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F Goffinet

Publications and source records attributed to F Goffinet.

At least 73 records · Page 4Linked to original sources
PubMed1997

[Clinical value of umbilical Doppler. Results of controlled trials in high risk and low risk populations].

OBJECTIVE: In order to assess the clinical utility of the use of arterial umbilical Doppler velocimetry, we performed meta-analysis in high and low-risk pregnancies with randomized controlled trials. We included in the low-risk meta-analysis the data of the french multicentric study submit to publication. STUDY DESIGN: Exhaustive review of published and non published trials was performed; quality of trials was assessed before inclusion in meta-analysis. Mantel-Haenzel statistic method was used. We used odds ratio with 95% confidence interval (CI) to present results. RESULTS: Meta-analysis in the high-risk population performed with 13 trials (n = 9162) shows a 36% significant reduction in perinatal-deaths in the Doppler group. The reduction in deaths was also observed in perinatal deaths after exclusion of lethal malformation (OR = 0.62, CI:[0.45; 0.86]) and in stillbirths (OR = 0.54, CI:[0.29; 0.91]). There is no difference in maternal, obstetrical and other perinatal outcomes. Meta-analysis in the low-risk population performed with 4 trials (n = 11451) does not show any benefit in the Doppler group, in particular in perinatal deaths (OR = 0.90, Cl:[0.50; 1.60]). CONCLUSION: Use of umbilical Doppler velocimetry in high-risk pregnancies involve a one third reduction in perinatal mortality. This proved effect should induce obstetricians to performed systematically an umbilical Doppler in pregnancies "at fetal risk". On the other hand, there is no indication to perform an umbilical Doppler in an unselected or a low-risk population.

Female↗
PubMed1997

[Echographic measurement of the inferior uterine segment for assessing the risk of uterine rupture].

BACKGROUND: Ultrasonography has been used to examine the scarred uterus in women who have had previous cesarean sections in an attempt to assess the risk of rupture of the scar during subsequent labor. The predictive value of such measurements has not been adequately assessed, however. We aimed to evaluate the usefulness of sonographic measurement of the lower uterine segment before labor in predicting the risk of intrapartum uterine rupture. METHODS: In this prospective observational study, the obstetricians were not told the ultrasonographic findings and did not use them to make decisions about type of delivery. Eligible patients were those with previous cesarean sections booked for delivery at our hospital. 642 patients underwent ultrasound examination at 36-38 weeks' gestation, and were allocated to four groups according to the thickness of the lower uterine segment. Ultrasonographic findings were compared with those of physical examination at delivery. FINDINGS: The overall frequency of defective scars was 4.0% (15 uterine ruptures and 10 dehiscences). The frequency of defects rose as the thickness of the lower uterine segment decreased: there were no defects among 278 women with measurements greater than 4.5 mm, three (2%) among 177 patients with values of 3.6-4.5 mm, 14 (10%) among 136 patients with values of 2.6-3.5 mm, and eight (16%) among 51 women with values of 1.6-2.5 mm. With a cut-off value of 3.5 mm, the sensitivity of ultrasonographic measurement was 88.0%, the specificity 73.2%, positive predictive value 11.8%, and negative predictive value 99.3%. INTERPRETATION: Our results show that the risk of a defective scar is directly correlated to the degree of thinning of the lower uterine segment at around 37 weeks of pregnancy. The high negative predictive value of the method may encourage obstetricians in hospitals where routine repeat elective cesarean is the standard procedure to offer a trial of labor to patients with a thickness value of 3.5 mm or greater.

Adult↗
PubMed1997

[The value of intravaginal ultrasonography of the cervix uteri for evaluation of the risk of premature labor].

