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Biomedical subjects

F Goffinet

Publications and source records attributed to F Goffinet.

At least 19 recordsLinked to original sources
PubMed2006

Women's interpretation of an abnormal result on measurement of fetal nuchal translucency and maternal serum screening for prenatal testing of Down syndrome.

OBJECTIVE: To assess the effects of sociodemographic and health-provider factors on women's understanding of abnormal results on measurement of nuchal translucency (NT) and maternal serum screening (MSS), 18 months after the implementation of a policy aimed at increasing women's awareness regarding MSS. METHODS: A representative sample of women (n = 734) who gave birth in Parisian maternity units in 1999 were asked about their understanding of an abnormal result on MSS and NT. We assessed the effects of sociodemographic and health-provider factors on the probability of women interpreting an abnormal result correctly, misinterpreting it as a definitive diagnosis, or declaring that they did not know how to interpret the result. Response rate was 92% and the analyses included multinomial models. RESULTS: For both MSS and NT measurement, the majority of women interpreted an abnormal result correctly. However, there were substantial sociodemographic differences in the probability of women interpreting an abnormal result correctly, and more so in the probability of their declaring not to know how to interpret the result. The probability of correct interpretations was substantially higher, and that of declaring not to know how to interpret the result substantially lower, for MSS than NT measurement. However, for several sociodemographic groups, the proportion of women who misinterpreted an abnormal result on screening as indicative of a definitive diagnosis was also higher for MSS as compared with NT measurement. CONCLUSIONS: These findings underscore the need for additional efforts, along with alternative strategies, to inform women about the implications of prenatal screening, particularly in the case of measurement of NT.

Adult↗
PubMed2006

[Trends in antenatal diagnosis, pregnancy termination and perinatal mortality in infants with congenital heart disease: evaluation in the general population of Paris 1983-2000].

OBJECTIVE: To examine population-based overall and malformation-specific trends in the prenatal diagnosis, pregnancy termination, and perinatal mortality for congenital heart disease (CHD) during a period of rapid progress in prenatal diagnosis and medical management of CHD and to explore the impact of prenatal diagnosis on early neonatal mortality for specific (isolated) cardiac malformations. METHODS: A total of 1982 cases of CHD, which were not associated with a known chromosomal anomaly, were obtained from the Paris Registry of Congenital Malformations. Main outcome measures were trends in the proportions diagnosed and terminated prior to birth, stillbirth and early (<1 day, one-week) neonatal mortality for (1) all cases; (2) all cases excluding isolated ventricular septal defects; and (3) malformation-specific trends for transposition of great arteries, hypoplastic left heart syndrome, coarctation of aorta, and tetralogy of Fallot. Analyses included cusum and binomial regression models for analysis of the trends during 1983-2000. RESULTS: Prenatal diagnosis rates for CHD increased from 23.0% (95%CI: 19.0-27.4) in 1983-1988 to 47.3% (95%CI: 43.8-50.8) in 1995-2000. Termination rates increased between 1983 and 1989 (9.9%; 95%CI: 7.2-13.2) and 1989 and 1994 (14.7%; 95%CI: 12.3-17.4) but seemed to remain stable thereafter. Other than for hypoplastic left heart syndrome, pregnancy termination was exceptional for the other 3 specific malformations examined. Early neonatal mortality decreased to less than a third in the period 1995-2000 as compared with 1983-1989 (risk ratio, first week mortality: 0.31; 95%CI: 0.18-0.53). First week mortality was significantly lower for cases of transposition of great arteries diagnosed before birth (risk difference: 15.4%; 95% CI: 4.0-26.7). CONCLUSION: Progress in clinical management, together with policies for increased access to prenatal diagnosis, has resulted in both a substantial increase in the prenatal diagnosis and considerable reductions in early neonatal mortality of CHD in the Parisian population.

English Abstract↗
PubMed2006

[First breech twin pregnancy: Can we still accept a vaginal delivery? Comparative study of perinatal outcome with attempt of vaginal delivery versus planned cesarean: 166 cases].

