Post-partum relapse in women with multiple sclerosis after neuraxial labour analgesia or neuraxial anaesthesia: A multicentre retrospective cohort study.

Background: The proportion of women with multiple sclerosis experiencing a relapse in the post-partum period after neuraxial labour analgesia or neuraxial anaesthesia remains uncertain. This study aimed to assess the association between neuraxial labour analgesia or neuraxial anaesthesia and the occurrence of relapse during the first three months post-partum.

Methods: In this retrospective cohort study, cases of women with a diagnosis of multiple sclerosis delivering between January 2010 and April 2015 were analysed.

Early and systematic administration of fibrinogen concentrate in postpartum haemorrhage following vaginal delivery: the FIDEL randomised controlled trial.

Objective: To assess the benefits and safety of early human fibrinogen concentrate in postpartum haemorrhage (PPH) management.

Design: Multicentre, double-blind, randomised placebo-controlled trial.

Setting: 30 French hospitals.

[Breech Presentation: CNGOF Guidelines for Clinical Practice - Labour and Induction].

Objectives: To issue guidelines on management of labour induction and breech vaginal delivery.

Materials And Methods: Bibliographic search restricted to French and English languages using Medline database®, Cochrane Library and international guidelines of medical societies.

Results: Breech delivery must take place in a maternity ward, in the presence of an obstetrician and gynaecologist and with the immediate availability of an anesthesiologist and a pediatrician during active second stage (Professional consensus).

Postpartum hemorrhage: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF): in collaboration with the French Society of Anesthesiology and Intensive Care (SFAR).

Postpartum haemorrhage (PPH) is defined as blood loss ≥500mL after delivery and severe PPH as blood loss ≥1000mL, regardless of the route of delivery (professional consensus). The preventive administration of uterotonic agents just after delivery is effective in reducing the incidence of PPH and its systematic use is recommended, regardless of the route of delivery (Grade A). Oxytocin is the first-line prophylactic drug, regardless of the route of delivery (Grade A); a slowly dose of 5 or 10 IU can be administered (Grade A) either IV or IM (professional consensus).

[Paraplegia and pregnancy].

Objectives: To describe the characteristics of the management of pregnancy and child birth in women with spinal cord injury.

Materials And Methods: Retrospective cohort study including paraplegics patients with motor deficit (whatever the etiology) who gave birth at the University Hospital of Toulouse between March 2003 and March 2014 (11 years). Monitoring and outcome of pregnancy were studied.

[Obstetric and anesthetic specificities in the management of a postpartum hemorrhage (PPH) associated with cesarean section].

Objectives: To describe the characteristics of post-partum hemorrhage (PPH) associated with cesarean section (CS), the modalities diagnosis and specific obstetric and anesthetic management.

Materials And Methods: Bibliographic search restricted to French and English languages using Medline database(®) and international guidelines of medical societies.

Results: Primary PPH associated with CS (incidence 3-15%) is defined as vaginal bleeding ≥500mL within 24hours after surgery.

Accidental dural puncture: combination of prophylactic methods to avoid post-dural puncture headache.

Accidental dural puncture (ADP) is a common complication of epidural catheter insertion, and may lead to post-dural puncture headache (PDPH), especially in obstetric patients. Epidural blood patch (BP) is the most effective treatment of PDPH. Prophylactic BP has shown its efficacy to prevent PDPH; nevertheless, this method may be insufficient.

[Pulmonary embolism and pregnancy].

Objective: Pulmonary embolism remains a leading cause of maternal death in France and in other developed countries. Prevention is well codified, but management remains complex both for diagnosis and therapeutics. The objective of this review was to update the knowledge on diagnosis and treatment of pulmonary embolism during pregnancy.

[Labour epidural analgesia for a woman with hereditary macrothrombocytopenia].

Epidural analgesia is often considered as risk of epidural haematoma in a patient with thrombocytopenia. In this observation, uncomplicated epidural analgesia was performed in a pregnant woman with hereditary macrothrombocytopenia. She received continuous epidural labour analgesia for a vaginal delivery with a platelet count at 63x10(9)/l but platelets with high mean platelet volume (20fL) and normal function.

[Quality assurance program for pain management after obstetrical perineal injury].

Introduction: A quality insurance program has been set up in order to improve the relief of pain in patients with perineal injury after childbirth.

Patients And Methods: The program has been developed according to the French standards of accreditation. After elaboration of a referential, a first study (103 patients) allowed to evaluate the ongoing practices and to appreciate the pain intensities.

[Prevention strategies during pregnancy].

