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Biomedical subjects

G Magnin

Publications and source records attributed to G Magnin.

At least 37 records · Page 2Linked to original sources
PubMed1998

External cephalic version after previous cesarean section: a series of 38 cases.

OBJECTIVE: To determine if external cephalic version (ECV) is a reasonable alternative to repeat cesarean section in case of breech presentation. STUDY DESIGN: Retrospective study of 38 women with one previous cesarean section and a breech presentation after 36 weeks of gestational age who have had at least one experience of ECV. Statistics used the Fisher's test with significance when P<0.05. RESULTS: Version attempts were successful in 25 of the 38 women (65.8%). Seventy-six percent of the successful version women went on to have vaginal birth after cesarean section. A total of 19 successful vaginal deliveries occurred (50%). Success rate of ECV was lowered when breech was the indication of the previous cesarean section. The vaginal delivery rate was increased after successful ECV in patients previously vaginally delivered, but this difference did not reached significance (P=0.057). No maternal or neonatal complications occurred. CONCLUSION: ECV is acceptable and effective in women with a prior low transverse uterine scar, when safety criteria are observed.

Adult↗
PubMed1998

C-reactive protein levels at the onset of labour and at day 3 post-partum in normal pregnancy.

OBJECTIVES: To record maternal serum C-reactive protein levels during normal onset of labour and normal puerperium and to evaluate if inflammation or infection could be predicted during these two periods when serum C-reactive protein is increased. METHODS: Eighty-five pregnant women were enrolled in a longitudinal prospective study and had a blood sample to assess serum C-reactive protein levels on admission to the labour ward for normal onset of labour and at day three post-partum. Inclusion criteria were no previous history, a normal single pregnancy, normal vaginal delivery and an uneventful post-partum course. Twelve non-pregnant women of the same age constitued a control group. An automatic Behring Nephelometer was used to measure serum C-reactive protein concentrations. The Student's t-test (significance p < 0.05) was used for statistical analysis. FINDINGS: C-reactive protein was significantly increased during the onset of labour (4.10 +/- 2.79 mg/L) and reached very high levels during the post-partum period (24.07 +/- 18.28 mg/L) compared to the standard normal serum C-reactive protein level in a population of non-pregnant women of the same age (2.39 +/- 0.07 mg/L). INTERPRETATION: Increased serum C-reactive protein has been reported to be a marker for subclinical infection during pregnancy in various situations including premature labour and premature rupture of membranes and for complications occurring during puerperium such as thrombophlebitis, thromboembolism or endometritis. This interpretation depends on which upper limit is considered as abnormal. Because serum C-reactive protein was raised during the onset of labour, values of less than 10 mg/L could not be considered as a marker for infection during this period. Elevated serum concentrations of estrogen, progestogen and prostaglandins during labour might be one explanation for those physiological changes. Normal vaginal delivery could be compared to a surgical procedure and tissue injury consecutive to vaginal birth as reflected by a dramatic increase in C-reactive protein. More studies using nephelometry are needed to determine normal and upper values of C-reactive protein during pregnancy.

Adolescent↗
PubMed1997

Prophylactic intrapartum amnioinfusion: a controlled retrospective study of 135 cases.

OBJECTIVE: To show that intrapartum prophylactic amnioinfusion (AI) in case of oligohydramnios or particulate meconium-stained amniotic fluid could be beneficial. STUDY DESIGN: From the first March 1993 until the 30th June 1995, 4031 women were delivered at the University Hospital of Poitiers. Patients presenting with oligohydramnios (G1) (71 patients with an amniotic fluid index below 5 cm) or a particulate meconium-stained amniotic fluid (G2) (64 patients) were included. Each group was compared to an historical control group constituted retrospectively according to the following criteria: oligohydramnios (CG1), particulate meconium-stained amniotic fluid (CG2), age, parity, gestational age and duration of labor. Statistical analysis was performed using the Student's t-test and the Fisher's exact test when appropriate with a level of significance of P less than 0.05. RESULTS: The mean infused volume was 893 ml in G1 and 734 ml in G2. A significant difference was found in terms of cesarean section between G1 and CG1 (11.3 vs. 24.5%; P < 0.05) and of assisted deliveries for fetal distress between G2 and CG2 (12.5 vs. 23.43%; P < 0.05). No other significant difference was found between the study groups and their control for all other studied criteria. When considering more specifically the presence of meconium below the vocal cords we also could not find any significant difference between G2 and CG2 (1.6 vs. 9.4%; P = 0.05). No neonatal or maternal adverse effect happened in this short study. COMMENT: AI is easy to perform during labour in case of oligohydramnios or particulate meconium-stained amniotic fluid. In case of oligohydramnios, a decreased rate of cesarean sections has been observed in the infused group. Considering patients with particulate meconium-stained amniotic fluid, less interventions for fetal distress and neonates with meconium below the vocal cords has been found in the infused group. Further prospective evaluation is needed to confirm these results in case of particulate meconium-stained amniotic fluid and to compare the advantage of prophylactic versus therapeutic AI performed in case of oligohydramnios and abnormal fetal heart rate.