OBJECTIVES: To evaluate practices and perinatal outcome in planned routes of delivery for first breech twins. MATERIALS AND METHODS: A retrospective study in first breech twin pregnancies with a gestational age of at least 35 weeks at onset of labor. Maternofetal pathologies known to be associated with a poor neonatal outcome were excluded. A low neonatal outcome was defined by at least one of the following criteria: neonatal death, 5-minute Agar Score < 7, cord blood pH < 7.10, traumatic neurological injuries, admission in neonatal intensive unit care. Neonatal and maternal outcomes were compared between attempt of vaginal delivery (AVD) and planned cesarean section (PCS). RESULTS: Among 166 included patients, an AVD has been performed in 105 cases (63.3%) and a PCS in 61 (36.8%). In AVD group, 46 women (43.8%) delivered vaginally. Low neonatal outcome was not significantly different in AVD group compared with PCS group (9 (8.6%) versus 6 (9.8%); p = 0.78 for the first twin and 7 (6.7%) versus 2 (3.3%); p = 0.49 for the second twin). There was no significant difference in maternal morbidity between the two groups. As a general rule, established practices for deciding route of delivery and labor have been applied in our department. CONCLUSION: No excess of neonatal risk in AVD group compared with PCS was observed. These results could be extrapolated to centers applying a careful protocol to decide the route of delivery and labor practices.

Adult↗
PubMed2006

Level of perinatal care of the maternity unit and rate of cesarean in low-risk nulliparas.

OBJECTIVE: To analyze the influence of level of perinatal care of the maternity unit on the rate of cesarean delivery during labor among women with low-risk pregnancies. METHODS: Using data from the PREMODA (PREsentation et MODe d'Accouchement: presentation and mode of delivery) study of 138 French maternity units, the delivery method in 3,654 low-risk nulliparas (live singleton fetus in cephalic presentation at term [37-41 weeks of gestation], born weighing 2,500-4,500 g, no uterine scar, no cesarean before labor, and no induction of labor for maternal or fetal disorders) was analyzed. Independent variables included maternal and fetal characteristics and the level of perinatal care of the maternity unit (level 1, 2a, 2b, and 3; where levels 2b and 3 routinely manage high-risk pregnancies). Univariable and multivariable analysis with a multilevel logistic model explored the factors associated with cesarean delivery during labor. RESULTS: Overall, the rate of cesarean during labor was 11.7%. The rate was significantly higher in level 2b (odds ratio 1.5, 95% confidence interval 1.1-2.1) and 3 (odds ratio 1.3, 95% confidence interval 1.0-1.9) maternity units than in level 1 facilities. The size and status of the facilities did not significantly affect these rates. Risk factors for cesarean were older maternal age, non-French origin, gestational age of 41 weeks, male sex, and high birth weight. CONCLUSION: Maternity units that frequently manage high-risk pregnancies (levels 2b and 3) have higher rates of cesareans during labor for their population of nulliparas at low risk than do facilities that deal mainly with low-risk pregnancies (level 1). LEVEL OF EVIDENCE: II-2.

Adult↗
PubMed2005

[Prevalence and prenatal diagnosis of congenital malformations in the Parisian population: twenty years of surveillance by the Paris Registry of congenital malformations].

OBJECTIVES: To assess overall and malformation-specific trends in the prevalence, prenatal diagnosis and pregnancy termination of congenital malformations in the Parisian population. METHODS: We used data from the Paris Registry of Congenital Malformations, which includes all births and pregnancy terminations with structural birth defects or chromosomal anomalies. Data on total and live birth prevalence were available for the period 1981-2000 and for prenatal diagnosis and pregnancy terminations for 1983-2000. Twenty malformations were selected for malformation-specific analyses due to their higher frequency and consistent definitions in different classification systems. RESULTS: For the period 1981-2000, the overall total prevalence of malformations was 3.2%. Prenatal diagnosis rates consistently increased from 16.2% (95% CI, 13.8-18.6) of cases with malformation in 1983 to 69.1% (95% CI, 66.7-71.5) in 2000. Pregnancy terminations increased from 8.8% (95% CI, 7.0-10.8) of cases with malformation in 1983 to 30.1% (95% CI, 27.7-32.6) in 2000. CONCLUSION: Registries of congenital malformations provide population-based data on the prevalence of malformations and their associations with other anomalies. Registry-based data can also be used to evaluate the impact of prenatal testing policies for congenital malformations.

Adult↗
PubMed2004

Thrombophilia and fetal growth restriction.

