Analysis of the obstetrician's posture and movements during a simulated forceps delivery.

Background: The objective of this study was to identify and qualify, by means of a three-dimensional kinematic analysis, the postures and movements of obstetricians during a simulated forceps birth, and then to study the association of the obstetricians' experience with the technique adopted.

Method: Fifty-seven volunteer obstetricians, 20 from the Limoges and 37 from the Poitiers University hospitals, were included in this multi-centric study. They were classified into 3 groups: beginners, intermediates, and experts, beginners having performed fewer than 10 forceps deliveries in real conditions, intermediates between 10 and 100, and experts more than 100.

A new approach to assessing the obstetrician's posture and movement during an instrumental forceps delivery.

Introduction: The number of deliveries by forceps decreases significantly in favour of the vacuum. Now, when the use of forceps is necessary, physicians less experimented with this procedure are likely to induce serious and preventable perineal or foetal injuries. Training therefore becomes essential.

In vivo measurement of the elastic properties of pelvic floor muscles in pregnancy using shear wave elastography.

Objective: We aimed to investigate changes in the elastic properties of levator ani muscle (LAM) and external anal sphincter (EAS) during pregnancy using shear wave elastography (SWE). Our secondary objective was to examine the association between the elastic properties of pelvic floor muscles (PFM) and perineal tears at childbirth.

Methods: This was a prospective monocentric study, including nulliparous women.

Reliability and validity of 2D-video analysis to objectively assess hamstring performance during the H-test.

The H-test is commonly used during return-to-sport decisions after hamstring muscle injury. The primary aim was to evaluate the reliability of two-dimensional (2D) video analysis for the H-Test. The second aim was to assess its validity compared to an electronic gyroscope (gold standard), and the third aim was to establish normative values.

In vivo assessment of the elastic properties of the external anal sphincter in term pregnant women using shear wave elastography.

Introduction And Hypothesis: The objective was to assess the intraobserver intersession and interobserver intrasession reliability of shear wave elastography applied to the external anal sphincter in term pregnant women.

Methods: This prospective study involved nulliparous pregnant women at 37 weeks or more with two visits (V1: one observer; V2 two observers) planned within a 12-h to 7-day interval. Measurements were performed using an Aixplorer V12® device with an SL 18-5 linear probe using a transperineal approach, allowing a measurement of the shear modulus (SM) in kPa.

Impact of fetal manipulation on maternal and neonatal severe morbidity during shoulder dystocia management.

Purpose: There are few data on maternal and neonatal morbidities associated with shoulder dystocia (SD), depending on the use of fetal manipulation (FM). A prior 5-year study was conducted in our center in 2012 for this purpose. Our objective was to compare severe maternal and neonatal morbidities according to FM execution in a larger cohort.

French guidelines for restrictive episiotomy during instrumental delivery were not followed by an increase in obstetric anal sphincter injury.

The objective was to assess the influence of the French guidelines in favor of a restrictive use of episiotomy on both episiotomy and obstetric anal sphincter injury (OASI) rates during instrumental delivery. It was aulticenter study involving 193 maternities between 2000 and 2016. We included women with a singleton pregnancy, with cephalic presentation at 34 weeks of gestation or more who underwent an instrumental delivery.

A New Paradigm in Managing Advanced Ovarian Cancer: Differentiating Patients Requiring Neoadjuvant Treatment from Primary Cytoreduction.

Our study aims to evaluate the comparability of primary debulking surgery (PDS) and neoadjuvant chemotherapy (NACT) patients. This single-center retrospective study includes all patients treated for advanced stages high-grade serous ovarian carcinomas (HGSOC) between 2007 and 2017. Preoperative characteristics and postoperative outcomes were compared after a propensity score matching analysis.

Cephalic marks and well-being in newborns after operative vaginal delivery.

Objectives: To compare the incidence of cephalic marks in newborns exposed to operative vaginal delivery and those who are not. We examined the factors associated with alterations in neonatal well-being and with cephalic mark occurrence.

Methods: Prospective study involving singleton term newborns delivered in a cephalic presentation.

Transperineal ultrasound shear-wave elastography is a reliable tool for assessment of the elastic properties of the levator ani muscle in women.

Our main objective was to assess the intraoperator intersession reproducibility of transperineal ultrasound Shear Wave Elastography (SWE) to measure the levator ani muscle (LAM) elastic properties. Secondary objective was to compare reproducibility when considering the mean of three consecutives measurements versus one. In this prospective study involving non-pregnant nulliparous women, two visits were planned, with a measurement of the shear modulus (SM) on the right LAM at rest, during Valsalva maneuver and maximal contraction.

How can we improve our practices in obstetric anal sphincter injury prevention, diagnosis, and management of symptomatic women?

Obstetric anal sphincter injury (OASI) is strongly associated with a major negative impact on women's health. Due to the consequences of an undiagnosed and therefore unrepaired OASI, it is essential to prevent or at least diagnose OASI at childbirth. We need to promote training of professionals to improve OASI screening at childbirth.