Adult↗
PubMed1997

Indications of laparoscopic hysterectomy.

OBJECTIVE: To determine when vaginal hysterectomy is contra-indicated and abdominal hysterectomy should be performed. To assess when laparoscopic surgery can avoid the abdominal procedure, and to determine the indications of this new technique in case of benign uterine lesions without prolapse. MATERIALS AND METHODS: A retrospective study of 171 hysterectomies performed by the same surgeon for benign uterine lesions without prolapse. When possible the vaginal route was chosen and the following criteria were studied: indication for hysterectomy, previous surgery, uterine weight, duration of the procedure, intra- and post-operative bleeding, complications and recovery time. Statistical analysis was performed using the Chi2 test and the Fisher's exact test when appropriate with a level of significance of p < 0.05. RESULTS: One hundred and nine vaginal (60.4%) and 62 abdominal (39.6%) hysterectomies were performed and the main indication was menometrorrhagia (respectively 97 (89%) and 49 (79%) cases). The indication for abdominal surgery was an enlarged uterus in 47 patients (76%). In 10 cases (6%) laparoscopy was indicated because of severe endometriosis, previous abdominal surgery or a suspect adnexal cyst. No complications occurred in either group. The duration of the procedure, blood loss and recovery time were lower in the vaginal group (p < 0.05). COMMENTS: Uterine volume limits vaginal hysterectomy, and this cannot be overcome by laparoscopic surgery. Only severe adhesions and endometriosis are more amenable to laparoscopic hysterectomy. The laparoscopic hysterectomy rate should not reasonably exceed 10 to 15%, yet is as high as 63% in some studies. Further studies are needed to determine the value of laparoscopic hysterectomy relative to the vaginal route.

Abdomen↗
PubMed1997

[Cervical maturation by repeated applications of prostaglandin E2 gel. 186 cases].

OBJECTIVE: A prospective clinical trial of cervical ripening with intracervical prostaglandin E2 gel in repeated administrations was performed. STUDY DESIGN: One hundred eighty-six patients were enrolled in this prospective trial between 01/01/89 and 31/12/93. these patients with unripe cervix (Bishop score < 5) required induction of labor because of pregnancy disorders. Mean patient age was 28.2 years (range 15 to 43), mean gestational age was 39.2 week's gestation (range 33 to 43) and mean parity was 1.8 (range 1 to 10). Our exclusion criterias were as follow: twin pregnancies, breech presentation and premature rupture of membranes. A 0.5 mg prostaglandin E2 gel was administered into the cervix every four hours maximal of three doses before induction of labor with oxytocin. Maternal and neonatal results were reviewed. RESULTS: Patients required a single dose of gel in 19.9% of cases, two doses in 26.3% and three doses in 53.8%. Induced labor during cervical ripening occurred in 55.4% of patients. A cesarean section was necessary in 22% of cases. This rate was both significantly related to the initial Bishop score and to the Bishop score at the end of the procedure. Patient with induced labor during the cervical ripening had a significantly lower cesarean section rate compared to these who needed induction with oxytocin (10.7% versus 33.8%; p < 0.01). The uterine hyperstimulation rate was 1.6%. A 1 min Apgar score less than 7 occurred in 1.1% of neonates. COMMENTS: Our results do not demonstrate benefit of repeated administration comparison to a single administration described in literature. Maternal and neonatal morbidity is low in this study but cervical ripening should be used only when pregnancy disorders require prompt delivery within twenty-four hours.

Administration, Intravaginal↗
PubMed1997

[Prophylactic amnion infusion during labor. Apropos of 195 cases].

