CHARACTERIZATION OF THE ASSOCIATION BETWEEN BIRTHWEIGHT AND SEVERE POSTPARTUM HEMORRHAGE IN WOMEN WITH DELIVERY AT TERM.

Background: Macrosomia, classically defined by an arbitrary birthweight threshold, is associated with an increased risk of postpartum hemorrhage (PPH). However, some preliminary evidence suggests that lower birthweights may also be at increased risk. We hypothesized that birthweight, analyzed as a continuous variable, is significantly associated with the risk of severe postpartum hemorrhage, with the risk increasing not only at higher birthweights traditionally associated with macrosomia but also potentially at lower birthweights.

Episiotomy to prevent obstetric anal sphincter injuries during instrumental delivery in nulliparous women: a national prospective comparative cohort study.

Background: We are lacking data with a high level of evidence on the use of episiotomy during instrumental delivery to prevent anal sphincter injury, which nonetheless presents the highest risk.

Objective: Our main objective was to assess the protective effect of episiotomy against obstetric anal sphincter injury in nulliparous women during instrumental delivery according to type of instrument. We also investigated its impact on immediate maternal and neonatal morbidity.

Episiotomies and obstetric anal sphincter injuries following a restrictive episiotomy policy in France: An analysis of the 2010, 2016, and 2021 National Perinatal Surveys.

Background: The French guidelines have recommended a restrictive policy of episiotomy since 2005. We aimed to assess variations in the prevalence of both episiotomy and obstetric anal sphincter injury (OASI) from the 2010, 2016, and 2021 National Perinatal Surveys.

Methods And Findings: A total of 29,750 women who had given birth to a live infant by vaginal delivery were included.

Prognosis for fetuses with isolated severe growth retardation from 23 gestational weeks with an initial assessment unfavorable to an active management.

Objective: To study perinatal outcomes for newborns with early, isolated, severe FGR, for whom initial active management was considered unreasonable or impossible at an obstetric-pediatric assessment and to identify the determinants associated with a course that made active management reasonable.

Material And Methods: This retrospective observational single-center study occurred in a level-3 university hospital maternity unit. It included all pregnancies with a singleton fetus presenting isolated FGR <3rd percentile at 23 weeks or more of gestation with an obstetric-pediatric assessment (OPA) initially unfavorable to active management.

Barriers to influenza vaccination during pregnancy in France: A national population-based study.

Background: Despite French national recommendations since 2012 that all pregnant women be vaccinated against influenza, in 2021 this vaccine coverage is low - around 30 % - in France.

Objectives: To identify barriers to influenza vaccination during pregnancy by assessing how often women were offered this vaccination and how often they accepted it.

Study Design: We used data from the French national perinatal survey (ENP), which covered all births during one week in March 2021 (N = 12,614).

Prevalence of anxiety symptoms and associated factors at 2 months postpartum, results from a 2021 French national prospective cohort study.

Background: Postpartum anxiety (PPA) symptoms have harmful effects on child development and mother-infant interactions. Accordingly, in-depth knowledge of associated risk factors is crucial for prevention policies. This study aimed to estimate PPA symptom prevalence at 2 months and to identify associated risk factors in a representative sample of all women who gave birth in France in 2021, and in two subgroups: women with no postpartum depression (PPD) symptoms, and those with no history of mental health care.

Continuation versus discontinuation of intravenous oxytocin in the active phase of labour.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of discontinuing intravenous oxytocin stimulation in pregnant women during the active phase of induced or augmented labour.

Evolution of Episiotomy Incidence and Obstetric Anal Sphincter Injury Over 10 Years: A Mixed-Methods Study.

Objective: To assess the association between the decrease in the use of episiotomy and the incidence of obstetric anal sphincter injuries (OASIS) over a 10-year period and understand their reasons by interviewing obstetricians and midwives.

Design: Mixed-methods study.

Setting: A tertiary university public maternity hospital, Paris, France.

Pertussis vaccination coverage in women at two months postpartum and associated factors in France, National Perinatal Survey 2021.

Background: Pertussis vaccination in young mothers aims to protect neonates through cocooning. We estimated pertussis vaccination coverage (VC) in women at two months postpartum in France in 2021, and the proportion of women who got vaccinated in the first two months postpartum; associated determinants were studied.

