment, and particularly sulprostone, could be used more frequently and earlier in case of PPH due to uterine atonia. Further controlled studies are necessary to know if they should be used as a first line treatment instead of oxytocin in this indication.

Adult↗
PubMed1995

[Preliminary study of the use of fetal pulse oximetry during labor].

OBJECTIVE: To assess continuous monitoring of fetal blood oxygen staturation (SpO2) during labour using a fetal pulse oxymeter. STUDY DESIGN: Preliminary results obtained with the Nellcor N-400 fetal pulse oxymeter at the Maternité Port-Royal-Baudelocque between November 1992 and November 1993 in cases of abnormal fetal heart rate are presented. We analyzed: the correlation between SpO2 during labour and cord vein pH as well as Apgar score, the correlation between changes in SpO2, expressed as a desaturation index, and cord vein pH as well as Apgar score. The negative predictive value of oxymetry was assessed. RESULTS: We found a significant positive correlation between the last SpO2 measurement during labour and umbilical vein pH as well as 1 minute Apgar score. We observed a highly significant correlation between the index of desaturation and cord vein pH as well as 1 minute Apgar score. No neonatal pH below 7.20 was observed when SpO2 was > or = 40% during labour. The negative predictive value of oxymetry was 100% in this short series of patients. CONCLUSION: If these results were confirmed in a larger series of patients, a normal SpO2 value during labour could be reassuring in case of abnormal fetal heart rate.

Apgar Score↗
PubMed1994

Association of pregnancy-induced hypertension with duration of sexual cohabitation before conception.

Pregnancy-induced hypertension affects at least 10% of all pregnancies. An association with first pregnancy or a change in paternity for subsequent pregnancies has been suggested. We studied the duration of sexual cohabitation with the father prior to conception and the incidence of pregnancy-induced hypertension. During a five-month period, 1011 consecutive women who delivered in an obstetric unit were interviewed about paternity and duration of sexual cohabitation before conception. Obstetric charts were abstracted to identify three groups: those with pregnancy-induced hypertension, chronic hypertension, and normal blood pressure. The incidence of pregnancy-induced hypertension was 11.9% among primigravidae, 4.7% among same-paternity multigravidae, and 24.0% among new-paternity multigravidae. For both primigravidae and multigravidae, length of sexual cohabitation before conception was inversely related to the incidence of pregnancy-induced hypertension (p < 0.0001). Similar results were observed after control for race, education, maternal age, marital status, and number of pregnancies. Pregnancy-induced hypertension may be a problem of primipaternity rather than primigravidity. Furthermore, an extended duration of sexual cohabitation before conception may protect against pregnancy-induced hypertension.

Adolescent↗
PubMed1994

Hyaline membrane disease in black newborns: does fetal lung maturation occur earlier?

Debate has developed among several authors about possible accelerated maturation of black fetuses in comparison with whites. In Guadeloupe, French West Indies, where 85% of the population is of black African-American origin, it has been noted that the incidence of hyaline membrane disease (HMD) represents a significant drop beginning after the 32nd week of gestation. Over a 3-year period, 419 black low-birthweight singleton newborns were admitted in the University Hospital's Neonatal Department covering 70% of all births of the island. The incidence of HMD was 50% among very low birthweight (< 1500 g) and 8.3% among moderate low birthweight (> or = 1500 g; P < 0.001). The incidence of HMD was 48.8% among the very preterm (< 32 weeks) and 7.8% (26/331) among the moderate preterm (> or = 32 weeks; P < 0.001). These differences were similar for appropriate for gestational age and small for gestational age infants. Significant differences remained after controlling for several maternal risk factors. These results suggest that the 32nd week of gestation represents a significant drop in the risk for respiratory distress syndrome in black premature compared with that reported in literature on European infants (34th week) and therefore may implicate different obstetrical decisions in the management of critical pregnancies in this population.

Black or African American↗
PubMed1994

Fetal pulse oximetry: correlation between changes in oxygen saturation and neonatal outcome. Preliminary report on 39 cases.

Arterial oxygen saturation of the fetus during labour (SPO2) measured with a fetal pulse oximeter was compared to the neonatal condition measured by umbilical vein pH and Apgar score. Changes in oxygen saturation (index of desaturation) during the second stage of labour were also compared to neonatal outcome. Fifty-five patients with abnormal fetal heart rate pattern during labour had a continuous monitoring of fetal oxygen saturation using the Nellcor N-400 pulse oximeter. SPO2 measurement during the last 10 min of labour was significantly correlated to umbilical vein pH and to 1-min Apgar score (P = 0.022 and P = 0.025, respectively). A much higher correlation was found between the index of desaturation and umbilical vein pH at birth and with 1-min Apgar score (P = 0.002 and P < 0.001, respectively). When considering the lower value of umbilical vein pH at birth to be 7.20, and the normal value of SPO2 during labour to be > or = 40% (negative test), we observed a 100% negative predictive value of oximetry. If these results are confirmed in a larger series of patients, analysis of the changes in fetal arterial oxygen saturation during labour (index of desaturation) could be a good indicator of the condition of the newborn. A normal SPO2 value during labour could be reassuring in case of abnormal fetal heart rate.

Apgar Score↗