Perinatal outcome of twins compared to singletons of the same gestational age: a case-control study.

Our objective was to determine the perinatal outcome of first- and second-born twins compared to singletons, born at the same gestational age. To that end we conducted a case-control study in Flanders (Northern Belgium). During a 10-year period (01.

Impact of fetal growth restriction on mortality and morbidity in a very preterm birth cohort.

Objective: To assess the impact of being small for gestational age (SGA) on very preterm mortality and morbidity rates by using different birthweight percentile thresholds and whether these effects differ by the cause of the preterm birth.

Study Design: The study included singletons and twins alive at onset of labor between 24 and 31 weeks of gestation without congenital anomalies from the Models of Organising Access to Intensive Care for very preterm births very preterm cohort in 10 European regions in 2003 (n = 4525). Outcomes were mortality, intraventricular hemorrhage grade III and IV, cystic periventricular leukomalacia, and bronchopulmonary dysplasia (BPD).

Rates of bronchopulmonary dysplasia in very preterm neonates in Europe: results from the MOSAIC cohort.

Background: A considerable local variability in the rate of bronchopulmonary dysplasia (BPD) has been recorded previously.

Objectives: The objectives of the present study were to describe regional differences in the rate of BPD in very preterm neonates from a European population-based cohort and to further delineate risk factors.

Methods: 4,185 survivors to 36 weeks' postmenstrual age of 4,984 live-born infants born at 24+0-31+6 weeks' gestation in 2003 (the MOSAIC cohort) in 10 European regions were enrolled using predefined structured questionnaires.

Differences in outcome between twins and singletons born very preterm: results from a population-based European cohort.

Background: About 10% of twins are born before 32 weeks of gestation and very preterm birth rates are increasing. Preterm twins tend to have more favourable outcomes than singletons of the same gestational age, but fewer data are available for very preterm infants. This study aims to determine whether outcomes differ between very preterm twins and singletons.

Distribution of maternity units and spatial access to specialised care for women delivering before 32 weeks of gestation in Europe.

Survival and quality of life are improved for very preterm babies when delivery occurs in a maternity unit with on-site neonatal intensive care (level III unit). We investigated the impact of distance on the probability of delivering in such a unit for births before 32 weeks of gestation from 9 European regions with diverse perinatal health systems (the MOSAIC cohort). We analysed distances between women's homes, and the nearest level III in population quartiles, adjusting for maternal and pregnancy characteristics.

Variability in caesarean section rates for very preterm births at 28-31 weeks of gestation in 10 European regions: results of the MOSAIC project.

Objective: Given the continuing debate about the benefits of caesarean section for very preterm infants, we sought to describe caesarean section rates for infants between 28 and 31 weeks of gestation in European regions and their association with regional mortality and short-term morbidity.

Study Design: Singletons and twins without lethal congenital anomalies alive at onset of labour from 28 to 31 weeks of gestation from the 2003 MOSAIC cohort of very preterm births in 10 European regions were analysed (N=3,310). Determinants included maternal and fetal characteristics as well as regional caesarean section rates for all births.

Changes in care and outcome of very preterm babies in the Parisian region between 1998 and 2003.

Objective: To assess evolution in the care and health of very preterm babies between 1998 and 2003 after implementation of a regionalisation policy in France.

Design: Comparison of two population-based cohorts.

Setting: The Parisian region.

Differences in rates and short-term outcome of live births before 32 weeks of gestation in Europe in 2003: results from the MOSAIC cohort.

Objectives: Advances in perinatal medicine increased survival after very preterm birth in all countries, but comparative population-based data on these births are not readily available. This analysis contrasts the rates and short-term outcome of live births before 32 weeks of gestation in 10 European regions.

Methods: The Models of Organizing Access to Intensive Care for Very Preterm Births (MOSAIC) study collected prospective data on all very preterm births in 10 European regions covering 494,463 total live births in 2003.

Risk factors for not delivering in a level III unit before 32 weeks of gestation: results from a population-based study in Paris and surrounding districts in 2003.

Delivery of very preterm babies in maternity units with on-site neonatal intensive care (level III units) is associated with lower mortality and morbidity. This analysis explores risk factors for not delivering in a level III unit, using data from a population-based study of very preterm births in Paris and surrounding districts in 2003. The sample for analysis included resident women with a fetus alive at the onset of labour between 24 and 31 weeks of gestation (n = 641).

[Mortality-morbidity conferences: evaluation of an intervention to expand their practice in a university hospital].

Background: Mortality-morbidity conferences (M&MC) are a recognized technique for evaluating and improving medical practices as well as improving patient safety.