A core outcome set development for a French national prospective study about the effect of mediolateral episiotomy on obstetric anal sphincter injury during operative vaginal delivery (INSTRUMODA).

Background: We aimed at developing a core outcome and variables of interest set to investigate the effects of mediolateral episiotomy on Obstetric Anal Sphincter Injury (OASI) during and after operative delivery in nulliparous women in a large-scale one-year observational French study including 15,000 women (INSTRUMODA).

Methods: A list of outcomes and variables of interest was suggested to obstetricians participating in the INSTRUMODA study using online questionnaires divided into 7 categories: the woman's history and course of pregnancy, course of labor, modalities of operative delivery, episiotomy characteristics, immediate maternal morbidity, one-year maternal morbidity, immediate neonatal morbidity. We used a three-round DELPHI method to reach a consensus.

In vivo assessment of the elastic properties of women's pelvic floor during pregnancy using shear wave elastography: design and protocol of the ELASTOPELV study.

Background: Animal studies have reported an increase in pelvic floor muscle stiffness during pregnancy, which might be a protective process against perineal trauma at delivery. Our main objective is to describe the changes in the elastic properties of the pelvic floor muscles (levator ani, external anal sphincter) during human pregnancy using shear wave elastography (SWE) technology. Secondary objectives are as follows: i) to look for specific changes of the pelvic floor muscles compared to peripheral muscles; ii) to determine whether an association between the elastic properties of the levator ani and perineal clinical and B-mode ultrasound measures exists; and iii) to provide explorative data about an association between pelvic floor muscle characteristics and the risk of perineal tears.

Does the McRoberts' manoeuvre need to start with thigh abduction? An innovative biomechanical study.

Background: Guidelines and description about the achievement of the McRoberts manoeuvre are discordant, particularly concerning the need for abduction before the beginning of the manoeuvre. We sought to compare the biomechanical efficiency of the McRoberts' manoeuvre, with and without thigh abduction.

Methods: In a postural comparative study, twenty-three gravidas > 32 weeks of gestational age and not in labour were assessed during three repetitions of two McRoberts' manoeuvre that differed in terms of starting position.

Biomechanical comparison of squatting and "optimal" supine birth positions.

In obstetric science, it is unknown whether the inherent biomechanical features of the squatting position can be achieved and/or transposed to the supine birth position. In this study Biomechanical features of the squatting position were compared with 2 hyperflexed supine positions for giving birth. Thirteen pregnant women past the 32 weeks of gestational age not in labor were assessed first in the squatting position with the feet flat on the floor, then in the hyperflexed supine position, and finally in the optimal supine position "crushing" the hand of the caregiver onto the bed.

Postpartum psychological distress associated with anal incontinence in the EDEN mother-child cohort.

Objective: To estimate the prevalence of flatus-only and faecal incontinence, to describe their risk factors and to analyse the association between anal incontinence and psychological distress over the first year postpartum.

Design: Cohort study from pregnancy to 12 months postpartum.

Setting: Two university hospital maternity wards in France.

Tissue biomechanical behavior should be considered in the risk assessment of perineal trauma at childbirth.

Perineal trauma at childbirth is associated with strong negative impacts on a woman's health but remains unpredictable. Pregnancy induces several changes in biomechanical behavior in humans as in animals, namely, an increase in ligamentous laxity and an increase in vaginal distensibility. Pelvic floor muscles in rats are reported to exhibit specific behaviors during pregnancy.

Perineal suture practices. Are they up to date with the evidence based medicine data: A local experience into a university maternity?

Objectives: To investigate the prevalence of perineal suture techniques then to identify the factors influencing suturing technique choices.

Methods: Prospective, observational, monocentric study over 20 weeks in a university hospital. A personal questionnaire was completed by medical practitioners performing perineal sutures: years of experience, training attendance, suturing techniques usually used for degrees 1 and 2 tears/episiotomies.

[National survey about the practice of episiotomy within French National College of Obstetricians and Gynecologists (CNGOF)].

Objective: The main endpoint was to perform a survey about the practices of episiotomy into a CNGOF (National College of French Obstetricians and Gynecologists) members population.

Methods: In November 2018, it was proceeded to a national survey from CNGOF members thanks to an online questionnaire. We collected prospectively: the answerer's characteristics, the rate of episiotomy and its systematics indications for spontaneous and operative delivery, the habits of the practitioners for the section and the reparation, the modalities of women's information and the data entered into the medical record.

Does the implementation of a restrictive episiotomy policy for operative deliveries increase the risk of obstetric anal sphincter injury?

Purpose: Our main objective was to investigate whether the implementation of a restrictive episiotomy policy in operative deliveries changes the incidence of obstetric anal sphincter injury (OASI).

Methods: This is an observational study over an 11-year period in Poitiers University Maternity, France. We included women with vaginal operative deliveries after 34 gestational weeks for singleton births in cephalic presentation.