OBJECTIVE: To determinate the predictive value of cervical length, measured by transvaginal ultrasound, for preterm delivery among patients with signs of preterm labor. PLACE: Department of Gynecology & Obstetrics, Poissy Hospital Center. MATERIAL AND METHODS: A prospective study that measured cervical length by transvaginal ultrasound was performed among 108 patients with a singleton pregnancy hospitalized with signs of premature labor between 24 and 34 weeks' gestation or within 21 days of inclusion. RESULTS: The rate of preterm birth was 22.2% (24/108). When cervical length was < or = 26 mm, the gestational age at delivery was significantly lower that when it exceeded 26 mm (36.3 +/- 3.0 weeks compared with 38.5 +/- 2.1 weeks; p < 0.0001). 40.4% (19/47) of patients whose cervical length was < or = 26 mm gave birth prematurely, compared with only 8.2% (5/61) of those with a cervix > 26 mm The sensitivity, specificity, positive predictive value, and negative predictive value of transvaginal ultrasonography were, respectively, 79.2, 66.6, 40.4, and 91.8% for delivery before 37 weeks' gestation, and 75.0, 62.0, 25.5, and 93.4% for delivery within 21 days of the ultra-sound measurement. CONCLUSION: Transvaginal ultrasound of the cervix provides an objective method for evaluating the risk of preterm delivery. Its predictive values are impressive and allow better discrimination between women at high risk of preterm delivery and those in false preterm labor.

Adult↗
PubMed1996

Laparoscopic unilateral ovarian transposition prior to irradiation: prospective study of 20 cases.

BACKGROUND: The objective of this study was to evaluate the feasibility, morbidity, and efficacy of unilateral laparoscopic ovarian transposition on the preservation of hormonal function in premenopausal patients requiring pelvic irradiation (external and/or intracavity by brachytherapy). METHODS: This prospective study was based on 20 patients: 17 presenting with cervical cancer, 2 with Hodgkin's disease, and 1 with ependymoma of the cauda equina. The operative technique consisted of releasing the right ovary from its pelvic attachments, and placing it as high and as laterally as possible in the right paracolic gutter, after creating a pedicle on the infundibulopelvic ligament. The follow-up of ovarian function was more than 1 year for 14 patients. RESULTS: The therapeutic protocol was not modified as a result of ovarian transposition. No intraoperative or postoperative complications were observed. The mean dose of irradiation received by the transposed ovary was 1.75 gray (Gy) (range 0.4-3.7). Mean follow-up was 2 years. Two cases of menopause (14.7%), in the only 2 patients older than 40 years, were observed among the 14 patients followed for more than 1 year. The success rate was 100% for patients younger than age 40 years. CONCLUSIONS: Laparoscopic ovarian transposition is a simple and reliable method, which does not complicate subsequent therapeutic protocol. Its short term efficiency is comparable to results obtained by laparotomy, with a lesser morbidity. Although long term evaluation is necessary, laparoscopic surgery should be considered as an alternative to laparotomy for ovarian transposition.

Adult↗
PubMed1996

Ultrasonographic measurement of lower uterine segment to assess risk of defects of scarred uterus.

BACKGROUND: Ultrasonography has been used to examine the scarred uterus in women who have had previous caesarean sections in an attempt to assess the risk of rupture of the scar during subsequent labour. The predictive value of such measurements has not been adequately assessed, however. We aimed to evaluate the usefulness of sonographic measurement of the lower uterine segment before labour in predicting the risk of intrapartum uterine rupture. METHODS: In this prospective observational study, the obstetricians were not told the ultrasonographic findings and did not use them to make decisions about type of delivery. Eligible patients were those with previous caesarean sections booked for delivery at our hospital. 642 patients underwent ultrasound examination at 36-38 weeks' gestation, and were allocated to four groups according to the thickness of the lower uterine segment. Ultrasonographic findings were compared with those of physical examination at delivery. FINDINGS: The overall frequency of defective scars was 4.0% (15 ruptures, 10 dehiscences). The frequency of defects rose as the thickness of the lower uterine segment decreased: there were no defects among 278 women with measurements greater than 4.5 mm, three (2%) among 177 women with values of 3.6-4.5 mm, 14 (10%) among 136 women with values of 2.6-3.5 mm, and eight (16%) among 51 women with values of 1.6-2.5 mm. With a cut-off value of 3.5 mm, the sensitivity of ultrasonographic measurement was 88.0%, the specificity 73.2%, positive predictive value 11.8%, and negative predictive value 99.3%. INTERPRETATION: Our results show that the risk of a defective scar is directly related to the degree of thinning of the lower uterine segment at around 37 weeks of pregnancy. The high negative predictive value of the method may encourage obstetricians in hospitals where routine repeat elective caesarean is the norm to offer a trial of labour to patients with a thickness value of 3.5 mm or greater.