This chapter deals with how to reduce, before delivery, postpartum hemorrhage. The strategy is explained for two risk levels, high and low. Means of prevention such as: logistical organisation; oral and parenteral iron therapy; erythropoietin; autologous blood transfusion; acute hemodilution; transfusion; bleeding disorders treatment; hospitalization, tocolysis, choice of mode of delivery, caesarean section and anaesthetic techniques for placenta praevia or accreta; interest of corticosteroids therapy and magnesium sulfate bleeding risks in severe pre-eclampsia, are addressed in turn.

Do prophylactic prostaglandins reduce the transfusion rate at cesarean section in high-order multiple pregnancies?

Objective: Cesarean section is the more usual mode of delivery in high-order multiple pregnancy (> or =3). Excessive uterine distension increases the risk of bleeding and the need for transfusion. The aim of this study was to investigate if prophylactic use of prostaglandins at cesarean section for high-order multiple pregnancies reduces blood loss and transfusion requirement based on historic data.

[General anaesthesia for Caesarean section in a patient with pulmonary atresia and an intact intraventricular septum].

We report the case of a 22-year-old primigravida patient presenting pulmonary atresia with intact ventricular septum, a rare congenital heart disease. Caesarean delivery was performed at 32 weeks of gestation because of moderate maternal function deterioration and foetal growth restriction. General anaesthesia was used because of the presence of lumbar Harrington rods.

[Chest pain and sulprostone during postpartum hemorrhage].

A case of chest pain in a 31-year-old woman after vaginal delivery with epidural analgesia during sulprostone administration is described. Chest pain occurred shortly after sulprostone was started and disappeared when sulprostone was stopped. Ischaemia related data were negative.

Iron therapy in iron deficiency anemia in pregnancy: intravenous route versus oral route.

Objective: The aim of this study was to compare intravenous iron sucrose versus oral iron sulfate in anemia at 6 months of pregnancy.

Study Design: A random, prospective, open study with individual benefit was performed involving 50 patients with hemoglobin levels between 8 and 10 g/dL and a ferritin value of <50 microg/L. In the intravenous group (IV group), the iron dose was calculated from the following formula: Weight before pregnancy (kg) x (120 g/L - Actual hemoglobin [g/L]) x 0.

[Avoidable anesthetic complications and their prevention].

Anesthesia-related mortality in France is being studied in a survey that began in 1996 using the United Kingdom survey as a model. We describe here the deaths reported in these two surveys and discuss the management strategies involved. These cases point out the risk involved with aspiration syndrome, difficult intubation, cardiac toxicity of local anesthetics, total spinal anesthesia, and respiratory depression.

[Severe complications of pregnancy and delivery: the situation in Lorraine based on the European investigation].

The level of maternal mortality appears to be higher in France than in other European countries according to the data collected in the 1995 European survey. We performed a retrospective analysis of severe hemorrhage, pregnancy induced hypertension, and maternal sepsis in 1995 in the Lorraine region and reviewed the management scheme used in each case. There was one maternal death and 223 cases of severe maternal morbidity (110 cases of hemorrhage, 105 cases of pregnancy induced hypertension, 8 cases of maternal sepsis).

[Antipublic antibodies and pregnancy: use of iron sucrose in autologous blood donation with cryopreservation].

An autologous blood donation with cryopreservation in a pregnant woman with natural antibody against a high frequency alloantigen is reported. A natural anti Gerbich antibody and a rare erythrocyte phenotype at high risk of polyimmunization was discovered during the third month of pregnancy. This leads to recommend the constitution of an autologous blood reserve.

Colostrum morphine concentrations during postcesarean intravenous patient-controlled analgesia.

Unlabelled: Patient-controlled analgesia (PCA) with morphine is a convenient method for providing postoperative analgesia. Despite the fact that it is used after cesarean delivery, data on transfer of morphine and of its active metabolite morphine-6 glucuronide (M6G) into maternal milk are scarce. It is not known whether breast-feeding during PCA with morphine has neonatal implications.

Evaluation of the quality of care for severe obstetrical haemorrhage in three French regions.

Objective: To determine what factors related to health services in France might explain substandard care of severe morbidity due to obstetric haemorrhage.

Design: Retrospective questionnaire survey.

Setting: Three administrative regions of France.

[Acute pulmonary edema associated with the use of beta2-mimetic tocolytic agents].

A case of severe pulmonary oedema during beta2-adrenergic agonist tocolytic therapy (salbutamol) in a pregnant woman admitted for preterm labor at 32 weeks of amenorrhoea is reported. Echocardiography and haemodynamic investigations did not show any left ventricular systolic or diastolic dysfunction. Pulmonary oedema is an exceptional complication of beta2-adrenergic agonist tocolytic therapy.