OBJECTIVE: To show that intrapartum prophylactic amnioinfusion in case of oligohydramnios or particulate meconium-stained amniotic fluid could be beneficial. STUDY DESIGN: From March 1st, 1993 until December 31st, 1996, 6845 women were delivered at the University Hospital of Poitiers. Patients presenting with oligohydramnios (G1) (118 patients with an amniotic fluid index below 5 cm) or a particulate meconium-stained amniotic fluid (G2)(77 patients) were included. Each group was compared with a historical control group constituted retrospectively according to the following criteria: oligohydramnios (CG1), particulate meconium-stained amniotic fluid (CG2)), age, parity, gestational age, and duration of labor. Statistical analysis was performed using the Student's t test and the Fisher's exact test when appropriate with a level of significance of p < 0.05. RESULTS: The mean infused volume was 883 ml in G1 and 751 ml in G2. A significant difference was found in terms of cesarean section between G1 and CG1 (14% versus 25%, p < 0.05) and of assisted deliveries for fetal distress between G2 and CG2 (5% versus 18%, p < 0.02). No other significant difference was found between the study groups and their control for all other studied criteria. When considering more specifically the presence of meconium below the vocal cords we also find a difference between G2 and CG2 (5% versus 14%) which was not significant. No neonatal or maternal adverse effects happened in this short study. COMMENT: Amnioinfusion is easy to perform during labor in case of oligohydramnios or particulate meconium-stained amniotic fluid. In case of oligohydramnios, a decreased rate of cesarean sections has been observed in the infused group. Considering patients with particulate meconium-stained amniotic fluid, less interventions for fetal distress and neonates with meconium below the vocal cords has been found in the infused group. Further prospective evaluation is needed to confirm these results in case of particulate meconium-stained amniotic fluid and to compare the advantage of prophylactic versus therapeutic amnioinfusion performed in case of oligohydramnios and abnormal fetal heart rate.

Adult↗
PubMed1997

[Biological diagnosis of premature rupture of membranes: respective values of diamine oxidase activity compared to vaginal fluid pH (Amnicator)].

OBJECTIVES: To compare the sensitivity (Se), specificity (Spe), positive predictive (PPV) and negative predictive (PNV) values of 2 tests used routinely for suspected premature rupture of the membranes (PROM) and their implication in the management of such cases. PATIENTS AND METHODS: From 1 November 1995 to 31 July 1996, 87 patients: 16 with obvious PROM on physical examination (group I) and 71 with suspected PROM (group II) were tested with both DAO and Amnicator. PROM was arbitrary confirmed in group II when delivery occurred within 48 hours after the diagnosis was suspected. The corrected chi 2 test was used to compare both tests results in group II. RESULTS: In case of obvious PROM, the sensitivity of the DAO and Amnicator tests were 75 and 87.5% respectively. Eleven patients from group II delivered within 48 hours following admission and the 2 tests results were respectively: Se 90.9 and 81.81%, Spe 100 and 83.33%, PPV 100 and 52.63% and PNV 98.36 and 96.15%. DAO gave better results in terms of Spe and PPV (p < 0.05). COMMENTS: The DAO test remains a reference test when PROM is suspected but when it is not available (during night or week-end), the quite good negative predictive value of Amnicator could avoid unnecessary hospitalisation and permit later DAO test.

Adolescent↗
PubMed1997

[How many abdominal hysterectomies can be avoided by laparoscopic surgery?].

Laparoscopic hysterectomy performed for benign uterine lesions without prolapse is becoming more and more popular. This surgical route has some of the advantages of the vaginal route and could avoid numerous abdominal hysterectomies. Our experience shows that most of abdominal or laparoscopic hysterectomies could be done using the vaginal route which is for us the reference. One question about laparoscopic hysterectomy is: can we perform this technique to avoid abdominal hysterectomy when the vaginal route looks impossible? To answer this question, we retrospectively studied 171 hysterectomies. The laparoscopic hysterectomy rate should not reasonably exceed 10 to 15%, yet is much higher for the promotors of this technique of which advantages compared with vaginal hysterectomy are not clearly demonstrated.

Evaluation Studies as Topic↗
PubMed1996

[Hepatic cytolysis caused by tocolytic treatment using micronized natural progesterone].

Micronized natural progesterone is often prescribed alone or in association with beta-agonists in the treatment of preterm labor in France. We observed drug-induced hepatitis in 4 such patients. The main manifestation of liver disease was pruritus. After drug withdrawal, elevated transaminase levels continued to rise for one week then normalized within 10 to 30 days. The imputability of this undesirable effect was assessed and considered to be likely. The effectiveness of micronized natural progesterone in the prevention of premature delivery and in decreasing perinatal mortality and morbidity has not yet been proven. This drug should therefore be used with care, keeping in mind the risk of hepatitis, particularly in patients presenting with pruritus.

Adult↗
PubMed1996

[Should pH scalp blood sampling still be done during labor?].