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

[Rational use of fetal fibronectin in the evaluation of premature labor risk].

OBJECTIVE: To better determined the usefulness of fetal fibronectin assay to identify patients at risk of premature delivery. SUBJECTS: 155 primiparous or multiparous patients presenting with single or twin pregnancies between 24 and 34 weeks and divided into 3 groups: high risk (70 patients), medium risk (35 patients), and low risk (50 patients) of premature delivery. MAIN OUTCOME MEASURES: The occurrence of delivery in the 21 days following sampling and/or a premature delivery. RESULTS: Among the 50 patients in the low risk group, there was one false positive and no premature delivery. Among the 35 patients in the medium risk group, there was no single positive fetal fibronectin test and no premature delivery. Among the 70 patients in the high risk group, 14 had a premature rupture of the membranes with very strongly positive fetal fibronectin test and all were delivery prematurely, 11 within a period of less than 21 days. The remaining 56 patients presented a threat of premature delivery without rupture of membranes; 20 gave birth prematurely (prevalence: 35.7%). In patients with a negative fetal fibronectin test, those with positive fetal fibronectin test were significantly more likely to experience preterm birth (odds ration: 12; 95% confidence interval: 3.4 to 42.1; p = 0.001) or to deliver within 21 days (odds ratio: 29.9; 95% confidence interval: 13.3 to 243; p < 0.001). CONCLUSION: Measurement of fetal fibronectin in cervico-vaginal secretions enabled us to define an authentic sub-group at high risk of premature delivery among patients presenting uterine contractions and changes in the cervix. In contrast, measurement of fetal fibronectin in cervico-vaginal secretions of patients with low and medium risk is not suitable, due to the low rate of premature delivery in these groups and the significant increase in the cost of pregnancy monitoring.

Adult↗
PubMed1996

[Vaginal administration prostaglandin E2 in premature ruptured membranes at term with an unfavorable cervix].

AIM OF THE STUDY: To compare immediate labor induction by vaginal prostaglandins to immediate labor induction by oxytocin or to expectant management in case of prelabor rupture of the membranes at term. MATERIAL AND METHODS: A meta-analysis of all randomized trials indexed in Medline or in the Cochrane Database of Systematic Reviews comparing labor induction by vaginal prostaglandins to labor induction by oxytocin or to expectant management. The statistical analysis was performed according to Peto and Yussuf's modified Mantel Haenszel method. The results were expressed as odds-ratios. RESULTS: Ten published studies meeting the above criteria were found. These trials included 1004 patients. When comparing labor induction by prostaglandins to expectant management, we observed a reduction of the admission-to-delivery interval, a decreased maternal and neonatal infection rate, without difference in the cesarean section rate. When comparing labor induction by vaginal prostaglandins to labor induction by oxytocin, a decreased cesarean section rate was observed without difference in maternal or neonatal infection rates. CONCLUSION: Immediate labor induction by vaginal prostaglandins provides better maternal and neonatal outcomes than labor induction by oxytocin or expectant management in case of prelabor rupture of the membranes at term.

Administration, Intravaginal↗
PubMed1995

[Transabdominal amnio-infusion facilitates external version maneuver after initial failure. Six successful attempts].