Methods: We used data from the 2021 National Perinatal Surveys conducted in metropolitan France (ENP 2021) and French overseas territories (ENP-DROM 2021).

Emergency cerclage: Neonatal outcomes and evaluation of prognostic scores - A decade of experience at a tertiary center.

Objectives: Emergency cervical cerclage is a high-risk surgical procedure associated with maternal and fetal risks, including preterm birth. Authors have developed scores to try to predict the probability of success following emergency cerclage, but these tools have yet to be externally validated. Our main objective was to assess the preterm birth rate before 32 weeks following emergency cerclage.

Female genital mutilation/cutting in women delivering in France: An observational national study.

Objective: International migration from source countries has meant that clinicians in high income countries, that is, receiving countries, are increasingly caring for affected women affected by female genital mutilation/cutting (FGM/C). The aim of the present study was to assess the prevalence of FGM/C among women at childbirth, and its association with pregnancy outcomes.

Methods: This was an observational study using data from a cross-sectional population-based study from the French National Perinatal Survey of 2021 (ENP) conducted in all maternity units in mainland France and including all women delivering a live birth during 1 week in March 2021 (N = 10 928).

Consent for interventions during childbirth: A national population-based study.

Objective: To assess the frequency and determinants of medical interventions during childbirth without women's consent at the population level.

Methods: The nationwide cross-sectional Enquête Nationale Périnatale 2021 provided a representative sample of women who delivered in metropolitan France with a 2-month postpartum follow-up (n = 7394). Rates and 95% confidence intervals (CI) of interventions during childbirth (oxytocin administration, episiotomy or emergency cesarean section) without consent were calculated.

Patient experience in prostaglandins-induced cervical ripening: A comparative study using a standardized questionnaire.

Objective: Cervical ripening for induction of labor is often associated with negative patient experience. The debate over the most effective cervical ripening method persist, with a significant gap in research specifically addressing patient satisfaction. Our study aims to compare patient experience with two induction methods, slow-release intravaginal dinoprostone device and orally administered misoprostol.

Passive second stage of labor: Does a fourth hour increase maternal morbidity in nulliparous patients at term with epidural?

Objectives: Prolonging the passive second stage of labor could increase vaginal birth rate, but the data concerning maternal and fetal morbidity are contradictory. The French guidelines did not specify a maximum duration of the passive second stage. Our objective was to assess if allowing a 4th hour after full dilatation before pushing increased maternal morbidity, compared to 3 h after full dilatation.

Validity of a Delphi consensus definition of growth restriction in the newborn for identifying neonatal morbidity.

Background: Small for gestational age is defined as a birthweight below a birthweight percentile threshold, usually the 10th percentile, with the third or fifth percentile used to identify severe small for gestational age. Small for gestational age is used as a proxy for growth restriction in the newborn, but small-for-gestational-age newborns can be physiologically small and healthy. In addition, this definition excludes growth-restricted newborns who have weights more than the 10th percentile.

[Update on the management modalities of expulsive efforts during childbirth].

The second stage of labour includes both the passive and active stages, involving expulsive efforts. The management of this phase of labour aims to minimise the maternal and neonatal complications that could be associated with a prolonged active2nd stage, but also to limit medical interventions. On the maternal side, prolonged duration of expulsive effort appears to be correlated with increased postpartum haemorrhage, perineal injury and, in the long term, urinary and anal incontinence.

Maintenance oxytocin in the immediate postpartum period: Frequency, determinants and practices in a tertiary maternity unit.

Objective: To prevent post-partum haemorrhage (PPH), national and international guidelines recommend the administration of a prophylactic injection of oxytocin after all vaginal births. Although additional maintenance oxytocin is not recommended in the immediate postpartum, its administration is quite common (30 % of French births in 2021). To assess in a single center, the frequency and determinants associated with the administration of maintenance oxytocin in immediate postpartum.

Impact of an e-learning training for interpreting intrapartum fetal heart rate monitoring to avoid perinatal asphyxia: A before-after multicenter observational study.

Introduction: Perinatal asphyxia, a condition that results from compromised placental or pulmonary gas exchange during the birth process, is rare but can lead to serious neonatal and long-term consequences. The visual analysis of cardiotocography (CTG) is designed to avoid perinatal asphyxia, but its interpretation can be difficult. Our aim was to test the impact of an e-learning training program for interpreting CTG on the rate of avoidable perinatal asphyxia at term.