OBJECTIVE: Genetic thrombophilia may represent a new risk factor for obstetrical complications. The aim of the study was to determine which subgroups may be associated with genetic thrombophilia for small for gestational age infants (SGA). METHODS: A case-control study was performed in three different maternity wards in Normandy. Cases (n=203) were women who had pregnancies complicated by unexplained SGA infants defined as a birth weight below the 3rd centile and control subjects (n=203) were women who had infants with birth weight > or =10th centile. Patients were tested in the immediate postpartum period and 2 months later for factor V Leiden mutation, and prothrombin 20210A mutation. Frequencies of these mutations were observed in different subgroups of SGA infants depending on pregnancy or neonatal outcomes usually associated with intrauterine growth restriction (IUGR), and were then compared with the overall prevalence for these mutations detected in the control group. RESULTS: Prevalences for factor V Leiden mutation (or=2.58; 95% confidence interval: 0.83-8.04), prothrombin 20210A mutation (or=2.03; 95% confidence interval: 0.51-8.01), were comparable between cases and controls (4.9% versus 1.9% and 2.9% versus 1.4%, respectively). Frequencies for these two polymorphisms significantly increased in subgroups of SGA infants with a normal Pourcelot index (13/133 versus 7/203; P=0.04), a gestational age > or =37 weeks of gestation (15/143 versus 7/203; P=0.01), a vaginal delivery (11/117 versus 7/203; P=0.04), a birth weight > or =2000 g (12/121 versus 7/203; P=0.03), no admission to paediatric ward (11/116 versus 7/203; P=0.01), a low Ponderal index <2.5(e) centile (6/45 versus 7/203; P=0.04), and normal head circumference >10th centile (7/53 versus 7/203; P=0.01) in comparison with the control group. CONCLUSIONS: An association was found between polymorphisms for factor V Leiden and prothrombin, and asymmetrical intrauterine growth restriction with immediate favourable neonatal outcomes.

Adult↗
PubMed2004

Interleukin-8 mRNA in vaginal secretions: a prenatal marker of congenital infection in case of preterm labor with intact membranes.

OBJECTIVE: To study whether interleukin-8 (IL-8) mRNA in vaginal secretions is associated with congenital infection and preterm delivery in the case of preterm labor with intact membranes. METHODS: This prospective clinical study in a tertiary referral center included 280 patients who gave birth to 360 infants from 1997 through 1999. IL-8 mRNA in vaginal secretions was determined with reverse transcriptase polymerase chain reaction. Logistic regression was used to examine the association between vaginal IL-8 mRNA and congenital infection independently of the time of birth. Main outcome measures were congenital infection and delivery before 37 and 33 weeks' gestation. RESULTS: A total of 100 women (100/280 (35.7%)) gave birth before 37 weeks. A total of 54 children (54/360 (15%)) had congenital infection. IL-8 mRNA in vaginal secretions was associated with delivery within 14 days of the sampling (24 (15.6%) vs. 7 (5.6%) p < 0.01), but not with delivery within 48 h, 7 days (p = 0.07) or before 37 or 33 weeks. There were more congenital infections in the group with detectable IL-8 mRNA (37 (19.3%) than in the negative group (17 (10.1%); p < 0.05). IL-8 mRNA was associated with congenital infection independently of the time of birth (OR: 2.6 (1.3-5.1)). This test had a sensitivity for predicting neonatal infection of 69%. Its specificity was 49%, its positive predictive value 19%, and its negative predictive value 90%. CONCLUSION: IL-8 mRNA could be a prenatal noninvasive vaginal marker of congenital infection.

Adult↗
PubMed2004

[Management of labor and delivery in low risk nulliparous women: comparison between level 1 and level 3 maternities].

OBJECTIVES: To compare obstetrical practices between level 1 ( community hospital) and level 3 (university hospital) maternities in a low risk nulliparous population. MATERIALS AND METHODS: 1532 low risk nulliparas were included in a retrospective study conducted in the setting of two maternities in the Ile-de-France area. Cesarean delivery and forceps rates, management of labor, analgesia, maternal and neonatal outcomes were compared. RESULTS: Cesarean delivery rates were not significantly different (11.5% in level 3 vs 10.2% in level 1). Level 1 maternity performed induction of labor more often (14.7% vs 8.7%, p<0.01). Peridural analgesia rates were higher in the level 3 maternity (95.1% vs 75.5%. p<0.01) but general anesthesia was two-fold more frequent in level 1 maternity. Level 3 maternity performed more instrumental deliveries (27.5% vs 17.4%, p<0.01) and more episiotomies (72.7% vs 39.3%). But we noted more first and second degree perineal tears in the level 1 maternity (29.9% vs 17.4%, p<0.01). Neonatal hospitalizations were more frequently in level 3 maternity. CONCLUSION: Some "interventionist" practices, but not all, were less frequent amongst physicians managing mainly low-risk women than amongst physicians managing mainly high-risk women but without difference for the cesarean delivery rates. The main differences were observed for epidural, instrumental delivery, and episiotomy rates but perineal tears and induction of labor were more frequent in the level I maternity. These differences could be explained by obstetrical politics in the two maternities rather than the type of level.

Adult↗