External version was successful after initial failure in 6 cases after transabdominal amnio-infusion. Filling the uterine cavity by amnio-infusion with 700 to 900 ml saline solution at 37 degrees C facilitated cephalic presentation in these 6 cases. In each case, a prior version attempt had been unsuccessful. Amnio-infusion was performed under continuous sonographic monitoring before a second attempt the next day. The clinical situation was different in the 6 cases which all terminated by normal cephalic delivery. Two patients were first parity, another has a single uterine scar, 3 had a normal pelvis (Magnin > 23), one a narrow pelvis (Magnin = 22.7) and 2 had a pelvis considered pathological (Magnin < 22). The main goal of this preliminary study was to evaluate the feasibility and safety of this new indication for transabdominal amnio-infusion. This new indication should be evaluated by several clinical trials, but it would new appear reasonable to propose transabdominal amnio-infusion in patients with a pathological pelvis and/or a single cicatricial uterus.

Adult↗
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

[Comparative value of transverse abdominal diameter and fetal abdominal perimeter. 3844 biometric examinations].

OBJECTIVE: Assess charts of abdominal size as they are used in a routine ultrasound screening, on a non selected population with 5 operators, to compare the interest of transverse abdominal diameter (TAD) with abdominal circumference (AC). METHOD: Retrospective study, in the department of Antenatal Diagnosis of the Centre Médico-Chirurgical et Obstétrical between September 1991 and August 1994. MAIN OUTCOME MEASURES: Abdominal biometry and gestational age to characterize the prenatal trophicity. Neonatal weight and gestational age at birth to characterize neonatal trophicity. RESULTS: Between 32 and 36 weeks, the TAD charts detected only one SGA (small for gestational age) out of 10. However, the AC sensitivity was 54.5% with a specificity of 94%. In the same period, the TAD charts suspect LGA (large for gestational age) for one exam out of two. The charts of AC have about the same performance to detect LGA and SGA. CONCLUSION: For a routine ultrasound screening between 32 and 36 weeks gestational age, the AC charts have to be preferred to TAD charts.

Abdomen↗
PubMed1994

Antepartum transabdominal amnioinfusion to facilitate external cephalic version after initial failure.

Transabdominal amnioinfusion can be used to facilitate external cephalic version. Our technique involves filling the uterine cavity with 700 or 900 mL of 37C saline under continuous echographic monitoring. External cephalic version is done the next morning. We have used this procedure in six women, all of whom had previous unsuccessful attempts at external cephalic version. After amnioinfusion, all six patients were converted to cephalic presentation and delivered normally, without obstetric or neonatal complications.

Amnion↗
PubMed1994

[Induced labor: a risk factor of maternal-fetal contamination during delivery?].

OBJECTIVE: This prospective study was conducted to determine the prevalence of maternal-fetal contamination at delivery in order to evaluate the factors of risk, particularly whether inducing delivery could be of additional help in selecting portage in mothers and infants. METHODS: Over a period of 4 months, samples were obtained from 360 mother/infant pairs. Vaginal sample at the beginning of labour, gastric sample from the infant at birth. RESULTS: Positive samples were obtained from 58 women (16.1%) and from 40 infants (11%). Streptococcus B was largely predominant (60%). The rate of maternal and neonatal carriers was significantly higher in pairs for which labour had been induced (n = 92) than in those with spontaneous labour (n = 268). Taking into account solely the classical factors of risk (opening of the membranes > 12 h, T > or = 38 degrees C, prolonged labour, premature delivery, premature rupture of the membranes), only selected 37% of the infant carriers (1 criteria or more); when induced labour was added as a criteria of risk, 68.4% of the infant carriers were identified. Streptococcus B was the cause of 2 neonatal infections in this series. None of the classic risk factors was observed in either of these cases but labour had been induced in both. CONCLUSION: The fact that labour is induced appears to be an additional factor of risk of maternal and fetal colonization. Routine screening at 12 and 24 hours before inducing labour could lead to the discovery of a large number of maternal colonizations and would allow prophylaxic antibiotics to be prescribed during labour. This protocol should be evaluated in a randomized prospective study involving a large number of cases in order to identify the beneficial effect in terms of neonatal morbidity and mortality.

Adult↗