OBJECTIVES: Determine whether the pH of fetal scalp blood gives a better evaluation of fetal status and whether cesarean section can be avoided in case of abnormal fetal heart rate. METHOD: For last 100 patients in which the scalp blood was sampled, scalp pH was compared with cord pH, Agpar score at birth and immediate neonatal outcome. RESULTS: Among the 100 cases, there were 75 vaginal deliveries. There was a good correlation between scalp pH, umbilical artery pH and the 5-min Apgar score. The specificity of scalp pH > or = 7.25 to identify infants with an umbilical artery pH > or = 7.25 and 5-min Apgar score > or = 7 was 98.5 and 90.7% respectively; the corresponding negative predictive values were 70.3 and 96.7%. Immediate neonatal outcome was favorable for all the vaginal deliveries (n = 75) even though fetal heart rate was abnormal. Scalp pH presumably helped avoid unnecessary cesareans in 60 cases as in 15 case delivery occurred within 30 min or less after fetal scalp blood sampling. CONCLUSION: Scalp blood sampling for determination of pH is questioned and other methods for evaluating fetal status are being examined. But until these methods can be validated, scalp pH provides a means of avoided some unnecessary cesareans in cases where the fetal heart rate is difficult to analyse.

Adult↗
PubMed1995

[Intra-uterine artificial insemination. Indications, techniques, results; 83 cases].

OBJECTIVES: Retrospective study of results after intra-uterine artificial insemination performed in the Poitiers University Hospital. MATERIAL: There were 95 infertile couples who benefited from intra-uterine artificial insemination. Indications involved pathology of the cervix in 53% of the cases and male infertility in 30%. Another cause of infertility was found in 5% and no cause could be identified in 12%. METHOD: The technique was as follows. Ovary stimulation using clomifene and hMG, sonographic monitoring with oestradiol assay, hCG for triggering ovulation, 2 inseminations at 24 and 48 h after swim-up sperm preparation and luteal phase supplementation. RESULTS: The overall success rate was 32.6% with a mean success rate per cycle of 11.1%. The best results were obtained in couples with unexplained infertility and cervix-related infertility (42 and 32% respectively). These results are comparable to those in the literature. CONCLUSION: The results of this series and the data reported in the literature demonstrate the interest of intra-uterine artificial insemination in cases of cervical sterility where it is indicated as first intention treatment. In case of impaired ejaculation, unexplained sterility and certain other causes of male infertility, intra-uterine artificial insemination can be useful but requires further study in order to determine the criteria for indications and the techniques to be used. Associating ovary stimulation increases the probability of success, especially in cervical sterility. Finally, more than 4 to 5 attempts do not increased success rate.

Drug Monitoring↗
PubMed1995

[Endocervical adenocarcinoma in situ. A histological entity to know].

We report diagnosis and treatment problems encountered in 4 cases of adenocarcinoma in situ (AIS) of the uterine cervix. The patients' ages ranged from 24 to 45 years. In 2 cases, Pap smears revealed strips of cells showing crowded nuclei and pseudostratification of AIS. In 3 cases, the diagnosis of AIS was confirmed from a colposcopically directed biopsy and, in the last case, from a surgical cone biopsy. In 3 cases, AIS was found to be associated with cervical squamous intraepithelial neoplasia. In all cases, it was difficult to rule out an early invasive adenocarcinoma. Three patients underwent total abdominal hysterectomy. The topographic data of lesions, notably the presence of endocervical AIS in hysterectomy specimen realised 4 years after conization, and a review of literature lead us to propose hysterectomy as a basic treatment. If conization is chosen, it should be cylindrical with adequate diameter and height.

Adenocarcinoma↗
PubMed1995

[Choledochal cysts. A rare prenatal diagnosis].

Forty to sixty percent of main bile duct cysts are diagnosed before the age of 10 years, often at the time of a complication. Current progress in echography now makes it possible to diagnose such cysts antenatally. Wze report a case discovered at 33 gestation and focus on the difficulty of formal antenatal diagnosis and the unpredictable, sometimes rapid, course of the disease. The main prognosis factor is the development of complications, especially liver fibrosis. Antenatal suspicion of main bile duct cyst is important as they can then be managed early after echographic confirmation during the first days of life with the potential reduction in severe complications.

Adult↗
PubMed1994

[Immature teratoma of the ovary. Apropos of 3 cases. Review of the literature and an evaluation].

Immature teratoma of the ovary is a rare tumour (1% of cancer of the ovary) usually seen in adolescents or young women. It is a malignant tumour derived from an abnormal germ-cell which undergoes meiotic division. The diagnosis is based on the pathological examination which reveals immature tissue derived from two or three types of embryonic tissue (endo-, meso- and ectoderm). Intraperitoneal dissemination occurs and immature or mature recurrence is observed. The prognosis was particularly severe before the use of polychemotherapy which has also made conservative surgery possible. At the present time, the consensus is to reduce the duration of the chemotherapy with a regular clinical and laboratory (tumour markers, aFP) monitory. A second look laparotomy verifies successful treatment.

Adolescent↗