Objectives: To describe the current practices for identification and management of care-related adverse events and to evaluate the effectiveness of an intervention to promote M&MC in a university hospital.

Methods: The study was designed as a before-and-after survey.

[Improving patient safety: decreasing adverse events associated with medical care].

Awareness of the importance of what were previously called iatrogenic accidents is not new, but recent publications have demonstrated the frequency and severity of the accidents and incidents associated with care, which are now known simply as "adverse events". Research has helped us to understand the principal mechanisms underlying them and the circumstances that promote them. It shows that root causes, often linked to the organization of care, should be sought beneath the initial appearance of mistakes.

Regionalization of perinatal care in Europe.

This review describes European health policies related to the place of birth of very preterm babies, and the organizational context in which these policies were enacted using data from two European studies. It also compiles available information on the place of birth of very preterm babies from the published literature. In Europe, there is significant diversity in approaches to the provision of intensive care services for the small proportion of pregnant women and babies that need it, both in terms of health policies and the supply and characteristics of maternity and neonatal units.

[Audit of obstetrical practices and prevention of perinatal deaths].

An audit of obstetrical practices, defined here as a critical analysis of practices, was accepted by the local authorities and obstetricians/pediatricians of the district of Seine-Saint-Denis (northern Paris, France). The study analyzed all perinatal deaths occurring during a three-year period (the Perinatal Enquiry, 1 Oct. 1989 to 30 Sept.

Fetal adaptation to stress: Part II. Evolutionary aspects; stress-induced hippocampal damage; long-term effects on behavior; consequences on adult health.

Humans share adaptative capacities to stress with other species, as demonstrated on amphibians: the physiological response to experimental water volume and food deprivation results in the activation of the endocrine axes that drive metamorphosis, in particular the neuroendocrine stress system. Unfavorable effects may, however, occur, probably due to inappropriate timing and/or duration of stress: recent experiments are converging to show a profound impairment of hippocampal functioning in the offspring of mothers exposed to prenatal stress. Moreover, fetal changes are likely one of the risk factors for a number of diseases in adulthood.

Fetal adaptation to stress. Part I: acceleration of fetal maturation and earlier birth triggered by placental insufficiency in humans.

This review is an attempt to provide an integrative view for the biological changes triggered by fetal stress through a multidisciplinary approach. Acceleration of brain and lung maturation in certain risk pregnancies was first described clinically and confirmed by biochemical, electrophysiological and experimental data. Moreover, new experimental findings suggest that a fetal clock centrally mediated by fetal nutritional status could determine timing of parturition.

[Obstetrics in crisis].

Obstetrical practice in France is in a crisis with several components. The number of obstetricians is in sharp reduction, a litigation crisis is obvious, an important number of for profit maternity units disappeared since five years for financial reasons. To rebuild an adapted system, one should be aware of the wills of obstetricians in training about the minimal number of members of any obstetrical team to share the on call duty (7 to 8).

History of induced abortion as a risk factor for preterm birth in European countries: results of the EUROPOP survey.

Background: The objective of this study was to investigate the relationship between history of induced abortion and preterm delivery in various parts of Europe, and according to the main cause of preterm birth.

Methods: We used data from a case-control survey, the EUROPOP study; 2938 preterm births and 4781 controls at term from ten European countries were included. Based on national statistics, we distinguished three groups of countries with high, intermediate and low rates of induced abortion.

Iatrogenic multiple pregnancies. Do they complicate perinatal care?

This review addresses questions related to medicosocial concerns surrounding the care of women with multiple births and their infants. Relevant articles and texts on twin and triplet pregnancies were reviewed. Population-based data were selected for inclusion whenever possible.

Delivery of the second twin: comparison of two approaches.

Objective: To compare two obstetrical approaches toward delivery of the second twin: one of expectant management, and the other, active; to compare the neonatal and maternal results and thereby identify, if possible, the optimal approach.

Study Design: This retrospective study looked at twin births in two maternity units in the Paris, France metropolitan region: Antoine Béclère (AB) in Clamart, and Port-Royal (PR) in Paris and concerned 113 deliveries of pairs of twins at AB and 78 at PR.

Results: The mean duration of the interbirth interval was 9 min at AB and 5 min at PR (P < 0.

A comparison of risk factors for twin preterm birth in the United States between 1981-82 and 1996-97.

Objective: This paper examines risk factors for twin preterm birth in 1981-82 and 1996-97 in the United States in order to see if they have changed over time.

Methods: We studied all U.S.