Binational confidential enquiry of maternal deaths due to postpartum hemorrhage in France and the Netherlands: Lessons learned through the perspective of a different context of care.

Objective: To learn lessons for maternity care by scrutinizing postpartum hemorrhage management (PPH) in cases of PPH-related maternal deaths in France and the Netherlands.

Methods: In this binational Confidential Enquiry into Maternal Deaths (CEMD), 14 PPH-related maternal deaths were reviewed by six experts from the French and Dutch national maternal death review committees regarding cause and preventability of death, clinical care and healthcare organization. Improvable care factors and lessons learned were identified.

[Fetal death beyond 14 weeks of gestation: induction of labor and obtaining of uterine vacuity].

The objective of this review was to assess benefits and harms of different management options for induction of labor and obtaining of uterine vacuity in case of fetal death beyond of 14 weeks of gestation. In second-trimester, the data are numerous but low methodological quality. In terms of efficiency (induction-expulsion time and uterine evacuation within 24 hours rate) and tolerance in the absence of antecedent of caesarean section, the best protocol for induction of labor in the second-trimester of pregnancy appears to be mifepristone 200mg orally followed 24-48 hours later by vaginal administration of misoprostol 200 to 400 μg every 4 to 6 hours.

[Iron deficiency anemia and pregnancy. Prevention and treatment].

Objective: To assess the effectiveness and the safety of prevention and treatment of iron deficiency anemia during pregnancy.

Methods: French and English publications were searched using PubMed and Cochrane library.

Results: Early screening of iron deficiency by systematic examination and blood analysis seemed essential.

[Fetal pulse oximetry: clinical practice].

Objective: To assess in current practice the application of our protocol of using fetal pulse oximetry during labor, to evaluate whether fetal scalp blood sampling can be reduced and to determinate reliability of fetal pulse oximetry on the prediction of poor neonatal outcomes.

Study Design: Prospective observational unicenter cohort including 449 patients during two years. All pregnancies were singleton, greater than or equal to 37 weeks' gestation, cephalic presentation, and had non reassuring fetal heart rate.

Rupture of the scarred uterus.

Objective: To assess the risk of uterine rupture of the scarred uterus according to mode of delivery in subsequent births recorded as spontaneous labour, labour induced by oxytocin, labour after ripening with prostaglandin E2, and planned cesarean section.

Methods: Retrospective study of 2,128 births with a low transversal scar after a previous cesarean section. The study population was realised in a level III university hospital from 1995 to 2003.

[Obstetrical complications of morbid obesity].

Objective: To determine whether morbidly obese women have an increased risk of pregnancy complications and adverse perinatal outcome.

Methods: In a retrospective study, 2472 women with morbid obesity, defined as a body mass index (BMI) more than 40 were compared with normal weight women (BMI 20-25). Fisher and Student tests were used for statistical analysis.

[Rectal prolapse resection by trans-anal approach and stapling technique].

We are introducing a simplified cure, derived from Alteimeier's intervention, of rectal prolapse by perineal way resection using a linear cutting stapler. It's a reproducible, quick and easy technique, which permits the elderly patients to come back in their middle of life rapidly with few complications.